BIA, breast implant associated. ALCL, anaplastic large cell lymphoma.
And so there’s a real association between textured implants, a rough shell of an implant, be it saline textured or cohesive gel textured. A rough surface of the implant is advantageous for tissue and growth to minimize migration of the implant after breast reconstruction or a whole, let’s say, shaped anatomic teardrop in place.
The problem is it leads a chronic inflammation, a low grade inflammation and you have immune cells constantly going after this rough texture. And many of these immune cells are lymphocytes. And a certain percentage of patients, somewhere between one in 4,000 and one in 30,000 will develop an aggregation of aggressively infiltrating proliferative lymphocytes, called a lymphoma.
Now, there’s different types of lymphoma. There’s the blood lymphomas like Hodgkin’s, non-Hodgkin’s where you need chemotherapy and there’s a very high mortality rate in some of those processes. This is not that kind of lymphoma. This is a locally invasive, proliferative aggregation of lymphocytes that are abnormal, or a lymphoma that’s locally invasive and requires surgical removal. The treatment is not radiation, not chemotherapy, but surgical removal. Removal of the implant and removal of the capsular tissue around it.
Now, the incidence of this is about one in 30,000, and it only affects textured implants. So if you have smooth shelled implant, you have zero risk of BIA ALCL. In my practice here at SpaMedica, I have only used smooth implants for the last decade. Only smooth implants, never textured. So for the past 10 years, any SpaMedica Dr. Mulholland patient does not have to worry about advanced, anaplastic, large cell lymphoma because I use only smooth implants, never textured.
In the era of the 90s and the early part of the last millennium, 2002 to 2007 or eight, when textured implants were an issue, there is about a one in 30,000 chance that you may develop BIA ALCL. How do you know you’ve developed it? Almost always there’s a sudden change in symptoms. Your implant gets hard and swollen, red and inflamed. You develop a capsular contracture, usually this comes on between eight and 14 years. You may get sudden pain and discomfort, redness and inflammation. Any of these symptoms should trigger a visit to your plastic surgeon’s office.
We might do some imaging, like an MRI, but clinically, on clinical diagnose of any of those type of symptoms, the treatment is removal of the implant and removal of the capsule and unblock resection, the entire capsule and the implant. And either leave it with nothing, or do immediate re-implantation with a smooth shell device, a smooth shell cohesive gel, or a smooth shell saline.
Again, smooth shell, smooth wall devices, zero risk of BIA ALCL is the anaplastic large cell lymphoma, locally invasive proliferative reaction around a textured implant. Is that fatal? If you do not get it treated and you let it to continue to progress, continue to proliferate, eventually, some of those cells will start to break off and travel to other organs and you will potentially succumb to a metastatic version of this aggressive locally invasive BIA ALCL. But treated promptly and early with removal of the implant and the capsule, curable.
So, if you are exploring Dr. Mulholland at SpaMedica for your breast implant surgery, rest assured you are not going to get a textured implant. For 10 years I’ve used nothing but smooth shell. And there’s absolutely no risk to smooth shell implants. If you’re a patient of mine and you had surgery done in the 90s or the early part of this last millennium and you have absolutely no symptoms, then the recommendation is generally, leave your implants alone.
If you’re worried about developing something like this in the future and you want to remove our implants, it needs to be a total capsulectomy and removal of the implant with re-implantation of a smooth device. However, to go through that kind of extensive surgery if you have no symptoms, no hardening, no seroma, no swelling and to put yourself through that kind of risk? The recommendation is generally, if your implants are textured and they have absolutely no symptoms, we leave them alone.
Remember, the one thing you should be worried about is not BIA ALCL, be cognizant, do your ultrasound screening every year for implant integrity, and that’s what we recommend. Ultrasound your breasts every year. But you really need to worry about breast cancer. Remember, BIA ALCL, one in 30,000. Breast cancer, one in eight. One in eight. One in eight women will get breast cancer in Ontario. And these one in eight women are not thinking of doing preventative mastectomies, or removing their breasts because of a one in eight risk of cancer. A one in 30,000, when you have no symptoms should not concern you, other than, touch base with your surgeon, make sure you’re doing your yearly ultrasound screening. And if you develop any of those symptoms, get your implants removed with the capsules quickly, because that’s cured.