As board-certified plastic surgeons, there is nothing Dr. Samuel Pearl and Dr. Alexander Ereso take more seriously than the safety and well-being of their patients. One issue that has recently emerged and could put a small number of their breast augmentation patients at risk is a disease known as ALCL. Read on as Dr. Pearl and Dr. Ereso explain what you should know about ALCL.
What is ALCL?
ALCL is anaplastic large cell lymphoma. It is a rare and treatable type of T cell lymphoma that can develop around breast implants. ALCL is not a cancer of the breast tissue itself. The time between implant insertion to diagnosis is reported to be between 2 and 28 years with a median of 8 years. The current reported incidence of ALCL is approximately 1 in 30,000. No cases to date have been reported in patients that have received smooth walled implants. The association of ALCL and textured implants may be related to increased surface area of the texturing, the chronic presence of fluid around the implants, the presence of bacteria around the implants and genetic factors. The disease has been associated with both silicone and saline implants in cosmetic as well as reconstructive patients.
The exact cause of ALCL has not yet been determined. A coalition of experts from the American Society of Plastic Surgeons, the U.S. Food and Drug Administration and breast implant manufacturers are currently conducting research to work toward identifying the cause. They have also established the PROFILE Registry to collect data about reported cases of BIA-ALCL (breast implant-associated ALCL).
How Do Patients Present with ALCL?
The majority of patients present as a delayed seroma or collection of fluid around the implant. This usually presents as an enlarging breast without any other cardinal signs like infection. Diagnosis is made by examining the fluid collection for tumor markers. If a positive diagnosis is made, PET-CT and MRI scans are obtained to determine the extent of spread. Mammograms have not been found to be helpful.
The majority of patients can be cured of this disease by undergoing a procedure to remove the implant itself along with the complete removal of the capsular tissue surrounding the implant. This is to prevent recurrence. In rare instances where distant spread was found, patients required chemotherapy and possible radiation therapy.
What Should Patients Do?
If you are a prospective breast implant patient, the FDA encourages you to research your options before committing to surgery, and talk to your plastic surgeon about the benefits and risks.
If you have implants, you should follow your doctor’s instructions regarding monitoring your implants and having routine mammography screenings. If you notice a change in the way your breast looks or feels, you should alert your primary doctor or plastic surgeon.
For more information regarding ALCL you may find www.plasticsurgery.org/alcl to be most helpful.
Please remember that Dr. Pearl, Dr. Ereso and their staff are available to help you! Feel free to contact our office if you have questions or need assistance.