A recent article in the news highlighted a finding that alarmed good deal of the population: individuals that had breast implants. For years now, there has been a link associated between Individuals with breast implants and a very rare form of cancer. However, the correlation has been, and continues to be, poorly understood.
But as the information on this topic grows, it is the duty of those in the plastic surgery community to educate themselves and their patients on this important finding.
To be clear, women (and men) with breast implants are NOT at a higher risk than the general population for developing breast cancer. Nor are all breast implants equally associated with an increased risk of cancer.
Individuals with breast implants are at risk from developing breast implant-associated anaplastic large cell lymphoma, or BIA-ALCL. Again, BIA-ALCL is not breast cancer—it is a type of non-Hodgkin’s lymphoma, which is a cancer of the immune system.
What is one’s risk? Current literature reported various estimates that BIA-ALCL may develop in 1 in between 3,817 to 30,000 women with textured breast implants (Clemens et al, 2017; Loch-Wilkinson et al, 2017; De Boer et al, 2018). The risk in individuals with smooth implants is considerably lower.
In the majority of cases, BIA-ALCL is found in the scar tissue around the implant, or capsule, and fluid near the implant. However, in some cases, it can spread throughout the body. Unfortunately, accurate risk profiles are difficult to determine. This is because it is not entirely clear how many individuals have breast implants worldwide. Or how long they have been in the body.
There simply isn’t enough data yet to precisely stratify one’s risk. The good news is that data is continually being collected and our ability to better risk stratify improves daily. But from what we do know, we can confidently say that the large majority of cases are associated with textured breast implants.
As of September 30, 2018, the FDA had received a total of 457 unique reports of of BIA-ALCL, including the death of nine patients.
Naturally, one must wonder how a breast implant could potentially cause a rare lymphoma. The gut reaction of course, is to blame silicone.. However, the same silicone gel is used in both smooth and textured implants. And yet, smooth implants are not associated with the same risk as its textured cousins.
Indeed, several recent journal articles have considered that the true risk factor exists in the methods used to create the textured surface. And the role of biofilm. Biofilm refers to the body’s response to generate tissue around foreign objects. Textured surfaces likely prompt a more aggressive tissue response than smooth surfaces. And somehow, this tissue response induces lymphoma.
What to do if You Have Breast Implants
For one, recognize that this is a very rare disease and the risk of developing it, particularly if one has smooth breast implants, is exceptionally small. There are presently no recommendations by the FDA, or the ASPS (American Society of Plastic Surgeons) to remove breast implants.
Also note that BIA-ALCL has been identified most frequently in patients undergoing implant revision surgery for late onset, persistent seroma (fluid collection around the implant); or late onset of symptoms such as pain, lumps, swelling, or breast asymmetry. Thus, prophylactic breast implant removal, either textured or smooth, in patients without any of these signs or symptoms is not recommended.
It is always wise to visit your plastic surgeon once a year for breast implant examination. Capsular contracture formation, while not life threatening, is far more prevalent than BIA-ALCL. Early detection of a capsular contracture will often offer patients non-non-surgical options to reduce or eliminate the contracture.
If a significant amount fluid is detected around an implant on physical exam or ultrasound, it makes sense to send the fluid for analysis. Likewise, any new breast mass should also be worked up in patients with or without breast implants.
What Else do I Need to Know?
Both saline and silicone implants may have a textured shell. BIA-ALCL is not associated with a leak of silicone. Ruptured breast implants do not increase one’s risk of cancer. Textured breast implants, while they have a higher association to BIA-ALCL than smooth implants, are still considered very safe medical devices. Textured implants do reduce the risk of capsular contracture and remain the device of choice for many plastic surgeons when performing a revision breast surgery on someone with a prior capsular contracture.
If you have any questions or concerns, it is always a good idea to reach out to your plastic surgeon.
Dr. Tim Neavin is a board-certified plastic surgeon located in Beverly Hills, California.