Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
The cancer associated with breast implants is called Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), a rare T-cell lymphoma that arises in the fibrous capsule surrounding the implant, not in the breast tissue itself. 1
Key Defining Characteristics
BIA-ALCL is a distinct entity from breast tissue cancers—it develops in the scar tissue capsule that forms around the implant. 1 The World Health Organization formally recognized this as a provisional entity in 2016, and it was subsequently incorporated into the 2017 WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues. 2
Diagnostic Requirements
- CD30 positivity is required by definition for diagnosis—the neoplastic cells must show strong, uniform CD30 expression. 1, 3
- ALK (anaplastic lymphoma kinase) negativity is consistent—this distinguishes BIA-ALCL from systemic ALK-positive ALCL. 1
- Clonal T-cell receptor gene rearrangements are identified in nearly all cases when sufficient cellular material is obtained for PCR testing. 1
Clinical Presentation Pattern
The hallmark presentation is late-onset seroma (fluid collection) occurring more than 1 year after implantation, typically 8-10 years post-placement. 1, 3, 4 Patients present with:
- Breast swelling, asymmetry, or sensation of fullness 1, 4
- Occasionally accompanied by pain 1
- Less commonly, a palpable mass in the capsule 1
A critical pitfall: effusions around implants are often mistaken for implant rupture or capsular contracture, delaying diagnosis. 1
Implant Type Association
Most reported cases are associated with textured-surface implants, not smooth implants. 1, 3 The FDA noted significantly higher risk with Allergan's BIOCELL textured breast implants compared to other textured implants, leading to their voluntary worldwide recall. 1 Each manufacturer's textured surface is created through proprietary processes, resulting in different surface characteristics. 1
Distinction from Breast Implant Illness
BIA-ALCL is entirely distinct from "Breast Implant Illness" (BII)—the latter is a syndrome of nonspecific systemic symptoms without pathognomonic findings, while BIA-ALCL is a defined malignancy requiring CD30 positivity. 3 BII symptoms do not correlate with implant characteristics, whereas BIA-ALCL is predominantly associated with textured implants. 3
Prognosis and Clinical Behavior
When disease is confined to the effusion and capsule without invasion, prognosis is excellent with appropriate surgical management. 1, 5, 2 However, BIA-ALCL can progress and cause death if untreated—all 16 reported deaths as of 2018 involved extracapsular disease. 3, 5 The disease follows a generally indolent course but has potential for local invasion through the capsule into breast parenchyma or spread to regional lymph nodes. 2, 6
Clinical Significance
Early diagnosis is critical because the disease is potentially curable when detected at the effusion-only stage, but becomes life-threatening with progression. 1 As of March 2018, approximately 529 unique confirmed cases had been reported across 23 countries. 5 Given the millions of women worldwide with breast implants, awareness of this entity is essential for all practitioners managing patients with breast implants. 5