New Concerns about Breasts Implants are Mostly Old Ones

Breast Implant Specialist

Recent concerns about safety issues surrounding breasts implants are primarily trying to reignite issues that pretty much had been resolved in the late 1990s after the 1992, so called, ” Breast Implant Scare”.

What Is ALCL And How Is It Associated With Breast Implants?

However, there i one new concern that has come forward that merits a discussion. This concern is ALCL or anaplastic large cell lymphoma1. This is rare type of non-Hodgkin’s lymphoma that has been associated with breast implant augmentation. This rare type of cancer has primarily been associated with highly textured implants (rough surfaced) which are believed to cause a chronic irritation. In some women, who are genetically susceptible the chronic irritation can occur along with the presence of certain bacteria has recently been implicated. Please be advised that ALCL is a cancer of the immune system, not a type of breast cancer.

These ALCL cases – which I have NEVER seen one after performing over two thousand breast augmentations-. present with an accumulation of fluid around an implant. The diagnoses are made by sending samples of the tissue and fluid for pathological examination. The treatment which is usually curative is removal of the “capsule” around the implant.

According to patient safety guidelines from the American Society of Plastic Surgeons, “the current lifetime risk of BIA-ALCL (BIA, Breast Implant Associated) is estimated to be 1:3817 – 1:30,000 women with textured implants based upon current confirmed cases and textured implant sales data over the past two decades”. Only 16 people worldwide have died from breast implant associated ALCL! As you can compare this number of cases to the total number of augmentations and reconstructions ALCL is EXTREMELY RARE. When caught early, BIA-ALCL is usually curable.

However, this does not mean we can take it lightly however. First of all, highly textured implants are rarely used in augmentation in the US and one manufacturer (Allergan) voluntarily removed them altogether from the European Market.

History and Safety of Breast Implants

For my breast augmentation/implant patients, I personally used smooth implants in over 98% of my cases. I did see a patient that had been reconstructed elsewhere with a textured implant and had recurrent collections of fluid around the implants. The biopsy of the capsule and the fluid submitted were both negative for ALCL. 

Concerns about “Breast Implant Related Disease” encompasses most of the concerns that were investigated in the 1992-1999 period that ultimately resulted in a lift of the ban of using silicone implants by the FDA in 2007. While statistically these concerns were not proven to be associated, many individuals still worried that their implants were causing some of their illnesses or at least the symptoms.

These included Auto-Immune illnesses such as Lupus, Rheumatoid Arthritis, Fibromyalgia, and other chronic maladies of unknown origin. Some that were explanted in the early 90’s got improvement of the symptoms. These improvements were also often correlated with the administration of steroids that are by themselves a treatment for the Autoimmune Diseases. There were, however, cases that improved without the use of steroids but the majority saw little or no improvement with explanation.

We did learn a lot about Implants in this period of research and introspection!

Do Implants Last  Forever?

No! implants have a finite life regardless if they are saline or silicon. On average around 15- 20 years. I have seen some rupture at one two years and some perfect at thirty years.

Why Do Some Breasts Get Hard After Augmentation or Reconstruction?

The body makes a “room” for implants when they are inserted and this is lined with special cells. As long as this “room” or “CAPSULE” is bigger than the implant then the breast feels soft. Sometimes an event (could be inflammation/infection of breasts during breast feeding) can trigger scar tissue to form and tighten around the implant causing a “CAPSULAR CONTRACTURE”.

These can also occur gradually, years after the implant was placed without any known “event”. Studies over the last ten years have implicated bacteria in their cause. Not enough bacteria to cause an infection but enough to irritate the body. The bacteria form a barrier around the implant to protect themselves and this is called a BIOFILM.

Treatment includes removal of this scarred capsule with its BIOFILM and a change to a new implant. We often change the “site” from above the muscle placement to below the muscle or vice versa. Recurrence of the Capsular Contracture is always a possibility and can range from 20-60% depending on the number of times this has occurred. (Note: The treatment of recurrent Contracture is beyond this blog).

I hope this shed some light on current thoughts and concerns about Breast implants/ augmentation. Bottom line over 90% of individuals that have a breast augmentation are glad they had it done.

If you have any questions or are interested in learning more about breast augmentation breast lift and/or breast asymmetry, please contact my office.

1Anaplastic large cell lymphoma (ALCL) is a rare type of non-Hodgkin lymphoma (NHL), and one of the subtypes of T cell lymphoma. ALCL comprises about one percent of all NHLs and approximately 16 percent of all T cell lymphomas. (Source: Lymphoma Research Foundation)

Is Breast Augmentation Painful?

Breast augmentation is neither more nor less painful than other surgical procedures. To learn what you can realistically expect, call Naples plastic surgeon Dr. Peña at (239) 348-7362Breast augmentation is a surgical procedure and, as such, may involve some postoperative discomfort. However, under the careful and experienced hand of Naples plastic surgeon Dr. Manuel Peña, your breast augmentation procedure will be crafted to minimize discomfort while optimizing results.

