Blood cancers

Lymphomas following breast augmentation to increase

Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) will become more common given the increasing popularity of textured implants in the last five years and the average eight-year timeframe for BIA-ALCL to develop.

The warning from a joint Australia and New Zealand taskforce was published in their review of 55 local cases, including four deaths, identified between 2007 and 2016.

Professor Miles Prince, a co-author of the review and director of the Centre for Blood Cell Therapies at the Peter MacCallum Cancer Centre, told the limbic doctors now had to be more proactive in identifying cases.

“This issue is only now coming to the fore and there have probably been lots of the more indolent cases – seromas that have developed, been aspirated and disposed of.”

“We don’t yet know whether this lymphoprofileration is an in situ but not invasive malignancy and whether it will develop or not.”

However it was now imperative that specimens were collected and analysed to ensure women with BIA-ALCL were appropriately managed with removal of the implant and capsule.

The review found most cases (69%) were cosmetic augmentations and the remaining women were reconstructions after mastectomy for cancer or prophylaxis. All women were exposed to a textured device including tissue expanders used prior to insertion of the definitive implant.

Using sales data from three major implant manufacturers, the review determined the risk of BIA-ALCL was as high as one in 3,817 for Biocell implants, one in 7,788 for Silimed polyurethane implants and one in 60,631 for Siltex implants.

Professor Prince said the high surface area of the textured implants was just one of three factors creating the ‘perfect storm’ for the lymphoma to develop.

“We propose the higher surface area acts as a passive conduit for the growth and proliferation of bacteria, which, once they reach a threshold, cause ongoing immune activation and transformation is susceptible hosts over time,” the review said.

“There is a specific microbiome associated with these implants and it is often rickettsial which may be the driving antigen for the underlying inflammation,” Professor Prince said.

Further research was required to identify the HLA factors or germline mutations involved in predisposition to BIA-ALCL.

“We have some hints for example in the geographical clustering of cases. BIA-ALCL has not been reported in Asians and South America, which has the most implants, has a relatively low number of cases, although this could be a reporting issue.”

He said a textured implant recall was highly unlikely however there would be changes in terms of appropriately consenting future patients for breast implants, stricter infection control protocols to reduce the risk of bacterial biofilm, and monitoring women potentially at risk with clinical examination or ultrasound.

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