Signs that you may have breast implant-associated lymphoma (and what to do)

There are now 102 women affected by breast implant-associated anaplastic large cell lymphoma , also known as AIM-ALCL . The Spanish Agency for Medicines and Medical Devices (AEMPS) reported this week that there are another 35 suspected cases . The figures correspond to the last decade, when monitoring began.

This disease is a rare and aggressive type of T-cell non-Hodgkin lymphoma , belonging to the group of CD30-positive lymphoproliferative disorders. As explained by the Josep Carreras Leukemia Foundation , it accounts for approximately 3% of non-Hodgkin lymphomas in adults and 10% to 20% of lymphomas in children.

For several years now, this has been a matter of concern to healthcare institutions around the world. In fact, a study by the The American Society of Plastic Surgeons , published in September 2024, clarified: “We predict a continued increase in the number of confirmed cases, most likely as a result of increased awareness leading to more frequent screening and a true increase in incidence due to the growth of cosmetic breast augmentation surgery.”

Surgeon Antonio Tejerina describes to this newspaper what a woman who has had rough implants [a type of breast prosthesis with an irregular surface designed to better adhere to the surrounding tissue] for more than ten years should do: “If you notice an increase in their size, you should have an ultrasound . If fluid is seen, a puncture will be necessary to see if there is lymphoma or not. If the ultrasound is not clear, it will be complemented with an MRI .”

He is well-versed in the issues involved, as his field is oncologic and plastic surgery . He works at the Tejerina Foundation and is also a representative of the Spanish Society of Senology and Breast Pathology (SESPM) for the AEMPS ALCL-AIM committee.

During his professional career, he has seen three cases of this type of lymphoma and operated on one. "That's a lot," he says. "When a diagnosis is made, in theory, we professionals should notify the AEMPS (Spanish Medical Association) , and thanks to that , the commission can study it ," he adds.

Similarly, she clarifies that there will be more cases : “Now we know how to diagnose them. Before, a girl with a prosthesis who wasn't comfortable would go to a plastic surgeon, have them changed, and if there was fluid in it, they wouldn't analyze it. We didn't even know this existed .”

Another aspect she highlights is that there are still "no confirmed cases" in women with smooth implants . "It is known that the causative agent of lymphoma is chronic inflammation caused by the roughness of the implants. There is another theory that suggests bacterial growth ," she explains.

However, the aforementioned study asserts that a “comprehensive review” of the available data shows that “there is insufficient substantiated evidence” to support a relationship between bacteria and lymphoma pathogenesis .

Last January, the AEMPS published an update of the protocols for the implantation , monitoring, and removal of breast prostheses, both for breast augmentation and breast reconstruction after mastectomy.

They also included a patient information document designed to provide relevant information in a comprehensible format so they can make a decision with adequate knowledge of the advantages, possibilities, potential drawbacks, and risks of the operation. This is crucial for Dr. Tejerina: "The most important thing is to inform women ; rough implants are still being used in Spain, and the risks must be communicated."

The explantation is doubled

During the Barcelona Breast Meeting (BBM) , a meeting held last March that brought together more than 300 international surgeons, they insisted that breast implant removal has doubled in Spain over the last 8 years.

Specifically, there were 3,647 cases in 2016 and 7,145 in 2023, something attributed to the change in priorities of many women who underwent implants two decades ago, who are now reconsidering their decision due to factors such as quality of life, self-esteem, or aesthetic considerations.