BACKGROUND: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an emerging cancer that has been linked to the use of textured devices. Recent increase in number and frequency of cases has led to worldwide regulatory action. OBJECTIVE: We aimed to longitudinally study the disease in Australia since the index case was first reported in 2007. METHODS: Confirmed historical cases were collected and then prospectively analyzed from October 2015 to May 2019. Clinical and implant exposure data was determined and compared with company sales data for four devices to generate implant-specific risk. RESULTS: A total of 104 cases of BIA-ALCL were diagnosed in Australia with exposure to 149 unique breast implants. The mean age of patients was 48.2 years (range, 22.4-78.5 years). They had an average time from implantation to diagnosis of 6.8 years. 51.7% of implants utilized in this cohort were Allergan Biocell devices. The indication for implant usage was for primary cosmetic augmentation in 70%, post breast cancer reconstruction in 23% and following weight loss/pregnancy in 7%. The majority of women presented with early (stage 1) disease (87.5%). The risk for developing BIA-ALCL ranged from 1 in 1947 sales (95% CI 1199-3406) for Silimed Polyurethane devices to 1 in 36730 (95% CI 12568-178107) for Siltex imprinted textured devices. CONCLUSIONS: Implants with higher surface area/texture seem to be more associated with BIA-ALCL in Australia. Recent regulatory action to suspend, cancel, or recall some of these higher risk devices is supported by these findings.