Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Symptoms, Causes, Diagnosis, and Treatment
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 17, 2026
Quick Answer
BIA-ALCL is a very rare lymphoma that forms in the scar-tissue capsule and fluid surrounding textured breast implants. [4] The most common warning sign is sudden swelling or a change in the size or shape of one breast [4], so contact a provider promptly if this occurs. When confined to the capsule, complete surgical removal often cures it. [5]
What the research says
Complete surgical removal is linked to better survival. In a study of 87 patients with BIA-ALCL, median overall survival after diagnosis was 13 years. Patients who had complete surgical excision (total capsulectomy with implant removal) had better overall survival (P = .022) and event-free survival (P = .014) than patients treated with partial capsulectomy, chemotherapy, or radiation alone. Lymphoma confined by the capsule also had a better outlook than lymphoma that had spread beyond it (Clemens et al., Journal of Clinical Oncology, 2016) [1].
BIA-ALCL is rare, and deaths have occurred only with spread beyond the capsule. A clinical review reported about 529 unique, confirmed cases in 23 countries as of March 2018. Sixteen patients had died, and all of them had disease that extended beyond the capsule. For disease confined to the fluid or capsule, removing the implant with complete capsulectomy was the preferred treatment, with chemotherapy or radiation reserved for advanced stages (St Cyr et al., Plastic Surgery, 2020) [2].
Key takeaways
BIA-ALCL is a rare lymphoma (immune system cancer), not breast cancer. It grows in the fluid and fibrous capsule around a breast implant. [4]
It is associated almost exclusively with textured (rough-surface) implants — the filler material (silicone or saline) does not appear to matter. [4] [5]
Symptoms appear on average about 8 years after implant surgery and include breast swelling, hardening, lumps, and pain. [4]
Complete surgical removal of the implant and surrounding capsule is curative in most cases; radiation and chemotherapy are used when the cancer has spread. [4] [5]
Early detection through monthly self-exams and annual checkups is the single best way to protect your outcome — routine mammograms do not detect this lymphoma. [4]
What Is Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)?
Breast implant-associated anaplastic large cell lymphoma is a rare form of lymphoma that occurs in some people who have had breast implants. Importantly, it is a type of immune system cancer — it is not breast cancer. [4]
This lymphoma develops in the fluid and scar tissue, called the fibrous capsule, that forms around the implant. In more advanced cases, it can spread to lymph nodes near the breast and to other parts of the body, and it can also enter the chest wall underneath the breast. [4]
BIA-ALCL generally grows slowly. Most cases are treated surgically by removing the breast implant and the surrounding capsule, and in rare cases the disease can be fatal. [4]
How Common Is BIA-ALCL?
Very few people with breast implants ever develop BIA-ALCL. As of January 5, 2020, there were 733 known cases and 36 deaths reported worldwide. [4] For the millions of people who have received breast implants, that represents a very small risk.
Which Implant Types Are Associated With BIA-ALCL?
BIA-ALCL affects a very small number of people with textured (rough) breast implants. In the past, the rough surface was chosen to help implants stay in place. Smooth implants are not as commonly associated with the disease, although research is still underway to confirm this. [4]
Notably, the material inside the implant does not appear to play a role. Both silicone-filled and saline-filled implants can be textured or smooth, and BIA-ALCL has occurred in people with both silicone and saline implants. [4]
Implant Feature | Relationship to BIA-ALCL |
Textured (rough) surface | Associated with nearly all known cases |
Smooth surface | Not as commonly associated; research still underway |
Silicone fill | No apparent difference; cases occurred with silicone implants |
Saline fill | No apparent difference; cases occurred with saline implants |
The Recall of Textured Implants
Reports indicate that approximately 85% of BIA-ALCL cases involved a specific line of BIOCELL textured implants made by one manufacturer. [4] [7] Because of this concentration, that manufacturer discontinued the implants and asked surgeons and hospitals to return any remaining stock. [7]
Textured tissue expanders from the same manufacturer were also included in the recall. [7] Tissue expanders are balloon-like devices implanted after a mastectomy [4] that inflate slowly over time to stretch the breast skin and tissue before a permanent implant is placed. Whether tissue expanders increase the risk of BIA-ALCL is not yet clear.
If you have recalled implants, the FDA does not recommend removing them. [4] [7] Instead, experts advise you to:
Be aware of BIA-ALCL symptoms and monitor your breasts for changes. [4]
Talk to a healthcare provider if symptoms develop.
Keep a record of your implants, including the manufacturer, model name, and device identifier (such as a serial or lot number). [4] If you do not have this information, contact your surgeon or the facility where the surgery was performed.
You can also always choose to have your implants removed or exchanged. [4]
What Are the Symptoms of BIA-ALCL?
