Current Breast Topics

BIA ALCL

Breast Implant Associated Anaplastic Large Cell Lymphoma

is a rare but important complication of textured breast implants.

The current incidence is 1/5000 in Australia.

It is more common in macrotextured not microtextured Mentor (1/86,000) implants or macrotextured Polytec (1/160,000).

It tends to develop at 6-7 years and appears as a visible volume change in the breast.

This fluid needs to be specifically tested for ALC – anaplastic large cells.

If it occurs the cure is removal of the implant and capsule with very rare instances of chemotherapy for systemic change needed.

The cause is not known but a theory is chronic inflammation due to infection at the time of the implant being inserted. Hence surgical technique is a very important factor in avoiding this change.

In Australia there is no current restriction on the use of textured implants but patients should be offered the option of smooth implants – with no incidence of this rare change recorded.

Breast MRI

This is the gold standard for breast imaging.

It is not routinely offered but is available to all patients.

The test is rebated for patients with a strong family history of breast cancer risk (=3 or more relatives with breast cancer of any age on one side of the family or two under the age of forty) or gene proven positive for breast cancer, annually til age 50.

Of great concern is the cost of this and quality of the test is hugely variable in Melbourne.

I direct my patients to the centre with proven >98% accuracy and also the lowest out of pocket cost!

DCIS = Ductal Carcinoma In Situ

This is a precancerous change, so not a breast cancer!

That is so important to understand because it is not a risk for spreading around the body like a true cancer is.

However it is the greatest risk for breast cells to make a cancer and treated actively.

It rarely presents as a lump or thickening or with bloody nipple discharge.

It is usually discovered at a mammogram where the cells with DCIS lay down a small dot of calcium and the mammogram sees this. This is called microcalcification and is not due to the intake of calcium and also the breast may lay down many normal blobs of calcium so it is a specific appearance – tiny and uneven in size and shape which needs investigation.

Unfotunately DCIS can also be invisible to mammogram and ultrasound so a breast MRI which looks at blood flow of the cells, and shows how they are behaving will detect it very accurately!

In planning a surgery the more information that is available preoperatively can aid in the best operative choice.  A breast MRI determines the extent of change and can provide great reassurance regarding the other breast.