Breast Implant Associated Lymphoma (BIA-ALCL)

You have been given this leaflet as you have chosen to have a breast implant as part of your reconstruction surgery. The leaflet explains what BIA-ALCL is and why you need to be aware of this risk. If after reading this leaflet 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), that grows in response to the body’s reaction to a breast implant.

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

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 one in every 15,000 implants sold. As of December 2020, the MHRA had received 83 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 those 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 about the potential known risks as well as the benefits of using breast implants before they agree to surgery. It must be the patient’s own choice.

Who can develop BIA-ALCL?

BIA-ALCL has mainly 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, with 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 causes your breast to swell.

• Less commonly, BIA-ALCL may present as a lump in your breast very close to the implant or even 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, but 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?

If your implant was inserted within the last year and you think your breast changes are caused by complications from the surgery, please contact your surgeon, clinic, or hospital (either private or NHS) who put them in.

If your implants have been trouble-free for many years and then you develop new breast changes, please remember these are most likely to be caused by benign breast or implant related conditions and not BIA-ALCL. However it is still important to have any new breast changes checked, so if this happens to you 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, so 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, and depending on where the implant is placed (under or over the muscle) less likely to form a hard scar tissue capsule (capsular contracture). If you have either of these you may need to have further surgery. More information about these are provided below.

• Capsular contracture (scar tissue forming in the breast around the implant) 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 but need to be textured, as any rotation of a tear-drop breast implant would be seen. Smoother implants which can also rotate / move are always a round, dome-like shape so the rotation is not visible, but they are thought to look less natural.

Further information

If you have any questions after reading this leaflet or you have any concerns about your breast implant, please speak to your Cancer Nurse Specialist via the Cancer Care Line 01227 866868.