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Breast implant associated anaplastic large cell lymphoma (ALCL)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Breast Implant Associated-ALCL (BIA-ALCL)

In 2016, the World Health Organisation (WHO) defined a new type of anaplastic large cell lymphoma (ALCL), which is, itself, an uncommon type of non-Hodgkin lymphoma with several subtypes

  • WHO labelled this new variant as breast implant associated anaplastic large cell lymphoma or BIA-ALCL*
  • has specific diagnostic criteria, which include positive expression of the marker CD30, negative for ALK, and a distinct cell morphology
  • most common symptom for people with BIA-ALCL around breast implants, is fluid collecting around the implant ('late' seroma)
    • the patient may notice a fairly quick, but painless, increase in size of the affected breast, usually over a few weeks. In some cases, it can affect both sides at the same time
    • most cases have happened years after surgery
    • very rarely BIA-ALCL has been found when a lump develops next to an implant, or within the tough fibrous tissue that can build up around an implant (termed the capsule)
  • in the UK, the current estimated incidence of BIA-ALCL, based on confirmed cases, is 1 per 15,000 implants sold
    • estimate is calculated by dividing the number of confirmed cases by the number of breast implants sold
    • estimate is based on data for all types of breast implants, including breast tissue expanders, that we know were sold in the UK
    • only an estimate because some cases may not have been reported to the manufacturer or to the MHRA during this time, and not all implants sold in the UK have been implanted
    • increase in the estimated incidence since August 2020 is due to a decrease in sales and surgical operations during the COVID-19 pandemic
    • in the confirmed cases of BIA-ALCL in people with breast implants reported to the MHRA, there has been one death. There have also been two deaths from ALCL which were not related to their breast implants

Information for healthcare professionals

Clinicians have a legal obligation to discuss the potential risk of BIA-ALCL when seeking informed consent of new patients, and with any patient returning for review of their breast implants.

When reporting a case of BIA-ALCL in patients with breast implants, surgeons are reminded to include (where it is known):

  • the patient’s CD30+/-, ALK +/- status
  • full details of the device, including manufacturer, model, surface texture (as identified by the manufacturer)
  • the presenting clinical features and the subsequent management
  • other information including the dates of initial implantation, revision, and explantation
  • information on previous implants, particularly whether tissue expanders have been used and for how long

Reference:


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