BIA - ALCL
Published on May 23, 2017
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PRESENTATION OUTLINE
BIA-ALCL
Breast Implant Associated - Anaplastic Large Cell Lymphoma
BIA-ALCL is a rare disease associated with breast implants though the exact etiology and pathogenesis remain unclear.
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ALCL is Lymphoma
Not Cancer of the Breast Tissue
BI-ALCL is a purely T-cell lymphoma arising either in the effusion or scar capsule surrounding a breast implant.
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of the Immune System
ALCL is a type of cancer
There was a median of 9 years between implantation and lymphoma diagnosis.
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Diagnosis
most patients were seeking treatment for implant related symptoms.
Most cases are diagnosed during implant revision surgery performed for a late onset problems at >1 year or more.
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Untitled Slide
- Hardening of the breast
- Lumps
- Swelling
- Asymmetry
- Pain
Periprosthetic capsulation is the most common complication resulting from breast implantation. The fibrous sacs of scar tissue that enclose the implant become contracted, causing pain and distortion of the breast, and depending on the degree of contracture, may require removal.
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The symptoms were due to a collection of fluid (seroma) and hardening of the breast (capsular contraction)
Patients presented with either a malignant effusion or seroma (70%) or a distinct mass (30%). A total capsulectomy with implant removal was performed in 93% of patients.
Examination of the fluid and capsule surrounding the implant led to the ALCL diagnosis.
Any aspiration of periprosthetic fluid should be sent to pathology for a cytologic evaluation. The pathologist may also want to analyze the gel inside the implant, the capsule and any other tissue removed with the implant. They look for inflammation, pathological changes and infiltration of foreign materials such as silicone and polyurethane.
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30,000
Breast implants removed annually
The recovery period after breast implant removal is usually similar to the initial breast surgery. Strenuous activities are postponed for about three weeks.
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Treating BIA-ALCL
- Removal of implant
- Removal of capsule
- Chemotherapy
- Radiotherapy
Patients with biopsy proven Bi-ALCL must be referred to an oncologist. Evaluation for systemic disease may include CT. PET scan and or MRI. Surgical treatment is a total capsulectomy which includes complete removal of the capsule including the posterior wall.
Removal may cost $1,000 -$5,000 in most instances its not always covered by insurance
Both silicone gel and saline implants have reported cases of BIA-ACL.
The lifetime risk for BIA-ALCL in previous epidemiological studies ranges from 1:30,000 to 1:50,000.
The Australian government believes it to be 1: 1,000.
The Australian government believes it to be 1: 1,000.
405 ALCL reports were filed in the Maude database since February 2017.
Early in 2016 the FDA issued a report that it had received 258 adverse event reports of breast implants and ALCL.
At least 27 deaths were attributed to BIA-ALCL.
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Types of Implants & Maker
- Saline - Mentor & Allergan
- Silicone - Allergan Natrelle
- Silicone - Mentor Memory Gel
- Silicone - Mentor MemoryShape
- Silicone - Sientra
To date, no specific causal factors have been identified. Implant texturing, bacteriologic contamination, and genetic factors have been implicated and are undergoing further study.
Bacteria have been identified within the lymphoma and around implants in affected breasts, and there is accumulating evidence that a long-term inflammatory response to the presence of these bacteria is one of the factors that may cause BIA-ALCL. Research is ongoing and cases are being monitored through the PROFILE registry.
Bacteria have been identified within the lymphoma and around implants in affected breasts, and there is accumulating evidence that a long-term inflammatory response to the presence of these bacteria is one of the factors that may cause BIA-ALCL. Research is ongoing and cases are being monitored through the PROFILE registry.
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