Breast Implant / Capsule Removal

Breast Implant Associated Anaplastic Large Cell Lymphoma. BIA-ALCL.

Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is a form of Non Hodgkin’s Lymphoma. Lymphoma is a cancer of the white cells in the blood. It is not a breast cancer. It develops adjacent to breast implants, usually in fluid around the implant. That fluid is often contained within the fibrous capsule. Capsules are the fibrous scar tissue around breast implants.

Risk Factors and Statistics

BIA-ALCL is a rare disease. The general risk of Lymphoma in a women, living in Australia tot 85 years of age is 1:50. It is estimated there are 35 million women with breast implants worldwide. There are presently 500 confirmed cases of BIA-ALCL and 16 documented deaths. Data shows the risk to vary between 1:2700 and 1:80 000 depending on the type of textured implants. The more coarse the texturing, the higher the risk. Smooth surfaced implants have not been shown to be associated.

Evidence suggests that limiting bacterial exposure at the time of insertion, reduces the risk. Infection control with a 14 point plan or steps has been shown to reduce the risk of capsule contracture. These guidelines may not be applicable in all cases. The cause is thought to be bacteria in a biofilm which results in a long term inflammatory response. In genetically susceptible women this may result in an expansion to BIA-ALCL. In summary – textured implants with low grade bacteria contamination in genetic susceptibility and sufficient time.

Symptoms, Diagnosis, and Treatment

BIA-ALCL presents with swelling (fluid) or a lump or both. This can be between 2 and 14 years, with an average of 7 years. Most fluid and swellings noted around implants are tissue fluid or seroma and not BIA-ALCL. Presentation is usually in the early stage of disease, greater than 85% of cases have symptoms of less than 8 months. Here the disease is usually contained within the capsule. Ultrasound may confirm fluid and mammograms are not helpful. Specific tests need to be performed on the fluid (CD30 receptors and ALK-). MRI and PET scans may be used to stage the disease.

When treated early, treatment is curable. Early cases can be treated with surgery alone. Late presentation with advanced disease and symptoms of over 22 months may spread through the capsule to lymph nodes. Treatment may then require additional radiotherapy and chemotherapy.

Implant and Removal

Implants that are implicated are textured or polyurethane foam coated. Both silicone and saline implants are involved. Both cosmetic and reconstructive cases are involved. There have been clusters associated with certain surgeons or institutions and probably warrant further investigation.

Guidelines are that without symptoms or changes, ultrasound scanning is not required. Routine implant removal is not required. As implants are not lifelong devices they do need to be removed at some stage. The most common causes for removal remain capsule contracture, migration, rupture, poor aesthetic results and size changes.

Anyone with concerns about implants should see their General Practitioner or Surgeon.

The body naturally forms a scar or capsule around breast implants. Over time this may harden and contract and may require removal.

Any prosthetic material inserted into the body is surrounded by scar tissue or a capsule. All scars contract and this also occurs with breast implants. Initially, the capsule feels firm, then becomes visible and finally may be tender or painful. The body may even deposit calcium into the capsule.

Contraction around the implant may cause them to distort, ridge or bulge. Once a capsule is causing symptoms, removal is recommended. It is best completely removed with the implants. At surgery, the implant can be left out or replaced with either a bigger or smaller implant. The breasts may also need to be lifted if some drooping (ptosis) has occurred. A small amount of breast tissue may also be removed with the capsule.

Following a medical complication with an implant some health funds and Medicare may contribute to the cost of replacement.

Surgical Considerations and Recovery

Surgery is usually performed in hospital under general anaesthetic. Drainage tubes may be required as there is usually a small amount of bleeding or ooze associated with surgery.

Recovery is proportional to the complexity and duration of surgery. At the time of consultation, the procedure, aftercare and recovery will be comprehensively explained. Dr Kippen will give you brochures to read as well as showing before and after photographs.

You should read the information presented here in conjunction with the information contained on the Frequently Asked Questions page of the website.