I dont get it. Weman who had implant removal and diagnosed later with bia alcl, has bia alcl already been there and was misdiagnosed while explant, or actually developed after removal on the retained capsule? And women who had enblock got it too?
BIA-ALCL follows the response to textured implant surface within the capsule. Explant without capsulectomy leaves textured particulate and/or affected capsule behind. Retained capsule means retained risk. Enbloc total capsulectomy offers the most risk reduction. Retained capsule can still be removed in patients who did not initially have total capsulectomy .
Total removal of the capsule should leave little to no chance of developing BIA-ALCL. That said, it is cancer, we still don't know everything about it because it is a relatively new phenomenon, and unfortunately I suppose anything is possible. If BIA-ALCL suspected complete capsule removal (capsulectomy), and removal of any other suspicious looking tissue, is called for.