Breast Implant Illness and ALCL: A rare type of non-hodgkin lymphoma

Some women who have undergone breast surgery experience symptoms/side effects from their implants, this is called Breast Implant Illness or silicone sickness. As of now, this is not an official diagnosis, but can be referred to as an autoimmune/inflammatory disease because of various substances. Those who report BII often report several different symptoms such as chest pain, chills, chronic pain, headaches, and inexplicable fatigue.

In such cases, the prostheses can be removed with or without the entire capsule (depending on thickness), and at the same time replace these with fat from your own body.

Some people want to take out their dentures because they feel that «the implants have done their job, or that they are done with them».

Other reasons for removing implants are ALCL, a rare type of non-Hodgkin’s lymphoma. ALCL is a very rare condition associated with implants. There is currently too little reliable information regarding the cause and connection to the various types of implants.

Breast prosthesis removal
Breast implant Conversion

Excerpt from our KK interview

https://www.kk.no/helse/janelica-fjernet-silikonbrystene/72751045

Reminiscent of rheumatism and connective tissue diseases

– Amin Kalaaji, head of the Norwegian Association for Aesthetic Plastic Surgery and senior physician at Oslo Plastic Surgery, has personally experienced that woman want to remove breast implants because they think they have Breast Implant Illness.

– The challenging thing is that the patients report so many different diffuse symptoms, everything from weakness and headaches to infections, hair loss and forgetfulness. Some of these symptoms are reminiscent of rheumatism and connective tissue diseases, he says.

– The dilemma for doctors is that we cannot deny that these are facts, even if we do not see that it has a direct connection with the implants. If the woman is convinced that the symptoms are due to the implants, she has the right to have them removed, but we can give no guarantee that it will help.

– Implant-to-fat (conversion) is a good option for complicated breast implant cases, with good long-term results and excellent patient satisfaction. Here, the implant is removed, and fat is inserted to fill the space left after the extraction. This gives a natural fullness and feel and is a growing trend among those who do not want their implants, but still do not want to go all the way back to the size before the prostheses.

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Dr. Amin Kalaaji

Dr. Amin Kalaaji, MD, PhD is a board-certified plastic surgeon and head of the clinic at Oslo Plastic Surgery, and president of the Norwegian Association for Aesthetic Plastic Surgery (NFEP) 2018-2020.

Dr. Kalaaji has established the Oslo plastic surgery clinic in the Frogner district, central Oslo, in 2002. In 2022, the clinic will celebrate its 20th anniversary.

Dr Kalaaji participates in many meetings and holds lectures and trainings around the world. This benefits all our patients as he is always up to date on the latest and most advanced treatments and surgical techniques. Patient safety, high quality and individual treatment always weigh the most at Oslo Plastic Surgery.

Dr. Kalaaji is trained in plastic surgery in France (Paris) and Sweden, with a doctorate in plastic surgery from Sweden, in bone transplantation for cleft lip and palate. He was previously chief physician at the plastic surgery department at Telemark Central Hospital, and chief physician and acting head of department at the plastic surgery department Ullevål, Oslo University Hospital. He now works at Oslo Plastic Surgery in Oslo and has had clinic responsibility there for over 20 years.

In recent years, his focus has been on aesthetic procedures including breast surgery, fat transplantation to all parts of the body, especially the face, eye, chin, chest, BBL buttock augmentation with own fat and intimate surgery. In addition, correction of inverted nipples is carried out (where he has developed a very special technique that preserves the function of breastfeeding), rhinoplasty and the usual face operations such as facelifts, eyelid surgery and ear surgery. He has also researched the quality of life of patients who have undergone breast surgery such as breast implants, breast lifts with implants, intimate surgery, and rhinoplasty.

Dr. Kalaaji has published several scientific articles and has given over 400 presentations and courses on plastic and aesthetic surgery in the Nordics, Europe, and the world.

Among other things at ASAPS, ISAPS, ISPRES, IMCAS, and at many national and international aesthetic surgery meetings and participates as Faculty in global aesthetic courses for the «International Society for Aesthetic Plastic Surgery» (ISAPS), in ASAPS (The American Society for Aesthetic Plastic Surgery) at a congress in Boston in 2011, which deals with the quality of life of women with breast implants and in New York 2018 with courses in Mommy Makeover in aesthetic surgery and other widespread combined operations, and the importance of choosing combinations. Many works have been published in the Norwegian journal «Kirurgen» in April 2012 and in the prestigious Aesthetic Surgery Journal and PRS (Plastic and Reconstructive Surgery) from 2013 to now.

