Clinical Corner - April 2023

Breast augmentation implants associated with development of anaplastic large-cell lymphoma (BIA-ALCL) have been increasingly reported over the last several years. The first case of BIA-ALCL was reported in 1997. The link between breast implants and ALCL became stronger more recently when six cases of ALCL involved the breast and three of these occurred in women with breast implants. A search of the literature turned up an additional 15 cases of BIA-ALCL.

As of late 2022, 1,333 cases of BIA-ALCL have been reported worldwide with 35 associated deaths. The total included 402 cases and eight deaths in the U.S. The number of cases of BIA-ALCL in the U.S. and elsewhere has probably been underestimated. BIA-ALCL is associated with textured breast implants; it does not appear to be associated with smooth implants.

There are a lot of different theories as to causation, but production of inflammatory cytokines due to the implant may be important. At FDA request, Allergan, manufacturer of textured implants, withdrew the product from the market in 2019. Many women still have the implants because the FDA did not advise removal in the absence of concerning signs or symptoms. The risks associated with textured breast implants may extend beyond ALCL. About 20 cases of squamous-cell carcinoma (SCC) and about 30 cases of B-cell lymphoma had been linked to the devices. These types of associations are uncovered when linkages can be documented in our cancer abstracts.