Breast Implant-Associated Lymphoma (BIA-ALCL) and Squamous Cell Carcinoma

Introduction

Welcome to our plastic surgery blog, where we aim to provide you with valuable information about various aspects of plastic surgery, including potential risks and complications. In this article, we will explore two rare but serious conditions associated with breast implants: Breast Implant-Associated Lymphoma (BIA-ALCL) and Squamous Cell Carcinoma (BIA-SCC).

Breast Implant-Associated Lymphoma (BIA-ALCL)

What is BIA-ALCL?

Breast Implant-Associated Lymphoma (BIA-ALCL) is a rare type of non-Hodgkin's lymphoma that has been linked to breast implants. It primarily affects the tissue surrounding the implant and, in some cases, may spread to other parts of the body. BIA-ALCL is not breast cancer but rather a type of cancer that develops in the immune system cells.  Our current understanding of the cause of this lymphoma is a state of chronic inflammation in the capsule causes the immune cells to transform into lymphoma.  This is hypothesized given the link of textured devices being associated and that bacteria has been grown from capsules removed with BIA-ALCL.

Incidence and Risk Factors

The risk of developing BIA-ALCL is extremely low. According to the FDA, there have been reported cases of BIA-ALCL, primarily associated with textured breast implants. The risk is higher with textured implants compared to smooth ones.  As of April 1, 2022, the Food and Drug Administration (FDA) has received a total of 1,130 US and global medical device reports (MDRs) of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL).

Symptoms and Diagnosis

Common symptoms of BIA-ALCL include swelling, pain, and fluid accumulation around the implant. If you experience any of these symptoms, consult your plastic surgeon immediately. Diagnosis typically involves a physical examination, imaging tests, and, in some cases, a biopsy of the fluid or tissue around the implant.  The fluid can be sent to a cytopathologist, a doctor that makes diagnosis by looking a fluid taken from the body, and analysis is performed looking for abnormal immune cells.

Treatment

The primary treatment for BIA-ALCL is the removal of the implant and surrounding tissue (capsulectomy). In most cases, this is curative, especially if the cancer is detected early. Chemotherapy or radiation therapy may be necessary for advanced cases.  Unfortunately, as of March 2023 there have been 59 deaths associated with BIA-ALCL worldwide.  There have been millions of women that have had breast augmentation worldwide and any death attributed to implants is tragic but the risk is low.  Close follow up with your surgeon is the best way to detect any issues.

Breast Implant Associated Squamous Cell Carcinoma (BIA-SCC)

What is BIA-SCC?

Squamous Cell Carcinoma (SCC) is a type cancer that can occur in the breast area, including the skin covering breast implants. Breast implant associated SCC (BIA-SCC) is associated with the implant capsule where abnormal squamous cells turn into cancerous cells.  This is rare with 19 cases reported to the FDA as of 2023.  Squamous cells are a type of cell typically seen in the skin but also occur naturally in other areas of the body.  

Risk Factors

We believe the same causes of BIA-ALCL or other cancers is also contributing to the development of BIA-SCC or chronic irritation, subclinical biofilms, and texturing of implants.

Symptoms and Diagnosis

Symptoms of BIA-SCC may include skin changes, such as a persistent sore, ulcer, or lump, as well as changes in the texture, color, or appearance of the skin around the implant.  Late forming seroma, or fluid collection around the implant, is concerning and should be evaluated by your surgeon.   If you notice any concerning changes, seek immediate medical attention. Diagnosis involves a sampling of the fluid or biopsy of the breast implant capsule.

Treatment

Treatment for BIA-SCC typically involves surgical removal of the capsule and in some cases, additional therapies like radiation or chemotherapy may be necessary, depending on the stage and extent of the cancer.

Conclusion

While the risk of developing Breast Implant-Associated Lymphoma (BIA-ALCL) and (BIA-SCC) is minimal, it is essential to be aware of these rare complications associated with breast implants. Regular follow-ups with your plastic surgeon and self-examinations can aid in early detection and treatment.

Remember, plastic surgery comes with its share of risks, just like any other medical procedure. It is crucial to consult with a board-certified plastic surgeon who can guide you through the decision-making process and provide proper post-operative care. Your safety and well-being are always our top priority when considering breast augmentation or any other plastic surgery procedure.