He has also given lectures and been a guest lecturer in London, Manchester, Berlin, Rome, Paris, Marseille, Tours (France), Helsinki, Linköping, Stockholm, Gothenburg, Karlstad, Uppsala, Tromsø, Lofoten, Oslo, Copenhagen, Marrakech, among others. , Tunis, Aleppo, St. Petersburg, Cape Town, Rio de Janeiro, Miami, Cairo, Beirut, Kota Bharu (Malaysia), Dubrovnik, Coventry, Belgrade, Sarajevo and Kyiv, about breast augmentation with fat transplantation, buttock augmentation with own fat, the clinic’s own operating method regarding inverted nipples that preserve breastfeeding function, rhinoplasty, intimate surgery, and breast lift with implants at high-quality international conferences.

Dr. Kalaaji currently sits on the editorial board of the Journal of Plastic surgery and Hand Surgery, and of the prestigious Aesthetic Surgery Journal in addition to the Acta Chirurgiae Plasticae Editorial board.

Dr. Kalaaji is an active member of the international organization International Society for Aesthetic Plastic Surgery (ISAPS) and was a member of the membership committee of the same organization. ISAPS is a leading organization for experts in cosmetic plastic surgery.

He has also been an active member of the American Society for Aesthetic Plastic Surgery (ASAPS) since 2007 and has since attended this prestigious annual meeting in the USA.

Dr. Kalaaji serves as a member of the International Committee of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2009-2023.
“The time and dedication offered by Dr. Kalaaji to the Society is truly appreciated by the members and by the Board of Directors of the American Society of Aesthetic Plastic Surgery (ASAPS),” stated ASAPS President, Dr. Jack Fisher, MD. 2017.

Dr. Kalaaji is also included on the International and Education/Program Committees of the American Society for Aesthetic Plastic Surgery (ASAPS).

In October 2015 and 2017, 2019, 2021, Dr. Kalaaji chaired the Norwegian American Aesthetic Meeting (NAAM 1,2,3,4) in Oslo. Link: www.naam.no

Dr. Kalaaji was chairman of the board of the Norwegian Association for Aesthetic Plastic Surgery (NEFP) 2018-2020, before this he was a board member of the Norwegian Association of Plastic Surgery from 1999-2001 and was elected as a board member of the Norwegian Association of Aesthetic Plastic Surgery (NFEP) 2014-2018. In addition, Dr. Kalaaji is an active member of the Nordic Plastic Surgery Association and the International Society of Plastic Regenerative Surgery.

In July 2017 and 2021, Dr. Kalaaji was elected as National Secretary of ISAPS in Norway for a period of 8 years, and in October 2018, Dr. Kalaaji was unanimously elected to the board of the International Society of Plastic Regenerative Surgery (ISPRES) 2018-2020 and is acting chairman of the membership committee in ISPRES (2020-2022)

Dr. Kalaaji was recently elected in June 2022 as the Assistant Chair of National Secretaries for all ISAPS National Secretaries, 2022-2024.

He has just published as editor-in-chief a book in two volumes: Plastic and aesthetic regenerative surgery and fat transplantation. Clinical application and operative techniques. This book—with its 117 chapters, approximately 2,000 pages, 1,625 educational figures, and 131 video clips—proudly represents the knowledge and expertise of 242 authors, including 72 female colleagues, from 31 countries and 5 continents.

These engagements and the roles Dr Kalaaji participate in mean that we are always up to date in the latest treatments, patient safety and surgical techniques.

FAQ

Oslo Plastikkirurgi answers here frequently asked questions, and we hope that this will give you good information. We want to be helpful in the process before an operation. If you have more questions, just write or call us.

There are women with breast implants who self-identify and present with various systemic symptoms and believe that these are related to their breast implants. They refer to these symptoms as Breast Implant Illness (BII).

