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Wednesday, March 13 2019

Cancer from breast implants? Important things you need to know about ALCL

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Approximately 5 to 10 million women worldwide have breast implants. Silicone breast implants are also the most studied device by the FDA with years of clinical research and long-term follow up that continues to be done. Based on those studies, there are constant improvements made to the implant options available. Currently, 7th and 8th generation silicone implants are being developed. 

In recent news, attention has been brought to a rare type of lymphoma that has been linked to breast implants. BIA-ALCL (Breast Implant-Associated anaplastic large cell lymphoma) has been a topic of concern for patients, physicians, and implant companies.

Being committed to your care, we feel it is important that we provide our patients with this information.

The seriousness of the existing cases, including nine deaths, should not be discredited. It is important to know that this is rarer than you may think, the risk is estimated to be between 1:3,817 and 1:30,000 for women with breast implants.

If you are thinking about getting breast implants, there are a few things to consider.  If you currently have implants, there are signs and symptoms to look out for.

 

Summary and Quick Facts

The following provides a summary of what is currently known about BIA-ALCL. (Information from American Society of Plastic Surgeons, updated 2.8.2019) 

  • Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon and treatable type of T-cell lymphoma that can develop around breast implants. BIA-ALCL is not a cancer of the breast tissue itself.
  • BIA‐ALCL should continue to be discussed with any patient considering breast implants as part of the informed-consent process.
  • The lag time between current implant insertion to diagnosis of BIA-ALCL has been from .08-27 years, with a mean of 9.2 years.
  • No cases of BIA-ALCL have been reported with patients who have only had smooth implants in case series, case reports, or registries. However, it is not possible to exclude the appearance of BIA-ALCL in association with smooth implants at this time. The FDA reports that they are aware of smooth only cases however they warn that this information is “unverified” and potentially “inaccurate.”
  • The association of BIA‐ALCL and textured implants may be related to the increased surface area of the texturing; however, this has not yet been definitively proven. The variation in surface texturing among manufacturers may mean there are variable risks for the development of BIA-ALCL.
  • The disease has been associated with both silicone and saline implants in aesthetic as well as reconstructive patients.
  • The majority of patients present as a delayed seroma, but also present with symptoms of mass, skin rash, fever and night sweats, and lymphadenopathy. Diagnosis is based on ultrasound‐guided fine needle aspiration of the peri-implant fluid, which is assessed with immunohistochemistry for CD 30-positive large anaplastic T-cell lymphocytes.
  • PET‐CT is performed following a positive diagnosis. Mammograms are not helpful for evaluating lymphoma, but are important for the evaluation of breast cancer.
  • Consideration should be given to a multidisciplinary approach including, when required, an oncological breast surgeon and an oncologist specializing in lymphoma.Incomplete capsular resection has been associated with both recurrence and significantly lower survival.
  • The majority of patients can be cured of their disease by bilateral total capsulectomy and implant removal.
  • Rare patients will present with a mass and have an increased risk of requiring radiotherapy and chemotherapy.
  • Treatment approach should follow international guidelines established by the National Comprehensive Cancer Network (NCCN) for BIA-ALCL, available at nccn.org.
    Current treatment recommendation is for bilateral complete capsulectomy and implant removal, as a small number of women have had contralateral disease found incidentally.

Textured vs smooth implants

Of the known ALCL cases, a majority of those patients had textured breast implants. Smooth shell implants were found to have a lower risk. In addition, most of those textured cases were found to have macro-texturing created by a chemical process called a salt-loss method.

There are still benefits of textured implants to consider. Textured implants have been shown to reduce the instances of capsular contracture, (hard implants)  which is one of the more common complications associated with implants. Texturing also acts as a type of friction that keeps implants from dropping or falling to the sides over time. It is often used in anatomical or tear drop shaped implants to help prevent rotation. Anatomical implants may provide the most natural look and are often used in breast reconstruction as well as cosmetic augmentation.  

Signs and symptoms to watch out for

ALCL is detectable and treatable! If you have breast implants and notice swelling of one or both breasts call your surgeon. This is the most common symptom. 

Other things to look for are breast pain or dimples as well as swelling in the underarm. The lag time between having your implants placed to a diagnosis of BIA-ALCL has been from .08-27 years, with a mean of 9.2 years i.e. a long time. It is always wise to check with your surgeon if you notice any new or sudden changes to your implants, especially if they are older implants. 

If any of these symptoms occur testing for ALCL can be done. Generally, when ALCL is detected, the implants are removed. 

Implant companies such as Mentor, Allergan, and Sientra are beginning to implement coverage for ALCL into their warranty programs. They are also funding research to help us learn more about how to treat and prevent ALCL in the future.

If you are considering breast implants make sure to seek a board-certified plastic surgeon and ask questions about the risks and benefits. If you already have breast implants it is important to continue with regular screenings such as mammograms and MRI’s, as recommended by your plastic surgeon. If you notice any abnormalities in your breast don’t wait to reach out to your physician.

If you have questions about ALCL or breast implants, please call our Scottsdale office at (480) 771-7771.

 

 


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