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.
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)