Breast augmentation remains one of the most popular aesthetic surgical procedures. But a recently described form of cancer called breast implant associated ALCL is creating concern.
Through the years, silicone breast implants have been linked to all sorts of conditions, without a shred of evidence. This lead to the FDA banning silicone filled implants in the United States for over a decade. It has since been proven through very long follow-up studies that silicone implants are absolutely, irrefutably SAFE.
There are however recent reports in the media that have made an association between breast implants and a very rare form of cancer.
SO, WHAT IS GOING ON, AND DO YOU NEED TO BE WORRIED?
Well, lets talk facts. The cancer that we are talking about is an exceedingly rare form of primary breast lymphoma called breast implant associated ALCL (anaplastic large cell lymphoma). ALCL is a relatively recently described condition. ALCL was first reported in the late 90s, although it really first came to light only 8 years ago after a Dutch study published an account of a number of cases of women presenting with an unusual condition some years after breast implants had been placed. Between 2008 when that study was published and now, we have seen an increased number of diagnoses, as Plastic Surgeons worldwide have become aware of the condition. To date, there are perhaps 300 known cases worldwide. Just for perspective, remember that there have been more than 10 million breast implants inserted since the first reports of this condition came to light.
Do you need to be worried if you have had a breast augmentation or a breast reconstruction with implants? No.
Do you need to be worried if you are planning to have a cosmetic breast augmentation? Again, No.
We do not know everything about breast implant associated ALCL yet, but we do know two things: it is very rare, and and it is very unlikely to require “typical” cancer treatments.
JUST WHAT IS ALCL, AND WHAT DOES IT LOOK LIKE?
Breast implant associated ALCL is an unusual condition. Just to be clear, ALCL is NOT breast cancer. ALCL is a type of lymphoma (which is a type of haematological or “blood” cancer), and in the vast majority of cases it is a particularly indolent condition (which is to say, almost benign). Breast implant associated ALCL represents (we think) a reaction of your body to two things:
- 1) certain bacteria on the surface of the breast implant in the breast implant capsule;
- 2) and surface texturing of the silicone breast implant.
It would seem that with the stimulus of the above two factors, some cells in the capsule that your body forms around a breast implant can replicate to form a very contained type of lymphoma.
ALCL presents some years after a breast implant has been placed (it seems to pop up 6-8 years after the implants were placed on average). The typical presentation is as a spontaneously enlarging breast (it will typically only affect one breast). This enlargement is due to a collection of fluid around the implant. For any woman who develops such a presentation, the correct course of action is to have the breast imaged by ultrasound, and have some of the fluid drawn off for testing. Provided the pathologist knows what to look for, this fluid can be assessed for the presence of the ALCL cells.
HOW IS ALCL TREATED?
This is the good part. Despite the fact that other types of lymphoma require treatment with chemotherapy or radiotherapy, ALCL typically requires neither.
ALCL is treated by the removal of the breast implant and the capsule. Once this is done, the condition is treated. Completely. Whilst it is important to exclude the spread of the ALCL into lymph nodes elsewhere, the chances of this happening are very slim. I should also say that it is vital that BOTH breasts are treated – by which I mean, the implants and capsules must be removed from both breasts. To be honest, it seems one of the things that bothers women most is the thought of having one implant “in” and one “out” and the lack of symmetry that would result. Treating both breasts isn’t just about symmetry though – the other breast must be treated to exclude the presence of ALCL in that capsule also.
Very rarely, a woman does not present with a collection of fluid, but rather she presents with a mass in the breast or hardening of the implant. This is an alternative presentation of ALCL and it must be acknowledged that this type of presentation is associated with a slightly higher chance of the ALCL having spread elsewhere, and some patients will require chemotherapy for example.
SO WHERE DOES THAT LEAVE US?
If a woman is diagnosed with ALCL, the implants and the capsule are then removed and she is “cured”. But what about putting breast implants back in? No doubt, that is the question on everyone’s mind.
Well, this is an unknown right now.
Some surgeons have gone back a year or two after the ALCL was treated and placed a “smooth” implant rather than a “textured” implant. As far as we know, this has not resulted in any recurrences. But we really cannot be sure that this is a safe move, and I certainly wouldn’t recommend anything of this nature until we have more data. (*UPDATE* we now have additional data on this, and I can add my own personal experience too. The replacement of textured devices with smooth implants either immediately, or alternatively, after 6 months or so, would appear to be completely safe with no documented recurrences)
The best option for a woman unlucky enough to be in this situation, is to consider having the breast re-augmented or reconstructed using her own tissues, much as we might after a mastectomy.
This isn’t anything that should cause panic. When I consent patients who are planning a breast augmentation, I discuss ALCL along with all the other risks associated with the surgery. It is important to remember how rare ALCL is. The risk of developing ALCL is hard to put a number on at this stage.
Just as we tell all women that they should check their own breasts regularly, it is simply a case of being aware of any change in your breasts if you have breast implants and informing your Plastic Surgeon if you have any concerns.