Breast Implant Illness (BII) is a term used by women who have breast implants and who self-identify and describe a variety of symptoms including (but not limited to) fatigue, chest pain, hair loss, headaches, chills, photosensitivity, chronic pain, rash, body odor, anxiety, brain fog, sleep disturbance, depression, neurologic issues and hormonal issues that they feel are directly connected to their saline or silicone, textured or smooth breast implants.

The recent increase in patients reporting Breast Implant Illness (BII) symptoms appears to be related to social media. There is one Facebook group alone with more than 70,000 members, all of whom report Breast Implant Illness (BII) symptoms. This is not to say that social media is the cause of Breast Implant Illness (BII) however, it may account for the rapid increases in patient reporting.  BII is not an official medical diagnosis.

Silicone is an element that exists in nature as crystalline silica, which has been shown to activate the immune system in conditions such as systemic sclerosis which has been seen in stone masons. Silicone used in breast implants is different and to date has not been proven to cause any disease. This silicone does not exist is nature, it is created by hydroxylating silica to form polydimethylsiloxane. Medical grade silicone has had antioxidants, dyes, and plasticizers removed during processing.

There is no diagnostic testing specifically for Breast Implant Illness (BII). This is one of the current areas of focus for the Aesthetic Surgery Education and Research Foundation, the research arm of the American Society for Aesthetic Plastic Surgery. There are tests for autoimmune diseases that can be performed to evaluate for potential causes of a patient’s symptoms. There are patients who have symptoms they attribute to Breast Implant Illness (BII) with positive immune testing and others with all laboratory tests which show no abnormalities.

In 1999, The Institute of Medicine Committee on the Safety of Silicone conducted an extensive review of the available literature and concluded there was no demonstrated clear link between silicone implants and any systemic illness. There have been studies of many different sizes and design to look at the safety of breast implants themselves. These have looked at specific autoimmune disorders and diseases. In aggregate, these studies show little to no links between breast implants and any disease. Studies of patients who have symptoms that they have related to their breast implants have not shown consistent laboratory abnormalities to define a distinct syndrome. To-date, there has been very little in the way of research into this entity that has been labelled Breast Implant Illness (BII) by women with breast implants.

Various studies show different degrees of improvement in patient symptoms after removal of their breast implants, some of which are temporary, and some showing permanent resolution of symptoms. There are no studies which specifically show which symptoms may or may not improve with implant removal with or without capsulectomy.

There is no current definitive epidemiological evidence to support a direct link between breast implants and any specific disease process. However, this does not mean further research is not indicated. In rare and unusual disease processes, it can take years to come to a scientific conclusion. There are many factors that can affect the interaction between a patient and her breast implants. Further study is required to determine the best way to potentially screen patients prior to breast implant surgery and to determine which of the multitude of reported symptoms might improve with implant and capsule removal.

A lack of a direct, proven scientific link does not mean that the symptoms experienced by these patients are not real. Some patients have legitimate concerns about a potential link between breast implants and symptoms, so it deserves our attention and further scientific research to better determine what symptoms may improve with explanation of implants.

Because there are many women that self-identify as having Breast Implant Illness (BII), we are listening. ASAPS and ASERF are developing a new scientific study to examine this entity. We are also providing our members with a questionnaire to use to collect a record of complaints from patients with implants, as well as one to utilize for post-explanation. We cannot yet define BII and therefore cannot say with any certainty that it exists, because we do not have any tests we can run to prove or disprove its existence. However, we can listen to and partner with our patients to determine what is the best course of action to address their complaints, be it explanation or otherwise.

There is no current definitive epidemiological evidence to support a direct link between breast implants and any specific disease process. However, this does not mean further research is not indicated. In rare and unusual disease processes, it can take years to come to a scientific conclusion. There are many factors that can affect the interaction between a patient and her breast implants. Further study is required to determine the best way to potentially screen patients prior to breast implant surgery and to determine which of the multitude of reported symptoms might improve with implant and capsule removal.

A lack of a direct, proven scientific link does not mean that the symptoms experienced by these patients are not real. Some patients have legitimate concerns about a potential link between breast implants and symptoms, so it deserves our attention and further scientific research to better determine what symptoms may improve with explanation of implants.

Do not ignore your patient’s concerns. Their symptoms are real and whether or not they can or cannot be attributed to their implants isn’t relevant since there is simply no existing way to prove nor disprove causation or association.

