Any surgery is not without risks. Using a medical device like a breast implant is no different. This is the focus of our discussion in a summary of the DiepCJourney podcast, Symptoms, Diagnosis, and Treatment of BIA/ALCL.
Four million women across the globe have undergone breast augmentation using a medical device called a breast implant. This is done for reasons such as cosmesis or enhancement of the breast, trauma to the chest wall or for oncological reasons, meaning for breast cancer and the breast implant is used to replace breast tissue affected by or lost due to these two reasons, breast cancer or chest wall trauma.
Meet A Leading Expert in the Field
I talked to a leading expert in the field about the medical definition of breast implant associated (BIA) anaplastic large cell lymphoma, an uncommon form of ALCL. I interviewed Mark Clemens, MD, MBA, FACS. After receiving his Medical Doctorate from Pennsylvania State College of Medicine, Dr. Clemens completed his Plastic Surgery residency at Georgetown University. In 2010, he came to the University of Texas MD Anderson Cancer Center in Houston, Texas where he completed a fellowship in Microvascular Reconstructive Surgery. Dr. Clemens is an active researcher whose interests include BIA-ALCL, long term implant outcomes, robotic-assisted, microvascular, and reconstructive surgery of the breast.
After I attended an informative session presented by an international group of surgeons, scientists, and researchers at the October 2023 American Society of Plastic Surgeons annual conference I approached Dr. Clemens and requested an interview on the topic. He graciously accepted. Dr. Clemens speaks frequently on this topic internationally to several organizations, so I am humbled and honored he joined me to inform our followers.
A TimeLine and Organizations Working to Educate
BIA/ALCL first emerged in the medical literature with a single case report in 1996. This was followed by a formal case report by Dr. Creech in 1997. However, it really wasn’t until about 2011 with an FDA safety communication that BIA/ALCL entered a broader public consciousness. Dr. Clemens encountered his first case in 2012 at a time when the disease was still very much shrouded in uncertainty. Now we know that it is caused by textured surfaced breast implants introduced in the market in 1987. Since the disease takes about a decade to develop we start to see that the timeline of the initial cases really aligns with our understanding of the disease latency.
I ask Dr. Clemens to share organizations who are working to educate about BIA/ALCL. These are organizations I am familiar with in my work as a patient advocate. He makes an important statement.
You raise a really good point. The fight against ALCL is not solitary.
Mark Clemens, MD, MBA, FACS
Dr. Clemens continues by saying it is a concerted effort by many esteemed organizations. He names a few:
- The National Institutes of Health Lymphoma Division under Elaine Jaffee
- NCCN: National Comprehensive Cancer Network under the leadership of Steven M.Horwitz, MD of Memorial Sloan Kettering Cancer Center.
- American Society of Plastic Surgeons Profile Registry Tracking data on national and global cases of ALCL.
- MD Anderson Cancer Center: BIA/ALCL website
I reference the panel at Plastic Surgery the Meeting of international scientists, researchers and surgeons who presented on the topic under the direction of panel moderator, Dr. Clemens, in October of 2023. This was the impetus for me walking up to the stage after the presentation to reach out to Dr. Clemens requesting this podcast. I am grateful.
When Should Patients be Informed About BIA/ALCL?
Dr. Clemens strongly believes that the possibility of this disease should be an essential part of the conversation from the very first breast implant consultation. It is also vital that it comes up during surveillance and follow-up when patients are coming back, particularly if they are not aware of it. The FDA recommends either an MRI or an ultrasound evaluation after five years from receiving a breast implant and every three years thereafter.
He shares “I probably don’t need to tell you it is unfortunately adherence to that recommended protocol that is really less than ideal and a concern we need to address through education to improve patient outcomes to know how they are doing after they receive a breast implant.” These FDA recommendations are in all the manufacturers package inserts. They are in the informed consents that patients sign when they receive a breast implant. The adherence to these guidelines and return of breast cancer patients receiving implants is much higher than those receiving cosmetic augmentation. Beyond this disease he shares with us it is important that women do follow up with their physician not just when something does not seem right but also as part of good breast health.
Symptoms and Treatment of BIA/ALCL
It is not just enough to know about this disease. You really need to know what to look for. So, if you have implants look for the following:
- Any new asymmetry.
- Unusual swelling.
- Sensation of a lump should prompt an immediate consultation.
These proactive steps can lead to early detection and treatment not just of a problem with the implant or ALCL but also breast cancer. I asked Dr. Clemens about the treatment. He tells us the majority of BIA/ALCL patients respond very well to surgical removal of the implant and the surrounding capsule. This is often referred to as an en bloc resection on social media. About one in eight patients may need additional treatment such as chemotherapy or radiation therapy. He tells us even for those in advanced disease the prognosis is generally very positive. There are also cases of delayed treatment with poor outcomes.
Having awareness of the disease, knowing the symptoms to look for, and knowing what to do, the action component, as Dr. Clemens refers to it as, is our call to action.
You will never find what you are not looking for. You need to have that awareness.
Mark Clemens, MD
Dispel Fear of the Choice for Breast Implants
Dr. Clemens and I have a combined passion for the shared decision-making model in plastic surgery and breast reconstruction consultations. What surgical option women chose to reconstruct their breasts is a very personal choice. I ask Dr. Clemens what we can do to dispel the fear of choosing breast implants for reconstruction.
He shares with me we have to be open about what are the possibilities and that it (BIA/ALCL) can occur. Supplying pertinent information is key. If we are informed but do not frighten women interested in implants this is how we can let women know what can happen without making them fearful of the choice of a breast implant. A vast majority of patients have a good experience with high patient satisfaction. What we are talking about are uncommon complications but ones they should be aware of.
Dr. Clemens feels it is through knowledge as well as another aspect that could be participation in a breast implant registry that will help. Then, as a community everybody is contributing to their experience, and we can all learn from that collective journey. Education is empowerment.
A Bonus as We Wrap Up
Dr. Clemens shares information about his book, Phoenix Rising: Empower and Transform Through Breast Reconstruction. Any sold support breast cancer and breast reconstruction research. He shares a quote from the last sentence of the first chapter in the book:
The journey of the Phoenix is one of surrender and rebirth, teaching us to let go of what no longer serves us and embrace the transformation that awaits.
Phoenix Rising: Empower & Transform Through Breast Reconstruction