Women with breast implants or those who are considering breast augmentation have probably heard or read reports about an unusual type of lymphoma associated with implants that have textured surfaces. I’ve discussed this topic with patients during breast augmentation consultations at my Eugene, Oregon, practice, but I wanted to share this up-to-date information in this blog post.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare and highly treatable type of lymphoma that can develop around breast implants, but it’s never been seen in patients who have implants with smooth surfaces.
The initial reports of BIA-ALCL occurred about 12 years ago. The lymphoma develops years after someone gets breast implants and is associated with a rare type of bacterial contamination that occurs during the breast enhancement surgery. This contamination causes fluid to accumulate around the implant, a condition called a late-term seroma, along with swelling in the breast. The fluid contains cancerous white blood cells (lymphocytes).
Even though not all late-term seromas are caused by BIA-ALCL, I recommend promptly evaluating when a seroma or swelling occurs regardless of the type of implant. We use an imaging study (a diagnostic ultrasound) and an ultrasound-guided fluid aspiration (to remove the excess fluid) and send samples to a lab for examination.
It’s important to understand that this condition is not breast cancer. Bacterial infection is a risk for all types of implanted medical devices, and BIA-ALCL has been found in orthopedic implants, dental implants, and chemotherapy ports. To date, 526 cases have been reported worldwide, which included 16 deaths. Treating BIA-ALCL for patients with breast implants involves removing the implant and the surrounding capsule tissue. Specific types of chemotherapy might also be needed.
Because bacterial contamination on the implant surface (biofilm) is linked to BIA-ALCL, I use specific surgical techniques and processes that drastically reduce the chances of implant surfaces being contaminated with biofilm. These steps include:
- Meticulous surgical technique
- Using antibiotics
- Irrigating with Betadine® (an iodine-based irrigation)
- A “touch-free” implant insertion using the Keller Funnel®
I believe bathing the implant pocket with the iodine solution during surgery is especially important because it kills the type of bacteria that is thought to cause BIA-ALCL. I co-authored a study involving the use of Betadine during breast surgery that appeared in the June 2018 issue of Aesthetic Surgery Journal.
Clinical outcome data I’ve compiled throughout my career demonstrates the effectiveness of these measures. To date, after using breast implants for 41 years, I’ve never had an infection in a primary breast augmentation or revision surgery. I joined 7 other plastic surgeons in publishing our outcome data involving approximately 42,000 implants placed in 21,650 patients with a mean follow-up of 11.7 years. These cases all involved surgical techniques designed to minimize biofilm contamination at the time of the surgeries. To date, no reported cases of BIA-ALCL occurred in this patient population.
Even though the incidence of BIA-ALCL is remote, patients concerned about this condition should consider choosing breast implants with smooth surfaces. If you have additional questions about BIA-ALCL or want to discuss it with me, contact us using the online form or call our office at (541) 683-3234 to schedule an appointment.