Ask Dr. Barber

Q. I have had silicone breast implants for over 10 years.  I am not having any problems but recently read about a type of cancer in the breasts that is related to breast implants.  I read that it is extremely rare but I want to know if this is something that I need to be concerned about.

A. There is a recently discovered rare cancer that has been identified in women with breast implants that appears to be related to the breast implants.  The cancer is called Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL). The disease is extremely rare, with only about 135 cases worldwide that have been recognized by the MD Anderson Cancer Center.  This is out of approximately 10-11 million women who have breast implants throughout the world.  The incidence of this disease occurring is estimated to be 1 in 300,000 cases.  It should be emphasized that this is not breast cancer, it is a cancer of the immune system that involves the lymphocytes and occurs in the breasts of women who have breast implants.  Interestingly, this disease also occurs in patients without implants, and in those patients who do not have implants, the disease is much more aggressive. 

Although the numbers of patients that have been diagnosed with the disease are too small to identify specific risk factors, it seems that the disease occurs more commonly in patients with silicone gel implants with the vast majority associated with textured surface implants. BIA-ALCL has been seen in women with saline implants as well, but the number of women with the disease associated with saline implants is a small minority of identified patients.  The disease is extremely rare in women with smooth shell implants.

Most plastic surgeons have never seen the disease and will likely never see it during their practice.  In spite of the rarity, all plastic surgeons should be aware of the possibility of it occurring.  The presenting signs of the disease are a spontaneous and fairly rapid swelling of the breast, with no history of trauma to the breasts.  The swelling is due to accumulating fluid (called a seroma) in the breast implant pocket.  The breast will enlarge and become tight and uncomfortable and possibly distorted in shape, because of the accumulating fluid.  Patients typically will have no other symptoms. 

The diagnosis is made by aspirating some of the fluid with a fine needle and submitting it for evaluation of the type of cells that are seen in the fluid.  If the diagnosis is confirmed, the treatment is to remove the implants and perform a complete removal of the capsule or membrane that surrounds the implant.  The capsule is then evaluated by the pathologists to once again confirm the diagnosis.  In most cases, there is no further treatment that is necessary and once the implant and the capsule have been removed, the lymphoma goes away.  In rare cases that do not respond to implant removal and capsulectomy, chemotherapy may be necessary.  If the diagnosis is confirmed, an oncologist should always be involved in the treatment plans.

If you are concerned, then you should see a board certified plastic surgeon to discuss your situation, however, I want to emphasize that the disease is extremely rare and is treatable if it occurs.  

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