Breast Implant Associated Lymphoma (BIA-ALCL)

This leaflet is for patients who have chosen to have a breast implant as part of their reconstruction surgery. The leaflet explains what BIA-ALCL is and why you need to be aware of this risk.

We hope this leaflet answers some of the questions you may have. If you have any further questions or concerns, please speak to your breast cancer nurse or doctor.

What is BIA-ALCL?

BIA-ALCL is an uncommon cancer of the white blood cells (lymphoma). It grows in response to the body’s reaction to a breast implant.

In the UK, the majority of BIA-ALCL is diagnosed early. It is cured by removing the implants and the surrounding scar tissue (total capsulectomy). In most cases no further cancer treatment is needed. However, a small number of patients may need further treatment, including chemotherapy, immunotherapy, or radiotherapy.

It is not known why some people with breast implants develop BIA-ALCL and others do not. So it is important to be aware of the signs and symptoms of BIA-ALCL, so we can start treatment as soon as possible.

How common is BIA-ALCL?

In the UK the risk reported by the Medicines and Healthcare products Regulatory Authority (MHRA) is approximately 1 in every 15,000 implants sold. As of December 2024, the MHRA had received 120 reports of BIA-ALCL in patients with breast implants. This figure includes cases reported where the original implantation did not occur in the UK.

Is it safe for me to have an implant?

• The risk of BIA-ALCL is low in comparison to:

  • other cancers, including breast cancer; and

  • cancers related to long-term use of hormone replacement therapy (HRT).

• It usually presents with clear and diagnosable breast changes in the early curable stages of the disease.

• A person must be fully informed of the potential known risks and benefits of using breast implants before they agree to surgery. It must be the patient’s own choice.

Who can develop BIA-ALCL?

Most cases of BIA-ALCL have been reported in people with breast implants which have a rough (textured) silicone surface. However, until the evidence is clearer we feel it is best to assume that any breast implant (smooth or textured surface) may cause BIA-ALCL.

Should I be checked for BIA-ALCL?

There are no screening tests for BIA-ALCL.

People with breast implants, who have no breast symptoms or signs, do not need routine clinical checks or monitoring with:

• mammograms

• ultrasound, or

• MRI scans.

How would I know if BIA-ALCL was developing around my implants?

Most cases of BIA-ALCL happen years after surgery.

As part of your regular breast check, please be on the lookout for the following symptoms of BIA-ALCL.

• A painless large collection of fluid (seroma) forming around your breast implant. The amount of fluid will grow quickly over a few weeks and cause your breast to swell.

• Less commonly, BIA-ALCL may present as:

  • a lump in your breast very close to the implant; or

  • as a build-up of thick scar tissue (capsular contracture) around your implant. This can cause a painful breast shape change / distortion.

These are two of the main symptoms to look out for. However, if you notice any changes to your breast following an implant, please speak to your GP or breast cancer nurse as soon as possible.

What should I do if I have an implant and notice breast changes?

Please contact your surgeon, clinic, or hospital (either private or NHS) who put them in, if:

• you had your implant inserted within the last year; and

• you think your breast changes are caused by complications from the surgery,

Some implants are trouble-free for many years and then new breast changes develop. If this happens, please remember benign breast or implant related conditions are likely to be the cause of the changes, not BIA-ALCL. However, it is still important to have any new breast changes checked, so if changes happen please see your GP or your GP practice nurse.

Not all GPs or nurses are aware of BIA-ALCL, as it is a relatively new condition. Please ask them for a referral to your local NHS breast clinic.

What are the advantages and disadvantages to having textured or smooth implants?

Textured silicone implants are felt to have some advantages over smooth silicone implants. Textured implants are less likely to rotate / move. Depending on where the implant is placed (under or over the muscle), they are also less likely to form a hard scar tissue capsule (capsular contracture).

Capsular contracture is when scar tissue forms in the breast around the implant. It is the most common reason for people to need further surgery and replacement of breast implants. For people having breast augmentation with implant insertion under the breast gland, textured implants have a much lower rate of scar capsule formation compared to smoother breast implants.

Anatomical (tear-drop shaped) implants are thought to give a more natural looking breast appearance. However they need to be textured, as you would see any rotation of a tear-drop breast implant. Smoother implants, which can also rotate / move, are always a round, dome-like shape so the rotation cannot be seen. They are thought to look less natural.

Further information

If you have any questions or concerns about your breast implant, please speak to your Cancer Nurse Specialist. Please contact them via the Cancer Care Line on 01227 866868.

Ask 3 Questions

There may be choices to make about your healthcare. Before making any decisions, make sure you get the answers to these three questions:

• What are my choices?

• What is good and bad about each choice?

• How do I get support to help me make a decision that is right for me?

Your healthcare team needs you to tell them what is important to you. It’s all about shared decision making.

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