There seems to be a growing concern regarding breast implant safety and some confusion and misinformation around the issues. Currently, there are TWO separate entities in the news. The first, and easiest to clarify, is the problem with breast implants associated anaplastic large cell lymphoma (BIA-ALCL). This is a form of lymphoma (NOT breast cancer) that has been found to grow in the tissue around certain kinds of breast implants with texturing on their outer shell. ALCL is a very rare type of non-Hodgkin Lymphoma that develops when white blood cells, called T-Cells, become abnormal. It is felt that the particular type of texturing on Allergan tissue expanders and implants induces the change in the T-Cells to produce the lymphoma (no other company’s implants in the U.S. have been implicated to this date). Those devices have been removed from the market. The incidence of BIA-ALCL is currently estimated to be between 1:2, 207-1:86, 029 for women with texturized implants. No cases have been confirmed involving only a smooth implants. BIA-ALCL is also not associated with either saline or silicone implants in particular. The filling material of the implant is not the cause, it is the outer texturing.
Common symptoms include breast enlargement, pain, asymmetry, lump in the breast or armpit, rash, hardening of the breast or a large fluid collection around the implant. These symptoms typically develop at least a year after implantation, but more likely 8-10 years out. If these symptoms develop, you need to see your doctor right away. There is no specific test for who is at risk for BIA-ALCL, but if symptoms develop then the diagnosis is made by biopsy of tissue and cytology of fluid from around the implant. MRI scans, ultrasounds and CT scans may be helpful in localizing the issues. When caught early, BIA-ALCL is usually curable.
Once diagnosed, a PET scan should be ordered to evaluate the extent of the disease process and to determine if it has spread. You will also be referred to an oncologist for staging of the disease and planning treatment. If it only involves the tissue around the implant, then removing the implant and the surrounding capsule (scar tissue) is all that is required. Lymph nodes under the arm will also be tested for tumor. In advanced cases, treatment may require chemotherapy or rarely radiation treatment or stem cell transplant. This is only in extreme cases. All of this sounds scary, but remember BIA-ALCL only involves certain texturized implants and the incidence from the FDA is quoted to be 1 per 3,817 patients to as low as 1 in 30,000. Other sources have even quoted it to be as low as 1 in 86,029 for women with texturized devices. This is extremely low, but significant enough that anyone with those implants should at least seek advice from their doctor or plastic surgeon and do participate in surveillance with breast exams and imaging studies as indicated by their doctors.
Stay tuned….we will address Breast Implant Illness in the next blog!