The most common symptoms involve a change in the size or shape of the breasts — typically one breast becomes larger than the other or looks different in shape. Symptoms can appear as early as one year after implant surgery or many years later; on average, they start about eight years after the implant procedure. [4]
BIA-ALCL Symptoms at a Glance
Symptom | Details |
Breast swelling or enlargement | Often the first and most common sign |
Change in breast size or shape | One breast becomes noticeably larger or differently shaped |
Hardening of the breast | The breast feels firmer or stiffer |
Lumps | May appear in the breast or in the armpit |
Pain | In the breast or armpit |
Redness or skin rash | On or around the breast (rare) |
Noncancerous Conditions That Cause Similar Symptoms
If you experience symptoms that concern you, keep in mind that noncancerous problems are a much more likely cause. [4] These include:
Capsular contracture (scar tissue squeezing the implant)
Implant rupture
Infection
Recent trauma
What Causes BIA-ALCL?
Healthcare providers are not yet sure why some people with textured implants develop BIA-ALCL. One possible cause is a chronic infection around the implant that stimulates the immune system; over time, this stimulation can lead to cancer of the immune cells. [4]
Scientists also believe there may be a genetic component, meaning some people may simply be more susceptible to this type of cancer. [4]
How Is BIA-ALCL Diagnosed?
A healthcare provider will review your medical history, ask about symptoms, and perform a physical examination. If BIA-ALCL is suspected, several diagnostic tests may follow.
Diagnostic Step | What It Involves |
Medical imaging (first line) | An ultrasound looks for fluid accumulation, lumps, and swollen lymph nodes |
MRI | Used if ultrasound results are unclear; provides more detail of the breast and lymph nodes |
Needle biopsy | A fine or hollow-core needle draws fluid or tissue from the breast for lab testing; perforating the implant is a procedural risk |
Laboratory testing | Microscopic examination for cancer cells plus biomarker testing to confirm BIA-ALCL and rule out other cancers |
Biomarkers are molecules associated with diseases. They help providers confirm a BIA-ALCL diagnosis and rule out other cancers and conditions. [4]
How Is BIA-ALCL Treated?
After a diagnosis, you will be referred to a cancer specialist (oncologist) for further evaluation and treatment planning. [2] This may include a PET scan to determine whether the cancer has spread. [4]
The main treatment is breast implant removal. A plastic surgeon removes the implant, the surrounding fibrous capsule, and any masses. If the disease is caught early and the entire capsule can be removed, surgery may be the only treatment you need. [2] [4]
The risk of the cancer returning is higher when the capsule is not completely removed. [1] If that happens, or if the cancer has spread, additional treatments may be needed. Planning considers your overall health, any previous exposure to chemotherapy or radiation, and your treatment goals.
Treatment | What It Involves |
Surgery (main treatment) | Removal of the implant, fibrous capsule, and any masses |
Radiation therapy | An energy beam destroys cancer cells, typically given several days per week for several weeks |
Chemotherapy | Anthracycline-based drugs are standard; adding brentuximab vedotin to standard chemotherapy improves outcomes |
What Follow-Up Care Should You Expect?
If you do not receive radiation or chemotherapy, you may be asked to see your provider routinely — perhaps every three to six months for a couple of years. [4] Visits may include PET/CT scans every six to 12 months to check for recurrence. [4] Follow-up after radiation or chemotherapy depends on your progress, and your provider will monitor you closely.
What Is the Outlook (Prognosis)?
The prognosis for BIA-ALCL improves with early detection, complete surgical removal of the capsule, and consistent follow-up care. For most people, the cancer remains confined to the fibrous capsule, which leads to a better outcome. [1] Only 3% to 5% of patients have cancer that spreads beyond the capsule. [4]
One study of 87 people diagnosed with BIA-ALCL found that 89% were alive five years after treatment. [1]
How Can You Reduce Your Risk?
BIA-ALCL cannot be prevented, but early detection can improve your outcome. Monthly breast self-exams and annual checkups help identify lumps or other changes before they spread. [4] Tell your provider right away if you notice swelling, lumps, breast pain, or changes in breast appearance.
One important point: while routine mammograms are essential for detecting breast cancer, they will not detect this type of lymphoma. [4]
Conclusion
BIA-ALCL is a very rare but serious condition connected almost entirely to textured breast implants. Although the numbers sound alarming, the overall risk remains very small for the millions of people with implants. The most important actions you can take are knowing what kind of implants you have, performing monthly breast self-exams, and contacting a healthcare provider promptly about any breast changes. Because complete surgical removal of the implant and capsule is curative in most cases, early detection makes all the difference.
Frequently Asked Questions (FAQ)
What exactly is breast implant-associated anaplastic large cell lymphoma?
BIA-ALCL is a rare type of lymphoma — a cancer of the immune system — that develops in the fluid and scar tissue (fibrous capsule) that forms around a breast implant. It is not breast cancer.
Is BIA-ALCL breast cancer?
No. It is a lymphoma, meaning it is an immune system cancer. It occurs in the capsule and fluid surrounding an implant rather than in breast tissue itself.
How common is BIA-ALCL?
