Breast Implants and Cancer; What You Need To Know
BREAST IMPLANTS AND CANCER; WHAT YOU NEED TO KNOW
By Dr. Lane Smith, F.A.A.C.S., F.A.O.H.N.S., F.A.B.F.P.R.S.
For many years it was widely assumed and taught that breast implants did not increase cancer risk. However, this is now known not to be completely accurate. Recently the FDA, in cooperation with breast implant manufacturers and medical societies such as the American Society of Plastic Surgeons, released a statement regarding the risks of a specific type of cancer associated with breast implants. This cancer is called breast implant-associated anaplastic large cell lymphoma, abbreviated by BIA-ALCL. To be clear, this is not a type of breast cancer but a type of lymphoma. Lymphomas are cancers that arise in the lymphocytes, the cells in the body that help fight infection. These cancers can occur when serous fluid or excessive scar tissue, called capsular contracture, forms around breast implants. Luckily, this type of cancer is usually easily treatable by removing the breast implants and the surrounding scar tissue.
While the FDA noted an association between breast implants and cancer, the FDA stopped short of recommending their removal. The benefits of breast augmentation have been proven in many studies. Breasts are strongly associated with femininity, and breast augmentation has been shown to have many positive benefits, including increased self-esteem, increased confidence, lower incidence of depression, and a general improvement in lifestyle and happiness. The patient satisfaction rate after a successful well-performed breast augmentation is well above 90%. Therefore, the benefits generally outweigh the risks in this case, provided a few guidelines are followed.
In 1996, the first reported case of this rare type of lymphoma, Anaplastic Large Cell Lymphoma (ALCL), was found arising in the scar tissue surrounding a breast implant. Over the ensuing years, several of these cases began to be reported. Because these occurrences were rare, it took until approximately 2011 for the medical community to start to notice that there may be an association between breast implants and ALCL. Fortunately, this cancer is uncommon, and as of March 18th, 2019, only 270 cases of BIA-ALCL have occurred in the United States and approximately 688 worldwide. This is relatively rare, as millions of women worldwide have breast implants. In the United States alone, about 300,000 breast implants are placed in women each year for cosmetic reasons, and approximately 100,000 breast implants are placed for reconstructive purposes (e.g., after breast cancer, etc.).
Knowing about breast implants is essential to understand your risk of developing BIA-ALCL. Breast implants have an outer silicone shell and an inner silicone matrix or gel. Some implants are filled with saline (salt water) instead of a silicone gel, but the outer shells are the same. The shell can be “smooth” or “textured.” As the name implies, the outer shell can have a smooth or rough surface. Textured implants are thought to have a lower incidence of capsular contracture and hold their shape slightly better. They are known to have a greater incidence of seroma or fluid build-up around the implant.
Smooth implants tend to feel more natural and ripple less. The implant manufacturers specifically treat the shells to make them rough and textured, and this treatment is postulated to be a possible cause of cancer. I used smooth implants 99% of the time in my practice because I think they look and feel more natural than textured implants. Most, if not all, of the cancers, occurred in women with textured implants. Whether any cancers occurred in women with “smooth” or non-textured implants is debatable. Therefore, women with smooth implants probably do not need to worry about BIA-ALCL, and women with textured implants have a lifetime risk of this cancer occurring which is estimated to be between 1:3800 to 1:30,000.
The presence of textured implants alone is probably not enough to cause BIA-ALCL. Usually, an additional occurrence, such as capsular contracture or fluid around the implant (seroma,) must also be present. All implants form some scar tissue around them. The body does this to “wall off” the foreign body (breast implant) from the surrounding natural tissue. Most of the time, the patient cannot feel or see the effects of this scar tissue. Breast implants can be placed under the breast tissue or the pectoralis muscle, which sits directly below the breast tissue. Approximately 3% to 9% of patients who have breast implants under the pectoralis muscle, called submuscular placement, and up to 24% of patients who have breast implants on top of the pectoralis muscle, called sub-glandular placement, will develop extra scar tissue, which can make the breast implants feel very hard and firm and give them a very round and fake appearance. When this occurs, it is called capsular contracture. Another possible side effect of breast implantation is the accumulation of serous fluid around the implant. This fluid is similar to the fluid one would find in a blister. When this occurs, it is called a seroma.
While there may be exceptions, in almost every case, to get BIA-ALCL, a patient must have a textured implant and the presence of either capsular contracture or a seroma. This is because cancer develops in the scar tissue or the fluid surrounding the implant and not on the implant or the breast or muscle on top of the implant.
What steps should a patient take who has breast implants? First, all women should perform monthly self-breast exams to screen for breast cancer, whether they have breast implants or not. While some studies have not shown this to be helpful, from my experience, I believe it is helpful. If a lump in the breast or armpit area is found, unusual breast tenderness is noted, or if there is a change in the skin texture over the breast or around the nipple or a difference in the shape of the breast itself, the patient should see their physician. While this is controversial, most physicians believe patients should have a screening mammogram at approximately age 40 or, if there is a strong family history of breast cancer, at age 35. A woman with a family history of breast or ovarian cancer at a young age should probably be tested for the BRACA 1 and BRACA 2 genes.
Depending on risk factors, patients should continue to have screening radiography every year or two after age 40 and every two years after age 55. If a woman has a smooth breast implant, this is probably all the necessary screening.
A woman with a textured implant must perform all the screenings listed above and immediately notify their physician if any of the above-listed signs or symptoms occur. They should also watch for a few additional things, such as late-onset capsular contracture, enlargement of the breasts due to fluid (seroma), and any change in the shape of the breasts. I recommend that any woman with a textured implant who develops a capsular contracture or seroma see a plastic surgeon for evaluation. Although the FDA or Plastic Surgery Society has not yet recommended this, I recommend that any patient with textured implants, capsular contracture, or seroma undergo surgery to have the textured implants and scar tissue removed prophylactically. Patients with textured implants and no seroma or capsular contracture probably do fine without surgery or removing their implants as long as they perform their monthly self-breast exam.
In performing over 4500 breast augmentations, which are among the most in the United States, I have seen the positive effects of breast augmentation on a woman’s life. I will continue to perform breast implantation surgery, and I highly recommend it for women who feel self-conscious about their breasts.
In my practice at Smith Plastic Surgery, I rarely used textured breast implants; however, from this moment forward, I have decided to eliminate them from my practice. When “smooth” breast implants have been used, the risk of BIA-ALCL may be non-existent or, at the very least, extremely rare.
In conclusion, it is essential to remember that breast augmentation is a relatively safe surgery with a high satisfaction rate that can positively impact a woman’s quality of life.
Lane F. Smith, M.D.
F.A.A.C.S., F.A.O.H.N.S., F.A.B.F.P.R.S.
Dr. Lane Smith holds 4 Board Certifications in Plastic Surgery and has published numerous scientific presentations over the course of his medical career. Dr. Smith practices in Las Vegas, Nevada
For More Information on Dr. Lane Smith and Smith Plastic Surgery please contact:
Smith Plastic Surgery
7650 West Sahara Avenue
Las Vegas, Nevada 89117