Anne Peled | Breast, Plastic, and Reconstructive Surgery Blog

Dr. Anne Peled is a breast, plastic, and reconstructive surgeon practicing in San Francisco. She is also an educator and innovator of novel breast surgery techniques and a breast cancer survivor.

Can I Get Cancer from My Breast Implants? What We Do and Don’t Know about Breast Implant-Associated Anaplastic Large Cell Lymphoma (BI-ALCL)

The potential association between breast implants and a rare form of cancer was recently brought to light in a New York Times article. Understandably, this has led to a lot of concern from women who already have or who may get breast implants about the safety of their implants. Although the article reports that the breast implants placed in the women featured in the article directly caused their diagnosis of a low-grade lymphoma, there are still many unanswered questions about the causation and the actual risk following breast implant placement.

Here’s what we know about BI-ALCL:

  1. The risk of getting lymphoma following breast implant placement for cosmetic or reconstructive reasons is very low.  Reported lifetime risk in the U.S. ranges from 1 in 30,000 to 1 in 50,000. Hundreds of thousands of breast implants are placed every year, but to-date only 359 cases have been reported from around the world.
  1. BI-ALCL can be treated and cured when discovered early. The typical signs of BI-ALCL are swelling in the breast around the implant after all of the post-surgical swelling has healed (2 or more years after surgery) or a mass in the breast near the implant. If these kinds of symptoms occur, women should be evaluated by their plastic surgeon as soon as possible. Depending on the findings, patients may require imaging of their breast and a possible biopsy or drainage procedure.  Once BI-ALCL has been diagnosed, women will need to undergo surgery to remove the implant and the surrounding capsule as well as any breast masses. Surgery alone is very effective for treating the lymphoma in most patients, though some patients will need chemotherapy or radiation therapy if the disease is more advanced.
  1. Plastic surgery organizations and the FDA are working together to collect more information to better understand BI-ALCL and learn how to prevent it in the future. The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery in conjunction with the FDA have been actively tracking all cases of BI-ALCL and collecting as much clinical information as possible to try to determine the specific risk factors for BI-ALCL. Research is also being done to investigate genetic and other patient factors that may make patients more susceptible to developing BI-ALCL if they do have breast implants.

Although we do have good information on how to diagnose and treat BI-ALCL, there are still many issues currently being studied about why women get BI-ALCL.  Here’s what we still don’t know about the disease:

  1. What type of implant and what qualities about the implant increase the chance of BI-ALCL. Complete data is not yet available for all of the implants associated with the reported cases of BI-ALCL, so it’s still difficult to make definitive statements about which implants may be more concerning. However, many of the cases have involved implants with texturing on their surface, which is a manufacturing technique that helps implants adhere to the surrounding tissue and is particularly important for shaped (“teardrop”) implants to prevent the implants from rotating the wrong direction when used for breast augmentation or reconstruction. It is not yet clear if implants from certain implant companies are more likely to have associated BI-ALCL or why the texturing might increase the risk, although there are several theories about the potential cause. BI-ALCL has been seen in women with both silicone and saline implants.
  1. Why do certain women develop BI-ALCL while the vast majority of women with breast implants do not develop it. There may be genetic factors that make women more susceptible to BI-ALCL that have not yet been discovered, or women who develop the disease may have higher levels of chronic inflammation around their implants. Further reporting of cases and analysis of the current cases worldwide is needed to better understand the cause of the disease.
  1. How can women who already have implants in place prevent the chance of getting BI-ALCL. As the cause of BI-ALCL is not yet known, there is no specific prevention strategy that women can do, although women should be vigilant about any new concerning symptoms and keep their plastic surgeons informed. Screening for BI-ALCL or removal of implants is not currently recommended or supported by available data.

Additional information can be found on the American Society of Plastic Surgeons’ site on BI-ALCL, which will be updated with newer information as it becomes available.

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