This consensus was held after Mr Shadi Ghali, Consultant Plastic Surgeon had given all those present a very informative update on the situation in relation to the BIA-ALCL. We were able to conclude that 5-10,000,000 implants had been implanted world-wide so far. The actual BIA-ALCL is a T-cell lymphoma of non-Hodgkin type and not a breast tumour in itself. Lymphoma of the breast itself is a B-cell lymphoma.
The WHO described the BIA-ALCL for the first time in 2016 and more and more reports of occurrence are currently following in the published literature. The most common symptom is a delayed persistent swelling or pain in one of the breasts. Diagnosis can be confirmed by aspiration of serous fluid after ultrasonic guided aspiration of the serous fluid surrounding the implant which would turn out to be CD 30 positive (immuno-histochemistry specific for BIA-ALCL).
The BIA-ALCL has a very good prognosis if it is treated with surgery where the implant is removed with fluid and capsules. In cases with more advanced disease, some targeted treatment in order to inhibit the so called JAK-STAT where the genitive mutation has been found.
The latest publications also communicate that high surface textured implants are more associated with the risk of BIA-ALCL than completely smooth implants. The textured Allergan implants have at the moment been denied its’ CE mark registration after the mark needed renewing at the end of last year as a consequence of this. Current investigations are ongoing. Allergan implants have been suspended from the European and Brazilian markets.
There is now also more litigation, mainly in the US, against both Allergan and also Mentor. The Association of Breast Surgeons, the Association of Aesthetic Plastic Surgeons and the British Association of Plastic, Reconstructive and Aesthetic Surgeons are all working in close collaboration with the MHRA. The British Government has issued an alert for the breast implants which are suspected to be BIA-ALCL for them to be reported. So far 40 cases have been reported of BIA-ALCL in the UK and confirms an approximate risk of 1:24,000 to 1:30,000 implants sold.
Patients with implants are not asked to change their routine medical care and follow up. Patients should however be alerted if a swelling or pain occurs into one implant late after the surgery.
The consensus group agreed that one should clearly ask patients who report with late swelling or pain to come back after a month for further check-up. It was in general agreed that such follow ups would be of importance due to the need for patient reassurance. Further reporting will continue and UKAAPS will continue to follow BIA-ALCL as further publications and information continue to emerge.
LENA C. ANDERSSON
M.D., Dr. med.
Consultant Plastic Surgeon