Dr. Peña offers a range of breast augmentation options – each playing a role in recovery time and comfort. Options including breast implant incision location and the placement of your breast implants can impact comfort, though steps are taken – including prescription medications when necessary – to help ensure you are comfortable and able to relax during the recovery period. While intensity and duration of discomfort can vary, most women are able to discontinue more powerful analgesics within seven to ten days.

Extreme pain is unusual and indicative of a problem. If you are experiencing extreme or prolonged discomfort, it is a good idea to call our Naples, FL plastic surgery office at 239-348-7362 to discuss the issue with Dr. Peña. If a problem such as capsular contracture has occurred, steps can be taken to address the issue and restore comfort.

While it is unrealistic to expect a surgical procedure to be pain-free, modern medicine and advanced techniques helpreduce postoperative breast augmentation discomfort. Once recovery is complete, pain is highly unusual and likely points to an underlying problem. During your initial consultation, Dr. Peña can discuss this in greater detail and address any other breast augmentation questions you may have to ensure you are fully prepared for this procedure.

To schedule your breast augmentation consultation at our Naples, FL office, please contact Peña Plastic Surgery today. We welcome breast augmentation patients from Ft. Myers, Estero, and all surrounding areas of Florida.

So Many Options Available for Breast Augmentation Today

30 years ago when I first started performing breast augmentation the options for implants and incisions were quite limited.  Don't get me wrong, were getting great results with smooth round saline and silicone implants placed through the areola or underneath the breast.  Around that time an implant (the Meme) of thicker silicone and wrapped in a polyurethane was found to decrease capsular contracture right significantly even if placed above the muscle. (We did finally confirm in the 80's that the placement of the implants behind the muscle was causing less capsular contracture (hardening of the breasts)  than above the muscle placement or as it is known more properly subglandular placement.) Unfortunately,  this device was taken off the market in 1991 with concerns that the polyurethane manufacturing left residue on the implant which could be toxic.  However the texture which was used was thought to contribute to the lower capsular contracture right.  Thanks to this early implant the textured implants that are now available in known as the gummy bear or form stable implants were developed.  These implants I believe have a greater place when we're reconstructing breast after cancer ordering complex cases.  There is a place for a textured anatomical implant as a first choice in breast augmentation in somecases.  I believe that I can deliver a great result in breast augmentation in approximately 90% of the cases with a round smooth implants placed behind the muscle.  In some cases of switching the implant from below the muscle to above the muscle I used a space called the sub-fascial where we tried to get the best of both worlds.  In those cases the gummy bear or form stable textured anatomical implants are the best option.  I often use this operation when the patients have an overdeveloped pectoral muscle from their time spent at the gym.  Placement of the implant below the muscle in these cases could result in a hyperactive-appearing breast with every pectoral contraction.  If there is significant breast tissue to start with this is not really a problem.

in the early 90s the trans-axillary or armpit incision was popularized can I became enamored with this approach for approximately 2 years.  At that time the use of the endoscope for proper dissection and hemostasis was not used in plastic surgery sewed the placement of the implants through the armpit was rather imprecise.  A novel but rather crude approach known as the trans-umbilical or bellybutton approach was then popularized in the media.  The incision was made in the bellybutton and the placement was above the muscle and somewhat blind.  Although initially these usually overinflated saline implants look great, in a couple years they usually drop like falling throat as a lot of the ligaments that naturally held the breast in place were disrupted.  The use of the endoscope and plastic surgery briefly brought back the transaxillary or armpit approach.  A steady performed approximately 5 years ago related each incision for contributing to capsular contracture right.  The hiatus was the armpit or transaxillary approach followed by the periareolar or nipple approach and release theinframammary approach.  The current thought was that  either  the sweat glands of the  armpit or  the milk producing glands exiting through the nipple contain bacteria live in them and will jump on the implants as they're passing  the area and while not causing an infection would contaminate the surface enough to irritate the body.  This would lead to the bodies reaction causing a capsular contracture or hardening.  This has caused me to change the majority of my augmentation from the peri  areolar to the inframammary incision.  The trans-umbilical augmentation mammoplasty or TUBA has never really taken off in the plastic surgery field. 

With the information that bacteria on the skin could contribute to implant infections and hardening, the use of a malleable plastic funnel was developed.The Keller insertion funnel is used to deliver the implant into the space created without it touching the skin was developed. The stress on the implant is also reduced minimizing the possibility and probability of an early leak of the device. 

The next great piece of information was that the confirmation of the benefits of using an antibiotic solution to wash the pocket before placement of the implant.  The studies concluded S chance of an infection and the lower capsular contracture rate..

The last great advance in breast augmentation actually is the improved precision in which the correct implant can be chosen for the individual patient.  This is been possible thanks to a remarkable 3-dimensional camera and software system known as the Vectra 3-D system.  With this technology  the individual can see how they would look with any of these devices and any size before stepping into the operating room.  While all this information can be overwhelming, it is also very important for those individuals desiring as close to a perfect outcome as possible!