ALCL stands for Anaplastic Large Cell Lymphoma and has been the subject of numerous medical publications and media stories recently because of possible association with certain types of breast implants. In cases where ALCL develops in a breast with an implant in place, it is known as Breast Implant Associated ALCL or BIA-ALCL. BIA-ALCL is NOT form of breast cancer. it is a rare form of lymphoma found in the tissue adjacent to a breast implant.
According to medical reports, BIA-ALCL has been found in women who have implants anywhere form 2 to 28 years after they underwent breast augmentation surgery with an average of 8 years. The most common presentation has been swelling in the breast caused by fluid building up around the implant. Others have discovered it during self-exams by finding a lump in the breast or in the armpit.
Smooth vs. Textured
At this time, according to the FDA, BIA-ALCL is an issue with textured implants only, not smooth implants. Dr. McMahan has used smooth breast implants almost exclusively for almost 20 years in Columbus, Ohio. The type of texturing also makes a difference in the development of BIA-ALCL. Mentor textured implants are 'micro-textured' while Allergan produces 'macro-textured' implants and not 'micro-textured' prostheses. Both saline and silicone 'macro-textured' implants have been implicated.
Based on current information, it is estimated that a woman in the United States with textured breast implants in place has a 1 in 30,000 chance of developing BIA-ALCL. Similar risk numbers have been reported in European women with textured implants while those in Australia and New Zealand shows a risk anywhere form 1:1,000 to 1:10,000.
Why Texture Implants?
Until the late 1980's virtually all breast implants had smooth surfaces however, most of these had very thin shells and a relatively liquid silicone gel resulting in 'gel bleed' through the implant resulting in a high percentage of capsular contracture. Polyurethane foam covered implants became all the rage in the late 80’s and early 90’s as they seemed to significantly reduce the risk of capsular contracture. At the time of the silicone controversy in 1992, it was discovered that polyurethane causes cancer in rats so those implants were taken off of the market. In an attempt to obtain similar reduction in capsular contracture rates, implant companies came out with implant texturing of the surface mimicking the texture of the polyurethane implants.
Another reason to texture implants is to prevent rotation of the implant. While rotation of a round implant is not an issue, there is a wide variety of shaped implants available now that can look abnormal if they move or rotate out of position. Texturing of the implant surface allows scar tissue ingrowth into the interstices of the implant surface significantly reducing the risk of implant rotation.
Current recommendation for women who have textured implants is to have regular follow up visits with your surgeon and to be seen sooner if you notice swelling or a lump in your breasts. There are no recommendations for removing your implants just because they are textured.
The FDA, ASPS and ASAPS are closely monitoring BIA-ALCL reports and studies. At this time, textured implants remain available for use because of potential benefits in certain situations. To learn more about BIA-ALCL, go to www.plasticsurgery.org/alcl or visit the FDA website.