We know textured implants are linked to a rare cancer called ALCL. But I have never seen any other associations with anything bad, and textured implants can be great for women who have thin skin flaps, as the texturing helps keep the implant from stretching out the skin and migrating.
So when I saw this catchy title in my doctor journal news feed, I thought I should look into it. The paper was in October 2020 JAMA (Journal of American Medical Association- not my usual journal to read, but a highly respected journal).
Study: 650 women who had total mastectomy with breast reconstruction. Study out of S. Korea.
Findings:
- Statistically significant association between textured implants and
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- increased distant breast cancer recurrence
- decreased disease free survival
- This association was independent of tumor stage, estrogen receptor status
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- “we believe this study raises an urgent need for further well designed investigations which either may refute the findings of this study with more solid evidence and reassure patients or may produce similar results and lead to increased caution in breast cancer surveillance.”
- In the commentary, American surgeons called the preliminary data “alarming and intriguing” and agreed multi institutional analysis needs to be done.
- They said data on adjuvant therapy (were they treated for estrogen positive tumors with anti estrogen therapy? did they get ERBB2 agents if they could?) was not included, so hard to know if breast cancer recurrence was due to lack of systemic therapy.
- They also said they did not differentiate between primary breast cancer and breast cancer recurrence (a recurrence would likely have a higher likelihood of spreading or recurring again).
What do I think?
I would love to know the manufacturers of the textured implants, as we know Allergan’s texturing has a higher association with ALCL. For the most part, when I went to my national meetings this year (yay virtual meetings!), at both the Aesthetic Plastic Surgical meeting and the ASPS meeting most breast plastic surgeons are not using any textured implants for breast cancer reconstruction or breast augmentation.
But this all reinforces for me inflammation is bad. Period. We are thinking that is true for the heart. We suspect biofilm and chronic inflammation leads to breast implant capsular contracture. We think chronic low grade inflammation may lead to ALCL. Chronic inflammation may be the root of more evil in the body that we realize.
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