First let’s get some terminology down (when I read my blog title, even I was like #)*&$#??? There are so many abbreviations it’s like a foreign language.)
TERMS:
BIA : Breast implant associated
ALCL: Anaplastic Large Cell Lymphoma
ASPS: American Society of Plastic Surgeons (*I am a member.)
ASAPS: American Society for Aesthetic Plastic Surgery (*I am a member)
So there is a weird lymphoma which has been found to be associated with breast implants. The numbers are VERY low, but it is real. We as a society have been monitoring the breast implant associated lymphoma cases since 2010. There is a national FDA established registry. There was a summary of what we know which our societies published, so I thought I would share with you. If you have a textured implant, when I do a capsulectomy (removal of the capsule) this is the reason we send the capsule to pathology for examination.
- BIA- ALCL is a rare and treatable type of T cell lymphoma
- It is not a cancer of the breast tissue itself- it is a cancer which forms around breast implants.
- The lag time between implant insertion and diagnosis of the cancer averages 8 years (2 – 28 years is the range)
- NO CASES HAE BEEN ASSOCIATED WITH PATIENTS WITH SMOOTH WALLED IMPLANTS. Only textured implants.
- Why? It is thought the association may be related to the increased surface area of the texturing
- It has happened in saline and silicone implants
- Cosmetic or reconstructive patients
- THE MAJORITY OF PATIENTS PRESENT AS A DELAYED SEROMA.
- Diagnosis is based on ultrasound guided fine needle aspiration of the fluid.
- Not helpful to diagnose: MRI, PET CT, or mammogram
- YOU MUST RESECT THE WHOLE CAPSULE when treating. Otherwise you can get recurrence and significantly lower survival.
- The majority of patients can be cured by bilateral total capsulectomy and implant removal.
- Rare patients have a mass, and are at increased risk of radiotherapy and chemo.
- You need to do bilateral surgery, because a small number of women have had disease found incidentally in the other breast.
I write this blog not to scare you, but to educate you. Most of my patients receive smooth walled implants, which has not been associated with this. It is very very rare. Using the FDA numbers, the risk is .00005%. But if I am doing a breast implant revision, particularly if you have a textured implant, I will always send the capsule to pathology just to check. And if you suddenly get a seroma (a fluid swelling around the breast), it is something which warrants a visit to your plastic surgeon.
Per the FDA report, there have been 100-250 cases reported worldwide. 3 deaths. This is out of 5 -10 million breast augmentations done worldwide. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm239995.htm