Blood cancers

More cases of breast implant ALCL

The TGA has updated its safety alert regarding breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) – confirming a total of 72 cases have been reported to date.

As previously reported in the limbic, cases were expected to rise given the trends in breast augmentation and the lag time for BIA-ALCL to develop.

All previous advice for consumers and health professionals remains current.

The evidence suggests the risk of BIA-ALCL might be reduced by using smooth rather than textured implants. The textured surface could encourage the growth of a bacterial biofilm, which in turn stimulates T-cells.

More stringent infection control measures including antibiotic prophylaxis, pocket irrigation, and avoiding the use of drainage tubes as potential entry sites for bacteria have also been suggested to reduce the risk.

The current consensus of expert opinion is that screening or prophylactic removal of implants in asymptomatic patients is not recommended.

“The management of this condition is multidisciplinary and all patients require a referral to a surgeon experienced with breast implants and the involvement of a haematologist who specialises in lymphoma, for initial and ongoing investigations and management,” according to the TGA.

“The main method of investigation is ultrasound evaluation to confirm the presence and extent of an effusion, determine if there is presence of a mass, and evaluate regional lymph node basins for lymphadenopathy.”

“Fine needle aspiration (+/- or core biopsy) of an effusion (mass) is performed and the aspirate (tissue) sent, for cytology (histology) and flow cytometry +/- molecular studies, for confirmation of the diagnosis of breast implant-associated ALCL.”

PET/CT and MRI are reserved for confirmed cases with no role for mammography.

The TGA said most cases are adequately treated with complete capsulectomy and implant removal.

“However, aggressive variants have been reported. To date, three deaths have occurred in Australia.”

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