BREAST IMPLANT ASSOCIATED CANCER: WHAT YOU NEED TO KNOW

Breast implant associated cancer is a rare form of cancer that can develop in people who have specific types of breast implants. It is not breast cancer as we more commonly know it, but an immune system cancer also known as anaplastic large cell lymphoma (ALCL). In this article, we will discuss the signs, symptoms, risk factors, causes and detection methods of breast implant associated cancer.

What is BIA-ALCL?

Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is a type of cancer that affects the immune system. The BIA-ALCL forms within the scar tissue capsule that encases a breast implant, typically originating in the scar tissue that naturally forms around the implant as part of the body’s response to a foreign object. This is a rare form of cancer. A recent review of BIA-ALCL cases reported to the Therapeutic Goods Administration (TGA), up until the end of 2021, indicates the following risk rate: 

• Polyurethane-coated implants have an estimated risk of 1 in 1,800. The Australian Register of Therapeutic Goods (ARTG) no longer lists this kind of breast implant, but some people may still have them.
• Macro-textured implants have an estimated risk of 1 in 2,400. The ARTG doesn’t include this type of breast implant, but some people still have them.
• Micro-textured implants have an estimated risk of 1 in 18,000.
• In Australia, there are no confirmed cases of BIA-ALCL in people with only smooth implants.

Breast Implant Cancer Symptoms

The most common symptoms of breast implant associated cancers include lumps, pain, or swelling around the implant. People may also have unusual skin changes in the breast. Below are the known signs and symptoms of breast implant associated cancer:

BIA-ALCL Symptoms

Symptoms can start any time after your breast implant surgery but can take years to develop. These symptoms are often non-specific and are much more likely to have an alternative cause. If your doctor suspects BIA-ALCL, they will likely send you for an ultrasound or magnetic resonance imaging (MRI). If there is excess fluid around the implant, a sample of the fluid can be obtained with a fine needle aspiration. If there is a mass, a tissue biopsy will be needed. These tissue samples will be sent to a laboratory for testing to confirm the diagnosis. Symptoms can include:

• Breast Swelling: Unexplained swelling or enlargement of the breast. This could occur years following implant placement. 
• Breast Pain: Persistent discomfort in the breast, chest, or underarm area. The important thing to note is that there are many more common causes for this, such as capsule contracture, injury, or infection, that need to be excluded first.
• Lump or Mass: Formation of a solid or firm lump near the breast implant, often immobile to the touch. 
• Asymmetry: Alterations in the shape or appearance of the breasts, especially changes that occur several years after implant surgery.
• Fluid Collection: Accumulation of fluid around the breast implant, known as a seroma. A seroma can potentially cause discomfort and swelling.
• Enlarged Lymph Nodes: Swelling of lymph nodes in the armpit area, also known as the axillary lymph nodes, or in the neck region. 

What Causes BIA-ALCL

While the exact cause of BIA-ALCL is unknown, it is believed that it may be related to chronic inflammation, caused by a bacterial biofilm formation on textured breast implants.

Which Breast Implants are Linked to Cancer?

BIA-ALCL is a rare form of non-Hodgkin’s lymphoma that has been connected to the use of textured breast implants. It is worth emphasising that this cancer is predominantly associated with textured implants, as opposed to smooth-surfaced ones.

Does Silicone from Breast Implants Cause Cancer?

There is no evidence that silicone from breast implants causes cancer. This is a common myth. Several research investigations have been conducted to explore the potential link between silicone-filled breast implants and breast cancer. These studies showed that women who have undergone elective breast augmentation are not at a heightened risk for the most prevalent forms of breast cancer. For more information about common breast cancer myths click here. 

A meta-analysis of observational studies published in 2015 examined the risk of breast cancer developing in women with cosmetic breast implants, where they found no increased risk to these women.

Breast Implant Recall

One of the major concerns surrounding the safety and long-term health outcomes of individuals who have undergone breast augmentation or reconstructive surgery is a breast implant recall. This issue has gained significant attention within the medical community and among patients, prompting a thorough examination of the potential risks associated with breast implants.

The Food and Drug Administration (FDA) alerted healthcare providers about a link between all breast implants, regardless of filling or texture, and BIA-ALCL in 2019. As of April 1, 2022, the FDA has received a total of 1,130 US and global medical device reports (MDRs) of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Allergan voluntarily recalled its Biocell saline and silicone-filled textured breast implants and tissue expanders in July 2019. If you are concerned about your own breast implants, we recommend discussing this with your doctor or GP.

How to Check for Breast Cancer with Implants?

The Australian TGA recommends healthcare professionals discuss the risk of BIA-ALCL with patients who have or are considering having breast implant surgery. When obtaining informed consent, it’s crucial to have a thorough discussion with the patient regarding BIA-ALCL. It’s essential for patients to be well-informed about the advantages and disadvantages of various breast implant options. Additionally, they should be given educational resources to review and contemplate at their own pace. The explanation of breast implants requires discussion of risks versus benefits and would be a clinical decision to be made in partnership with a fully informed patient.

Routine monitoring is recommended by the TGA, and according to NSW Health, patients with breast implants should see their GP or surgeon every 12 months for a clinical review, regardless of whether you have noticed breast changes during this time, or the implant type. A clinical review will usually involve being asked some questions about whether you have any symptoms or have noticed any changes, and an examination of your breasts, implants, and armpit. In some cases you will be asked to undergo Ultrasound or MRI screening. 

In conclusion, while there is no evidence to suggest that breast implants cause the more common types of breast cancer that are diagnosed each day in Australian women, they may increase the risk of other cancers such as BIA-ALCL. Breast cancer that develops in people who have implants is much more likely to be to the usual types of breast cancer

It’s important for people with rough or textured breast implants to monitor their breasts for any changes and seek medical attention if they experience any unusual symptoms or concerns.