What is ALCL?
Anaplastic large cell lymphoma (ALCL) is a form of cancer that can form in the capsule that inevitably develops around a breast implant. It has been recognized for many years, but there has been an increasing awareness of it, and therefore of the potential risks of breast implants, over the past 5 years. As awareness has increased, the true rate of it happening has been thought to increase, from initially something closer to 1:1,000,000, to perhaps as lows as 1:300. These are very concerning numbers, and are a reason for considerable changes in how we think about breast implants.
As of this time, it is thought that the two greatest contributors to the development of ALCL are time, and presence of a “textured surface” to the implants (as opposed to smooth surface). In response to this, I am not aware of any surgeon in the United States who is currently placing a textured breast implant. Hopefully this will bring down the number of cases of ALCL that occur in the years to come.
This raises another interesting question: what should women who currently having textured implants do? There is no consensus answer to this question. If there are concerning symptoms (which include late onset of swelling, a mass, or fluid accumulation around the implant) then it should be evaluated with imaging (such as ultrasound or MRI) and sampling of the tissue or fluid. If there is an obvious diagnosis of ALCL, then the treatment is removal of the implant and the entirety of the capsule, and this is sometimes followed by chemotherapy. If there are no concerning findings or anything to suggest a diagnosis of ALCL, then there is still considerable alarm, at least in some patients, and this can impact quality of life. So, at this point it is still thought to be reasonable in such cases to remove implant and the capsule and send both for pathologic analysis (and if the woman would like a smooth implant placed at that time, it is reasonable to do).
As one more point of warning, there are additional new concerns about other forms of cancer besides ALCL (such as squamous cell carcinoma) that can form in the capsule around the implant. More information will continue to emerge about this situation, and we will continue to post about it as it becomes available.
In summary, the risk of ALCL and other forms of cancer in the tissue immediately surrounding the breast implant is something that is being monitored closely. Women who have implants should discuss with their surgeons what to watch for, what the risks are, and what options are available to them. Women who are considering undergoing placement of breast implants (for reconstructive, augmentation, or gender affirmation reasons) should equally discuss the risks and benefits of the procedure, hear about alternatives that may help them achieve the same goal, and come to an informed decision about what is right for them.