BIA-ALCL (Breast Implant Associated-Associated Anaplastic Large Cell Lymphoma): What Patients Need to Know

Breast implants are some of the most highly studied medical devices in the world. Nonetheless, despite decades of research, breast implant illness remains a confusing subject for many patients. These devices are made from fully biocompatible medical-grade silicone, an inert and durable material that’s also used in a wide range of other implant devices (such as cardiac pacemakers) without issue. Still, a small number of women who have silicone breast implants report experiencing a wide range of uncomfortable symptoms. Emerging evidence also suggests that in very rare cases, one specific type of breast implant can slightly increase the risk of developing BIA-ALCL, an uncommon and highly treatable form of T-cell lymphoma.

Before you arrange a breast augmentation consultation, it’s important to research the various types of implants available. Choosing the safest type of implant and understanding your personal risk factors can help you avoid complications and enjoy a safe, comfortable surgical experience.

As Nashville’s only all-female plastic surgery group, our team at the Plastic Surgery Center of Nashville is deeply invested in feminine health and safety. To help our breast augmentation patients maintain an optimal quality of life, we’ve compiled a comprehensive guide to breast implant illness and BIA-ALCL. Prospective patients are also welcome to contact us directly with questions about the safety of silicone breast implants.

What is Breast Implant Illness?

The term “breast implant illness” is often used to refer to a loose collection of non-specific symptoms attributed to the use of silicone breast implants. These symptoms include fatigue, joint pain, “brain fog,” poor sleep quality, hair loss, and digestive issues, among others. Because these symptoms are so general (and so common in the broader population), they cannot be conclusively linked to the presence of breast implants. Likewise, silicone itself is completely non-toxic, so scientists have not been able to identify any direct mechanism by which this material could cause illness. Many medical experts have therefore stated that breast implant illness does not exist, and the symptoms attributed to breast implants are instead caused by other medical conditions. The American Food and Drug Administration has repeatedly assured the public that they “do not have evidence suggesting breast implants are associated with health conditions such as ‘chronic fatigue, cognitive issues, and muscle pain.’”

Nonetheless, many women have identified a correlation between when their symptoms started and undergoing breast augmentation surgery. Most women who experience breast implant illness say they were perfectly healthy prior to having silicone breast implants inserted. Many also report that their symptoms spontaneously resolved after having implant removal surgery. If breast implants are non-toxic, how is this possible?

The reason for this conflicting evidence may lie in the human immune system. Sometimes, the human body spontaneously attacks otherwise harmless substances, issuing an inflammatory response that results in diverse symptoms. Dysfunctional autoimmune responses cause a range of illnesses, like Lupus, Sjoren’s syndrome, and rheumatoid arthritis, wherein the body’s immune system attacks healthy tissue. Autoimmune responses can also lead to the rejection of implanted materials, such as transplanted organs and, quite possibly, silicone medical devices. This could explain why some women’s bodies produce a wide range of symptoms after breast augmentation even though implants themselves are not toxic or harmful in any way. Their bodies might, in essence, become confused and mistake implants for “invaders,” then create an inflammatory response. This inflammatory response is similar to the one we experience when we have a cold or flu, so it results in flu-like symptoms, including fatigue, aches and pains, and brain fog.

Though breast implant illness is uncomfortable, it’s important to understand that these symptoms aren’t necessarily dangerous. No fatalities have ever been linked to (non-BIA-ALCL) breast implant illness, and the vast majority of women who experience an adverse reaction to silicone implants recover completely after implant removal. Serious complications related to breast implants are extremely rare and generally occur during or immediately after surgery.

There is, however, one area where the link between the immune system and breast implants can cause more serious medical issues: In a tiny number of cases, one type of silicone breast implant has been connected to an elevated risk of developing BIA-ALCL, a cancer of the immune system. BIA-ALCL is highly treatable—almost all of the patients diagnosed with this condition make a full recovery—but it’s still important to understand what BIA-ALCL is and how it can be prevented. Taking certain precautionary steps can greatly reduce your risk of developing BIA-ALCL.

What is BIA-ALCL?

BIA-ALCL is not a type of breast cancer. This illness is a form of non-Hodgkin’s lymphoma, a cancer of the cells of the immune system, called Anaplastic Large Cell Lymphoma. Though non-Hodgkin’s lymphoma can potentially occur in anyone, a specific sub-type of this illness has been linked to the use of textured silicone breast implants. This does not mean that all—or even most—women who have textured breast implants will get BIA-ALCL. The vast majority of women with breast implants will never get sick; in fact, up until recently, the number of BIA-ALCL cases was too low to allow for sufficient data collection. To date, only slightly over 600 cases of BIA-ALCL have been reported to the FDA—An extremely low number when you consider the fact that millions of women have had breast augmentation surgery.