Options can include: further medical work up with or without the consultation of a rheumatologist, observation without medical work up, implant removal without capsulectomy, exchange with or without capsulectomy, removal with total capsulectomy, or removal with en bloc capsulectomy.

Patients who present with concerns of Breast Implant Illness (BII) have real symptoms that often cannot be categorized into any specific know disease entity. This does not mean their symptoms are not real and they deserve a full evaluation. The various options need to be discussed and hopefully, with further research, we may be able to determine which patients may see symptom improvement or resolution with removal of their implants and which may not see any change.

There is no current definitive epidemiological evidence to support a direct link between breast implants and any specific disease process. However, this does not mean further research is not indicated. In rare and unusual disease processes, it can take years to come to a scientific conclusion. There are many factors that can affect the interaction between a patient and her breast implants. Further study is required to determine the best way to potentially screen patients prior to breast implant surgery and to determine which of the multitude of reported symptoms might improve with implant and capsule removal.

A lack of a direct, proven scientific link does not mean that the symptoms experienced by these patients are not real. Some patients have legitimate concerns about a potential link between breast implants and symptoms, so it deserves our attention and further scientific research to better determine what symptoms may improve with explanation of implants.

As there is no definitive link between the often subjective and divergent list of symptoms, and no means for testing, there is no ‘known’ risk. Many of the symptoms described by breast implant patients are experienced by the general public on a regular basis with or without implants. That isn’t to write-off a potential connection, but no connection has been established to-date.

Patients should however be informed of the risks that can be associated with breast implants, including (but not limited to) BIA-ALCL, a rare spectrum of disorders that can range from a benign accumulation of fluids around the breast (seroma) to an extremely rare lymphoma. They should know that BIA-ALCL is not a cancer of the breast tissue itself and that when caught early, it is readily curable. If the disease is advanced, chemotherapy or radiation may be required.

There are many medical inaccuracies perpetuated by the internet. BII patients tend to believe that a total capsulectomy is necessary to remove all causative agents and they prefer it en bloc, oftentimes without having a full understanding of what size incision is necessary for en bloc. Rather than react, first discuss the reasons you would perform a total capsulectomy with any patient. Not all plastic surgeons routinely perform a capsulectomy with explant, but some do.

If you wish to perform capsulectomy on a patient, it is important to explain that it is not always possible to remove all of the capsule. Sometimes a portion of the capsule must be left behind or is disintegrated with the use of electrocautery to prevent significant damage to muscle, rib or lung. Explain what size incision is necessary for an en bloc (as many may not be aware of how large an incision may be necessary). If they had an axillary approach or periareolar approach for breast implant placement, it must be explained to them that they cannot have the procedure done through those incisions. It is recommended to reinforce that there are increased surgical risks associated with en bloc capsulectomy which requires a complete dissection of all the tissues surrounding the breast implant and, that we do not have enough collective data to guarantee any improvement in their symptoms they have labelled Breast Implant Illness (BII).

Patients should however be informed of the risks that can be associated with breast implants, including (but not limited to) BIA-ALCL, a rare spectrum of disorders that can range from a benign accumulation of fluids around the breast (seroma) to an extremely rare lymphoma. They should know that BIA-ALCL is not a cancer of the breast tissue itself and that when caught early, it is readily curable. If the disease is advanced, chemotherapy or radiation may be required.

BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma) is a rare spectrum of disease that can range from an indolent accumulation of fluids around the breast (seroma) to a potentially metastatic lymphoma especially when there are delays in diagnosis. It is a disease that ranges from indolent to full-blown metastatic disease when not caught early. BIA-ALCL is not a cancer of the breast tissue itself. When diagnosed early, it is readily curable. If the disease is advanced, chemotherapy or radiation may be required.

BIA-ALCL is currently classified as a lymphoma.  Many experts believe that it behaves clinically as a lymphoproliferative disorder (LPD) that encompasses the spectrum of disease from benign CD30+ seromas, to CD30+ malignant seromas, to invasive capsular disease, and finally metastatic disease. Current ASERF research is underway to further understand the proper classification of this disorder. Similar to LPDs, BIA-ALCL is a highly treatable disease with high cure rates.

