BIA-ALCL and Textured Implants: What Breast Patients Should Know

BIA-ALCL (breast implant–associated anaplastic large cell lymphoma) is a rare cancer of the immune system that can develop in the scar tissue and fluid around a breast implant. It is not breast cancer, it is not the same as breast implant illness, and it has been linked mainly to implants with a textured surface. It is uncommon, but it's worth understanding before you choose an implant, and it's a reason to know exactly what's in your body.

This guide explains BIA-ALCL in plain language: smooth versus textured surfaces, the 2019 worldwide recall of one textured implant line, the symptoms usually described, how it's evaluated, and the questions to ask a Colombian surgeon. If your main concern is fatigue, joint pain or other whole-body symptoms, read our separate guide on breast implant illness.

What BIA-ALCL is, in plain language

When any implant is placed in the body, the body forms a thin layer of scar tissue around it, called the capsule. In BIA-ALCL, a type of lymphoma develops in that capsule or in fluid that collects between the capsule and the implant. Lymphomas are cancers of the lymphatic and immune system. This particular one is a T-cell lymphoma called anaplastic large cell lymphoma.

Two points often get lost in headlines. First, BIA-ALCL is not breast cancer. It doesn't start in breast ducts or glands. Second, when it's found early and is confined to the capsule and fluid, it is often treated by removing the implant and the entire surrounding capsule. More advanced cases may need additional treatment from an oncology team.

The U.S. Food and Drug Administration (FDA) maintains a dedicated page on BIA-ALCL, updated as new information emerges. If you want current figures on reported cases, that's the source to check, and note the date on the page. We don't repeat numbers here because they change as reporting improves.

How BIA-ALCL differs from breast implant illness

The two are often mentioned together, but they are very different things. BIA-ALCL is a specific, diagnosable cancer with defined tests. Breast implant illness (BII) is a term patients use to describe a range of whole-body symptoms they attribute to their implants. It isn't a formal diagnosis, and research on it is ongoing.

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For more on BII, including what's known about explant surgery, see breast implant illness: what we know.

Smooth vs textured implants

Implants differ in their filling (saline or silicone gel), their shape (round or anatomical, sometimes called teardrop), and their outer shell surface: smooth or textured. Textured surfaces were developed partly to help implants stay in position, which mattered especially for anatomical implants that need to keep their orientation, and with the aim of reducing capsular contracture.

The concern is that BIA-ALCL has been associated mainly with textured implants, and the risk appears to vary with the type of texturing. That's why many surgeons worldwide have shifted toward smooth implants for routine cosmetic augmentation, while some still use certain textured or micro-textured products in particular situations.

Neither choice is risk-free; every implant carries risks such as capsular contracture, rupture and the need for future surgery. The point is to make the surface choice a deliberate, informed decision rather than something you learn about years later.

The 2019 BIOCELL recall

In July 2019, the FDA requested that Allergan recall its BIOCELL textured breast implants and tissue expanders from the U.S. market, based on data linking them to a higher risk of BIA-ALCL than other textured implants. Allergan announced a worldwide recall of these products. Other regulators had already taken action on certain textured implants before then.

At the time, and since, the FDA has said it does not recommend that people without symptoms have their implants removed just because of this risk. Removal surgery has its own risks. Instead, people with implants are advised to know what they have, watch for symptoms and get any changes checked.

Symptoms and how BIA-ALCL is evaluated

The most commonly described sign is a new, persistent swelling or fluid collection around one implant (a late seroma), typically appearing long after the surgery has healed, often years later. Some people notice a lump, pain, a change in breast shape or hardening, or a lump in the armpit. Any of these can also have other causes, but none should be ignored.

Evaluation generally follows a logical sequence. Your doctor will usually begin with imaging such as an ultrasound, and, if there's a fluid collection, sample the fluid with a needle. The fluid is sent to a lab for specific testing, which typically includes checking cells for a marker called CD30 and other studies that distinguish lymphoma from ordinary fluid. Further imaging may be used to check for spread. If BIA-ALCL is confirmed, treatment is planned with specialists and often centers on removing the implant and the entire capsule.

Seroma after the first weeks of surgery is common and usually unrelated; early swelling in recovery is a different question. Our guide to fibrosis, seroma and normal swelling covers that period.

What to ask a Colombian surgeon about your implant

Colombian surgeons use implants from several international manufacturers, and implants sold in Colombia must be registered with INVIMA, the national health products regulator. Ask the following before you agree to a plan, and ask for the answers in writing.

• Which brand and model do you plan to use for me?
• Is the surface smooth, micro-textured or textured? Why do you recommend that surface for my case?
• Is this implant registered with INVIMA, and can I see the registration?
• Will I receive the implant card or stickers with serial and lot numbers after surgery?
• Does the manufacturer offer a warranty or patient registry, and how do I enroll?
• How would you evaluate a late fluid collection if one appeared after I'm home?

For an overview of brands and how they differ, see breast implant brands in Colombia. A surgeon who answers these questions clearly and doesn't brush off the surface question is a good sign.

Keep your implant records for life

Implant records matter long after recovery. If there's ever a recall, a safety notice or a symptom, the first question any doctor will ask is: what implant do you have? Without the card, answering can be difficult, especially if your surgery was in another country.

• Implant card or stickers showing manufacturer, model, size, surface and serial/lot numbers for each side.
• Operative report (in Spanish, plus a translation).
• Your surgeon's contact details and the facility name.
• A photo of everything, saved in cloud storage and shared with someone you trust.

If you ever decide to have implants removed, whether for BIA-ALCL, BII or personal reasons, our guide to breast implant removal and explant surgery explains the options.

Frequently asked questions