BIA-ALCL is not a highly invasive type of cancer. Most cases of BIA-ALCL have occurred exclusively within the capsule of internal scar tissue that forms around each breast implant, without any intrusion into surrounding breast tissue. Removing the capsule of tissue around each implant (along with the implants themselves) generally gets rid of the cancer. However, in a small number of cases, BIA-ALCL has spread outside the breasts and caused more serious illness. As such, it’s important to take steps to prevent and detect BIA-ALCL.

How to Minimize Your Risk of BIA-ALCL

Currently, the best way to minimize your risk of developing BIA-ALCL is to use smooth silicone implants, not textured implants. Smooth implants have a thinner, more flexible silicone shell with an even surface. Many patients prefer this type of implant because it provides the most natural look and feel. Textured implants, on the other hand, have a thicker, rougher outer shell. They come in either a round or teardrop shape and are less likely to shift with movement. Textured implants are usually only recommended for use on patients who have a convex breast bone or limited natural breast tissue. For other women, they offer a few advantages over smooth implants. Unless you have unusual anatomy, choosing smooth breast implants will not compromise the aesthetic results of your breast augmentation in any way.

Scientists are not sure why textured implants are associated with a higher risk of breast implant illness and BIA-ALCL, but a leading theory suggests that the textured surface may permit bacterial overgrowth on the surface of the implant. It’s possible that the immune system actually reacts to the presence of this bacteria and not the implant itself, causing inflammatory symptoms and slightly elevating the patient’s risk of BIA-ALCL. However, more research is needed to clarify whether or not this is the case.

Other than choosing smooth implants, there are a number of steps you can take to further reduce your risk of BIA-ALCL:

  1. Make sure your plastic surgeon is certified by the American Board of Plastic Surgery.

Board-certified plastic surgeons operate in hygienic hospital settings and use only high-grade implant materials, which greatly reduces the risk of bacterial contamination during surgery. Many board-certified plastic surgeons also use special surgical techniques designed to keep implants completely sterile. For example, some surgeons insert implants using a device called a Keller funnel. The Keller funnel prevents any contact between the implant and the patient’s skin, thereby maintaining sterility. Taking steps like these has been shown to reduce the risk of certain complications, like capsular contracture (a hardening of the tissue around the implant). It’s possible that these techniques may also lower the risk of BIA-ALCL, if bacteria play a role in the development of these conditions.

  1. Consider your family’s medical history before you have breast augmentation.

If autoimmune conditions run in your family, or you have a family history of lymphoma, you may want to avoid the use of silicone breast implants. There are other surgeries, like breast lift (mastopexy), that can improve the shape and projection of your breasts without implants. When you visit us for a consultation, our doctors will review your complete medical history and let you know whether or not breast augmentation is the right choice for you.

  1. If you do have breast augmentation surgery, don’t ignore irritation or other symptoms, even if they occur many years after your operation.

BIA-ALCL is often curable if it’s caught early, so it’s important to have unusual symptoms looked at right away. See your doctor or plastic surgeon if you experience any of the following symptoms: Breast pain or tenderness; skin irritation around your implants; swelling or fluid retention; the development of a lump in your breast or armpit; breast asymmetry; a hardening of one or both breasts.

Illnesses Not Caused by Silicone Breast Implants

Though there is a link between textured silicone breast implants and BIA-ALCL, many myths linking breast implants to other illnesses have been thoroughly debunked. Breast implants do not cause breast cancer or reproductive problems. They do not create any risks during breastfeeding, either. There is very little evidence to suggest that breast implants cause any illness outside of BIA-ALCL; even other conditions related to the immune system (i.e., autoimmune diseases) do not appear to be linked to the use of silicone breast implants. These devices have been deemed safe for use by most women, most of the time.

Weighing the Risks and Rewards of Breast Augmentation

Many of the most rewarding choices in life come with some measure of risk, whether it’s international travel, taking up a new sport, driving a vehicle, or having breast augmentation surgery. For many women, the benefits of breast augmentation—including increased confidence and a heightened sense of femininity—are well worth the statistically small risk of complications. After all, even textured implants are usually safe; only 1 in 30,000 women who have textured implants will ever develop BIA-ALCL.

If you feel that having larger, more shapely breasts would greatly improve your quality of life, you shouldn’t let reports of breast implant illness dissuade you from considering this life-changing surgery. To learn more about how you can have your breasts enhanced safely, contact Dr. Mary Gingrass and Dr. Melinda Haws to arrange a personal consultation today.