What you need to know about breast implants

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There are some nasty surprises associated with implants. If you’re thinking about them, ben_franklinyou need to have a serious conversation with your doctor. If he or she seems unaware of these issues, find another doctor.

A New York Times article today discusses a rare form of cancer that seems to be caused by implants. The problems are particularly linked to implants that have a textured shell or covering. Presumably, the texturing was introduced to help the implant stay in place. The theory now is that the roughness triggers inflammation that can facilitate cancer. The disease originates in scar tissue that builds around the implant.

The cancer is breast implant-associated anaplastic large-cell lymphoma. It’s a cancer of the immune system that is easily treated if detected early, but can (and has been) fatal if not.

The first case of this disease was reported ion 1997. The FDA reports that it has known about this since 2011, but refers to disease as rare. However, the FDA’s reporting system is strictly voluntary, and there is some evidence that a majority of doctors are unfamiliar with this cancer version. One study reports that only 30% of doctors who do implants discuss this risk with their patients.

Right now, the burden of protection from this disease appears to fall on the patient.

The FDA released an advisory statement to doctors on March 21st, 2017, six years after the topic first came up. The American Society of Plastic Surgeons republished the information from the FDA to its members after the FDA statement was released. That’s how new this is.

That’s one reason why it’s likely that there have been misdiagnosed cases, and that the incidence of this disease is under reported.

Another reason for misdiagnosis is that detection of this disease isn’t simple. The Anderson Cancer Center provides this guidance:

Because other diseases and cancers of the breast can cause similar symptoms, implant-associated ALCL is often a difficult diagnosis. Symptoms can vary from person to person.

More common symptoms include:

  • A spontaneous fluid collection in the breast, developing many months or years after receiving a breast implant
  • Redness and swelling of the breast around an implant that is not from an infection

Less common symptoms:

  • Contraction of the scar tissue capsule surrounding the breast implant

If you have one or more of these symptoms, it does not mean you have implant-associated ALCL. However, it is important to discuss any symptoms with your doctor since they may indicate other health problems.

So how many cases are there, really?

There are enough cases that one major cancer center brags about their expertise in this form of cancer:

MD Anderson’s Breast Center cares for more patients with breast implant-associated anaplastic large cell lymphoma (ALCL) than almost any other center in the United States.

There are two other facts buried in the Times article that women — and the people who love them — need to know:

  • Implants often require follow-on surgery. The additional surgery may be more expensive than the original, and may not be covered by insurance even if it is medically necessary. There are law suits pending.
  • The first line of treatment for implant-associated ALCL is REMOVAL OF THE IMPLANT. Based on case studies, that’s something else that some doctors don’t know.

It’s critical to find a competent doctor. Don’t feel bashful about changing doctors if you’re not sure the first one you see has the experience and knowledge you need. Ask questions. It’s your life at stake.

Happy Mother’s Day!


Sources:

  1. Denise Grady, “A Shocking Diagnosis: Breast Implants ‘Gave Me Cancer’,” The New York Times, 14 May 2017.
  2. US Food and Drug Administration, “Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm239995.htm
  3. MD Anderson Cancer Center, “Implant Associated Anaplastic Large Cell Lymphoma.” https://www.mdanderson.org/cancer-types/implant-associated-anaplastic-large-cell-lymphoma.html
  4. Mark Clemons, MD, “Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL),” American Society of Plastic Surgeons. https://www.plasticsurgery.org/for-medical-professionals/quality-and-registries/bia-alcl-by-the-numbers
  5. Garry Brody et. al., “Anaplastic Large Cell Lymphoma (ALCL) Occurring in Women with Breast Implants: Analysis of 173 Cases,” Plastic & Reconstructive Surgery 135(3) · December 2014, DOI: 10.1097/PRS.0000000000001033