If you wish to perform capsulectomy on a patient, it is important to explain that it is not always possible to remove all of the capsule. Sometimes a portion of the capsule must be left behind or is disintegrated with the use of electrocautery to prevent significant damage to muscle, rib or lung. Explain what size incision is necessary for an en bloc (as many may not be aware of how large an incision may be necessary). If they had an axillary approach or periareolar approach for breast implant placement, it must be explained to them that they cannot have the procedure done through those incisions. It is recommended to reinforce that there are increased surgical risks associated with en bloc capsulectomy which requires a complete dissection of all the tissues surrounding the breast implant and, that we do not have enough collective data to guarantee any improvement in their symptoms they have labelled Breast Implant Illness (BII).

Patients should however be informed of the risks that can be associated with breast implants, including (but not limited to) BIA-ALCL, a rare spectrum of disorders that can range from a benign accumulation of fluids around the breast (seroma) to an extremely rare lymphoma. They should know that BIA-ALCL is not a cancer of the breast tissue itself and that when caught early, it is readily curable. If the disease is advanced, chemotherapy or radiation may be required.

There have been 17 confirmed deaths globally, (9 in the United States), attributed to BIA-ALCL since the disease was first reported nearly 20 years ago.

The first symptom of BIA-ALCL is usually a swelling of the breast between 2 to 28 years after the insertion of breast implants, with an average of about 8 years after implantation. The swelling is due to a collection of fluid surrounding the implant. This fluid can cause the breast to enlarge significantly over a period of days or weeks. It can also present as a lump in the breast or armpit, firmness of the breast, or pain. It is usually easily and completely treated if patients see their doctor at the first symptom.

The FDA reports that it is 1:3,817 to 1:30,000 in their latest statement. These risk assessments are changing on an ongoing basis, but this is the most accurate information currently available. 

Based on current data, the risk can be further explained by the texture grade of the implants as follows:

  • Grade 1 (Smooth only) – In global databases, there has not been a confirmed case of smooth only. In the Feb 2019 FDA statement, it was reported that “there have been reports of BIA-ALCL in patients with smooth-surfaced implants and many reports do not include the surface texture of the implant at the time of diagnosis.” At the time of this publication it is known that a single case of smooth only BIA-ALCL was originally reported to the FDA; however, it was later determined that this was not accurate and the case was a mixed implant case, and the report to the FDA was amended.
  • Grade 2 (e.g. Microtexture, Siltex and similar) – 1:82,000
  • Grade 3 (e.g. Macrotexture, Biocell and similar) – 1:3,200
  • Grade 4 (e.g. Polyurethane) – 1:2,800*

*Based on data form an Australian study – however this was 100% Silimed PU implants that had a manufacturing defect and have since been taken off the market.

Loch-Wilkinson, A., et al. (2017). «Breast Implant-Associated Anaplastic Large Cell Lymphoma in Australia and New Zealand: High-Surface-Area Textured Implants Are Associated with Increased Risk.» Plast Reconstr Surg 140(4): 645-654

That answer is not known and is a very important piece of information for patients and plastic surgeons. Most of the time patients see their plastic surgeon right away when they develop significant swelling of the breast. In these cases, the disease is almost always caught early and cured with a straightforward operation. Some women with advanced disease ignored earlier symptoms or saw a doctor who did not properly diagnose them. There are a few patients who presented with advanced disease who said that they never had earlier symptoms. 

Although it is rare, BIA-ALCL appears to currently develop exclusively in women with textured implants. To date there has not been a case of BIA-ALCL in a patient with only smooth implants. There are several theories which attempt to explain the higher rate for textured implant patients: many believe that the increased surface area of textured implants allows a higher number of bacteria around the implant, which forms a biofilm in some patients, and can result in chronic inflammation, ultimately leading to a proliferation of lymphocytes. Less accepted theories are that textured implants create greater inflammation because of chronic mechanical irritation, and another postulates that microscopic shedding of silicone from the textured wall induces inflammation.

Of the 457 unique cases of BIA-ALCL (FDA 2-2019) implants are both silicone and saline.  It appears to purely be related to the surface of the implant and not to what the implant is filled with.

