For decades there have been concerns, myths, misconceptions, and truths about the link between breast implants and cancer.
In the 1990s, there was a huge fear of the implant itself and the silicone that was inside of it. People were concerned that it could be leaked into the body’s tissues and would cause autoimmune disorders.
The concerns were so great in fact that in 1995 a large American corporation that manufactured silicone implants called Dow Corning was sued by so many women during this hysteria that it quickly claimed bankruptcy. After these lawsuits, it was discovered that all this panic was unfounded. Silicone implants were not causing autoimmune disorders, silicosis, etc.
Today the association between breast cancer and breast implants is typically in terms of implant usage in breast reconstruction after a mastectomy.
New Discoveries — Breast Implant Associated Anaplastic Large Cell Lymphoma
In the last 10 years, a new type of lymphoma has been discovered. It has been named Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). It is related to the inflammation that is thought to be caused by the texturing on some implant surfaces—there are both smooth and textured implants.
In 2011, the FDA began to study this possible link between breast implants and this new large cell lymphoma. In the beginning, it was nearly impossible to research because there were so few reported cases. Additionally, while BIA-ALCL looked like a lymphoma under the microscope, it did not act like a lymphoma at all.
Fast forward and in total as of February 1, 2017, the FDA has received 359 medical device reports (MDRs) of BIA-ALCL, including nine deaths. Out of this number, only 231 had a recorded implant surface type. Of this 231, 203 (88%) were textured and 28 were smooth surfaced.
Although the body’s reaction to foreign textures is thought to be causing this phenomenon, researchers say that there is still not enough data right now to be 100% sure of the correlation.
Smooth vs. Textured Breast Implants: What is the Difference?
Most women in America have round implants with a smooth surface. These round implant surfaces are sleek like thin plastic. These do not require textures because it doesn’t necessarily matter if they rotate, for the same shape and appearance are maintained.
Largely, implants that are specifically shaped, commonly tear-drop shaped, must be textured to help them maintain their position within the breast. If the implants were to change position, it would have to be manually or surgically fixed. Otherwise, the implant could cause an odd shape, and even discomfort.
The surface of these textured implants is similar to fine sandpaper.
How Common is BIA-ALCL?
This disease is fairly rare. The risk is estimated to be around one in 10,000 women with breast implants who may experience BIA-ALCL. In fact, the rate of implant-related ACLC is so low that some doctors say it is still more important for women wishing to get implants to pick the best augmentation for them, than to simply default and get smooth implants.
The FDA reports that BIA-ALCL has mostly only been identified in patients receiving implant revision operations due to persistent seroma (pockets of clear fluid that can develop after surgery).
Signs of BIA-ALCL and Actions You Should Take
Although there is no need for hysteria or extra imaging studies, it is important for women who have implants to be aware of the signs of the disease.
Signs include rapid swelling of the breast, causing increase in size and tenseness. The breast will swell up to 20, 30, 40% larger over the course of a couple weeks. Usually, this will happen to one breast rather than both. If this occurs, the woman should see a physician immediately to determine if it is in fact BIA-ALCL.
As with any breast cancer surveillance, all women should be practicing at-home breast examinations. Additionally, the FDA does not recommend breast implant removal in women who are not experiencing any symptoms or abnormalities.
How This Rare Cancer is Treated
If a woman does happen to be diagnosed with BIA-ALCL it is fortunately extremely easy to treat, especially if it is found relatively early. Implant-related ALCL is nearly benign and fortunately does not act at all like standard anaplastic large cell lymphoma.
If it is caught early, the implant is removed along with the shell and the cancer is cured. If the swelling is left untreated, it can progress into an entity that is more difficult to treat, but in general, detected early, treated properly, it’s almost a 100% cure rate.
What the Scientific Community is Doing
The first step taken was to create the registry through the American Society of Plastic Surgeons to begin tracking and tabulating data. BIA-ALCL is difficult to study because there is simply not enough of it out there to even get a good chance to look at it under a microscope and do the proper studies for it.
Implant manufacturers are also conducting studies where they examine the implants and test them to see how reactive the shell is to the body. Long-term irritation and inflammation in general are a common cause of cancer so this is a focal point.
Final Thoughts on BIA-ALCL
“I think the important takeaway thoughts for this are, one – it’s out there, so you need to be aware of it. Two, it’s exceedingly rare, so you shouldn’t be scared, or worried, or do rash treatments, such as just remove your implants because of this,” Dr Dorner said.
The important takeaway from what we know currently is that while you need to be aware of this and the rapid swelling signs, but in general the risk is so low that there is not cause for worry or paranoia. Certainly removing implants because of fear of BIA-ALCL would be a rash and unrecommended action.
Continuing to perform your standard breast exams on a monthly basis is the most important tactic as general breast cancer is far and away more common. Surveillance and early detection are key.
Be sure to discuss any questions or concerns you may have with a physician or board-certified plastic surgeon.