As of January 2020, there were 733 known cases and 36 deaths reported worldwide — a very small risk relative to the millions of people who have received breast implants.
Which breast implants are linked to BIA-ALCL?
Nearly all cases are linked to textured (rough-surface) implants. Smooth implants are not as commonly associated, and the filler material — silicone or saline — does not appear to affect risk.
Do textured implants have to be removed if they were recalled?
No. The FDA does not recommend prophylactic removal. Instead, people with recalled implants are advised to monitor for symptoms, keep records of their implant details, and see a provider if changes occur. Removal or exchange is always an option.
What are the first symptoms of BIA-ALCL?
The most common early sign is a change in breast size or shape — usually one breast becoming larger or looking different. Breast swelling, hardening, lumps, and pain are also common symptoms.
How soon after implant surgery can BIA-ALCL appear?
Symptoms can begin as early as one year after surgery or many years later. On average, they appear about eight years after the implant procedure.
Can BIA-ALCL symptoms be caused by something other than cancer?
Yes. Noncancerous conditions such as capsular contracture, implant rupture, infection, and recent trauma are much more common causes of similar symptoms.
What causes BIA-ALCL?
The cause is not fully understood. One theory is that a chronic infection around the implant constantly stimulates the immune system, eventually leading to cancer of immune cells. A genetic predisposition may also play a role.
How is BIA-ALCL diagnosed?
Diagnosis begins with a medical history review and physical exam, followed by ultrasound imaging, MRI if needed, a needle biopsy to collect fluid or tissue, and laboratory testing including microscopic examination and biomarker testing.
Can a routine mammogram detect BIA-ALCL?
No. While mammograms are important for detecting breast cancer, they will not detect this type of lymphoma. Ultrasound is typically the first imaging test used.
How is BIA-ALCL treated?
The main treatment is surgery to remove the breast implant, the surrounding capsule, and any masses. If the cancer has spread or the capsule was not fully removed, radiation therapy or chemotherapy may be added.
Is surgery alone enough to cure BIA-ALCL?
In many cases, yes. When the disease is caught early and the entire capsule is removed, surgery is often the only treatment needed. Incomplete capsule removal raises the risk of the cancer returning.
What is the survival rate for BIA-ALCL?
In one study of 87 patients, 89% were alive five years after treatment. Outcomes are best with early detection, complete capsule removal, and consistent follow-up care.
Does the cancer usually spread?
For most patients, the cancer stays confined to the fibrous capsule. Only 3% to 5% of patients have cancer that spreads beyond the capsule.
What follow-up care is needed after treatment?
Patients who had surgery alone may be seen every three to six months for a couple of years, with PET/CT scans every six to 12 months to check for recurrence. Follow-up after radiation or chemotherapy is tailored to individual progress.
Related Reading
Breast MRI: Why It's Done, What to Expect and How It Compares to a Mammogram explains how this imaging test checks breast tissue, implants and known cancer.
Sources
Clemens MW, Medeiros LJ, Butler CE, et al. Complete surgical excision is essential for the management of patients with breast implant-associated anaplastic large-cell lymphoma. J Clin Oncol. 2016;34(2):160-168. PMID 26628470. https://doi.org/10.1200/JCO.2015.63.3412
St Cyr TL, Pockaj BA, Northfelt DW, et al. Breast implant-associated anaplastic large-cell lymphoma: current understanding and recommendations for management. Plast Surg (Oakv). 2020;28(2):117-126. PMID 32596187. https://doi.org/10.1177/2292550320925906
Clemens MW, Jacobsen ED, Horwitz SM. 2019 NCCN consensus guidelines on the diagnosis and treatment of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Aesthet Surg J. 2019;39(Suppl_1):S3-S13. PMID 30715173. https://doi.org/10.1093/asj/sjy331
Cleveland Clinic. Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Cleveland Clinic. Last updated June 28, 2022. https://my.clevelandclinic.org/health/diseases/21078-bia-alcl
American Society of Plastic Surgeons. Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) Disease Summary. American Society of Plastic Surgeons. Accessed October 30, 2026. https://www.plasticsurgery.org/patient-safety/breast-implant-safety/bia-alcl-summary
U.S. Food & Drug Administration. Medical Device Reports of Breast Implant-Associated Anaplastic Large Cell Lymphoma. FDA. Content current as of February 6, 2025. https://www.fda.gov/medical-devices/breast-implants/medical-device-reports-breast-implant-associated-anaplastic-large-cell-lymphoma
U.S. Food & Drug Administration. FDA takes action to protect patients from risk of certain textured breast implants; requests Allergan voluntarily recall certain breast implants and tissue expanders from market. FDA News Release. July 24, 2019. https://www.fda.gov/news-events/press-announcements/fda-takes-action-protect-patients-risk-certain-textured-breast-implants-requests-allergan
Disclaimer
This article is for general informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider for diagnosis, treatment decisions, and personalized guidance regarding breast implants or any health condition.
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