ASAPS and ASERF emphasize that the most important issue for women with breast implants is to screen for breast cancer with self-exam, a regular physician exam, and mammography/ultrasound/MRI as recommended by their physician. Regardless of BIA-ALCL, all women should see their plastic surgeon immediately if they note a change to the size, feel, or shape of their breasts.   

Patients considering textured breast implants should discuss this issue with their plastic surgeon. Since our knowledge of this condition is continuing to evolve, thanks in large part to ASERF-sponsored research, patients should check surgery.org and the FDA website for any updates.

The choice of implant type is ultimately a decision between an educated patient and her board-certified plastic surgeon.  There may be certain circumstances where a textured implant is recommended for particular patients. 

All patients should have a detailed conversation with their surgeon about the risks associated with textured implants, beyond what is published online or in pamphlets. Ultimately, there are instances where textured implants are the best choice for them. 

If a woman develops swelling in an augmented breast, she should undergo an ultrasound scan. If fluid is detected, it should be drained and tested for:

  1. Cytology
  2. CD30

CD30 immunohistochemistry is not diagnostic for BIA-ALCL; however, it is a marker for activated T-Cells. If a patient’s seroma is CD30 positive, and the cytology is negative, this likely represents a precursor to BIA-ALCL, and should be treated with total capsulectomy.   If the seroma test is CD30 negative with negative cytology, then it should be treated as a benign seroma using the individual surgeon’s protocol.  

The majority of seromas seen clinically are benign seromas and not BIA-ALCL. 

Management of all seromas should be by a board-certified plastic surgeon. Mammograms are not useful in diagnosing BIA-ALCL. In confirmed cases PET or MRI/CT scans may be used to help stage the disease.

If a patient wants to have their textured implants removed and replaced, the options are: 

  • Exchange to smooth implants
  • Exchange to smooth implants with a capsulectomy

Current recommendations for the treatment of BIA-ALCL call for bilateral capsulectomy (removing all the scar tissue) and removal of the old breast implants. This is a very common procedure performed by plastic surgeons, identical to what is done when an implant has ruptured or capsular contracture has developed. Smooth implants can be put back in or the patient can choose not to have implants. In all early stage cases, the disease has been fully resolved by this surgery alone. The majority of patients require no additional treatment.   However, if the disease has spread to lymph nodes or grown into the adjacent tissues, chemotherapy and radiation may be necessary. These are very serious treatments with significant side effects.

The rates of BIA-ALCL seem to have different rates throughout the world. This may be due to different reporting and registries, but there is likely to be a genetic predisposition that is not yet fully understood. For instance, as of this time there are very few cases in Asian patients. The risk is only with textured implants and not smooth implants; the rate is no different between silicone and saline; it occurs in both cosmetic and reconstructive patients. There is no test to determine whether one textured implant patient is at any more risk of developing this disorder than any other patients.

For textured implant patients, neither the FDA nor any plastic surgery society currently recommends that women should preventatively remove textured breast implants to prevent BIA-ALCL. However, there are women who have been concerned enough about BIA-ALCL and have chosen to have their implants removed. There are some women who were already considering a breast implant revision, and the BIA-ALCL issue gave them one more reason to decide to proceed.

Breast implant patients should have ongoing follow up. Current FDA recommendations and ASAPS recommendations indicate that patients with textured implants with no issues should not do anything and implant removal is not recommended.

There is no blood test to specifically screen for BIA-ALCL. The expert opinion is that asymptomatic women without breast changes do not require more than routine mammograms and breast exams. But if a patient experiences a change in her breasts – especially if there is swelling or a lump – she should undergo immediate examination, imaging, and consultation with a plastic surgeon. If there is fluid around the implant the fluid should be aspirated under ultrasound guidance and sent for analysis.

ASAPS, ASERF, the FDA, and the implant manufacturers are intensely studying BIA-ALCL. To date, no specific causal factors have been identified.  Implant texturing, bacteriologic contamination, and genetic factors have been implicated and are undergoing further study. 

 The best theory today is that a combination of four factors are required for the development of BIA-ALCL:

  1. Textured implants (surface area to  sequester bacteria)
  2. Chronic bacterial-inflammation
  3. Genetic predisposition
  4. Time

The source of the chronic inflammation is thought to be bacteria that have been identified around the implants in affected breasts.  Evidence is accumulating that a long-term inflammatory response to the presence of these bacteria is one of the factors that may cause BIA-ALCL. Research is ongoing and cases are being monitored.

