An Update on Breast Implant Associated Anaplastic Large Cell Lymphoma

At the recent meeting of the Australasian Society of Aesthetic Plastic Surgeons an update was provided on this disease which can occur in women who have textured breast implants.

To date we have had over 60 reported cases in Australia and New Zealand.  Although the disease is curable (if detected early) we have had 2 patient deaths from this disease.

How does the disease present?

This disease presents by a swelling (usually on one side) of the breast usually some years following a breast augmentation operation.

How is the disease diagnosed?

The disease is diagnosed by removing some of the fluid that has formed around the implant under ultrasound guidance and having the fluid tested for cancer cells.

How is the disease treated?

The first requirement is to stage the disease.  This means that you will be required to have full body scars to see if the disease is confined to the breast or if it has spread to other parts of the body.

In most cases the disease is confined to the breast and is cured by removing the implants and by performing a total capsulectomy – i.e. removing all of the capsule that is surrounding the implant.

In cases where the disease has spread beyond the breast, then other treatments such as chemo therapy and radio therapy may be required.

Who is at risk of this disease?

This disease occurs only in women who have had textured implants inserted.  In fact, mainly in women who have had a macro textured implant such as the Allergan 410 implant.  It has also occurred in patients with polyurethane (or Gummy Bear implants).  The risk of the disease occurring in patients with a micro textured implant is significantly less and the disease has never been reported in patients with smooth-walled implants.

What is the exact risk of developing the disease?

If you have a macro textured (Allergan) or polyurethane implant, then the risk is approximately 1 in 3700.  If you have a micro textured implant (e.g. the Siltex implant) then the risk is 1 in 60,000.  It is important to note however that the risk of any individual woman developing the disease increases the longer the implant  is in place.

What causes this disease?

We don’t know.  Because certain bacteria have been found in the capsules of women with this disease, the theory has been put forward that the disease is due to infection combined with a genetic predisposition.  The theory is that the macro textured implants are more likely to be contaminated by bacteria and therefore these women are more likely to develop this disease.

However smooth-walled implants have been in use for 50 years and many patients with smooth-walled implants have developed very thick capsules but have never developed this disease.  It would seem that the cause is more specifically related to the macro texture of certain implants.  How this triggers the condition is not known but it could be a simple mechanical effect of constant friction of the textured surface against the capsule causing a seroma and, in some patients, this disease.

Should I still consider having textured implants?

As the Therapeutic Goods Association (TGA) has not yet banned these implants, they are still available for use.  Interestingly, some  Australian surgeons still use these implants as they believe that adopting the “14 point plan” for infection control will prevent the disease.  There is however no evidence that the adoption of this plan will prevent the disease and indeed, in the US, virtually no surgeon continues to use these implants.  When the critical question is asked of surgeons “Would you allow your daughter or your wife to have these macro textured implants inserted” the answer is almost invariably a resounding “NO”.

What should I do if I already have one of these implants inserted?

First, there is no need to panic as the disease is still relatively rare and takes a long time to develop.  As breast implants are not lifetime devices it is likely that your breast implants will need to be replaced at some stage.  If you have these implants, then you may desire to have your implants replaced sooner rather than later.

What are the best alternatives to these implants?

If you have a silicone implant with a macro texture then the best alternative is to remove the implant and to replace the volume with your own fat (Autologous Fat Transfer).  However, as only a few surgeons in Australia are experienced and proficient at this procedure, an alternative is to have your implants replaced with a smooth-walled implant.