Genetic factors may play a role.   Some geographic areas have reported very few cases. Ongoing data collection worldwide will help to determine whether or not there are any genetic propensities for this disease.

The available data does not support discontinuance of textured implants. The best practice is always for the physician to discuss with each patient the known risks and potential complications associated with any procedure. It is important for the patient and her doctor to frankly discuss all options available, and the risks involved.

Every plastic surgeon offers patients options regarding breast implants in terms of sizing, shape, and surface. Depending on a particular patient’s needs, a textured implant may be preferable. The plastic surgeon must provide a frank and transparent discussion regarding the benefits and risks of implants, both smooth and textured. The patient must then make an informed decision, based upon her own assessment of her needs and the risks involved.

Every plastic surgeon needs to help each individual patient make her own decision about which implant she prefers in a fully transparent manner. This involves weighing any possible increased risks against the advantages offered by a particular type of implant. It is critical that the patient makes a fully informed decision following a full discussion of the risks and benefits.

Additional information and resources on BIA-ALCL are available online at https://www.surgery.org/media/resources

The Mollenkopf Aesthetic Breast Reconstruction Fund and the BIA-ALCL Patient Assistance Fund can offer financial assistance to patients. Additionally, Sientra offers to cover lab testing for any seromas associated with their implants.  

  • The Mollenkopf Aesthetic Breast Reconstruction Fund: http://www.aserf.org/attachments/223_mollenkopf-grant-request-form.pdf

 

  • The Mollenkopf Aesthetic Breast Reconstruction Fund The Aesthetic Surgery Education and Research Foundation (ASERF) is pleased to announce available funding for breast reconstruction patients. The Mollenkopf Aesthetic Breast Reconstruction Fund provides grants to ASERF/ASAPS member surgeons, to financially assist patients in completing their aesthetic breast reconstruction journeys. These funds are intended to help underinsured or uninsured patients nationwide cover the associated costs with breast reconstruction. The goal of this fund is to provide women with limited financial means the opportunity to achieve the best possible aesthetic breast reconstruction result. In particular, the grant is focused on women who need a final surgery or revisional surgery to complete their aesthetic reconstruction. The goal is for ASERF/ASAPS members to help women feel good about themselves after their reconstruction and aid them in returning “back to me.”

 

  • The BIA-ALCL Patient Assistance Fund: http://www.aserf.org/images/documents/bia-alcl-patient-fund-grant-request-form.pdf

 

  • The American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS), in conjunction with the Aesthetic Surgery Education and Research Foundation (ASERF) and the Plastic Surgery Foundation (PSF), are pleased to announce funding for patients diagnosed with breast implant associated anaplastic large cell lymphoma (BIA-ALCL). These funds are intended to help underinsured or uninsured patients who are seeking surgical treatment of BIA-ALCL, total capsulectomy and explantation, and excision of associated mass with biopsy of suspicious node(s) and implant-based reconstruction, if indicated. The goal of this Fund is for ASAPS, ASPS, ASERF, and PSF members to help patients obtain treatment when insurance limitations would have otherwise restricted their ability to do so. The Fund is made possible by generous contributions from Allergan, Mentor Worldwide, LLC and Sientra, Inc.

 

  • Sientra : http://sientra.com/Content/pdfs/LGL-0006%20R2-Sientra%20Warranty%20Terms%20and%20Conditions.pdf

 

The Sientra Platinum20™ Product Replacement and Limited Warranty Program for Sientra Opus™ Silicone Gel Breast Implants (Smooth and Textured Surface) offers assistance with patients presenting with late-forming seromas.

ASERF is currently funding two BIA-ALCL studies on the Pathogenesis of BIA-ALCL and Genomic Profiling to Understand the Pathogenesis of BIA-ALCL.

ASERF is sponsoring leading, cutting edge research on BIA-ALCL to better define the disease and improve diagnosis and outcome. More information can be found on the ASERF website:  www.aserf.org

If you haven’t donated to ASERF, here’s the link:  http://www.aserf.org/donor-benefits/make-a-difference

The American Society for Aesthetic Plastic Surgery

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