Breast Implants – What you need to know

Recently there has been a lot of media coverage around a illness known as BIA- ALCL or Breast Implant Associated Anaplastic Large Cell Lymphoma.
As the name states this illness is associated with implants however it is not the implants themselves that are the cause. The most important things for women who have had, or are considering Breast Augmentation is to do adequate research, be aware of the symptoms and ensure to regularly see their Specialist Plastic Surgeon. 

If you are doing research on this subject we recommend you focus your attention on accredited organisations with accurate information. 
Both the TGA and the Australian Society of Plastic Surgeons are posting up to date, factual information on this topic. 

What Is It?


Breast implant associated lymphoma, which is also known as breast implant associated anaplastic large cell lymphoma (BIA-ALCL), is a rare lymphoma of the immune system. It is not breast cancer, which forms from cells in the breast, but instead a lymphoma that is found in the fluid and scar tissue that forms around a breast implant – it is not caused by the implant but linked to textured implants with scientists believing the textured surface allows for the bacteria to grow.

Will I Get It?

Breast implant associated lymphoma is rare. Between 1 in 1000 and 1 in 10,000 people with breast implants are diagnosed with the condition. Breast implant associated lymphoma can occur after both cosmetic and reconstruction surgery, with 95% of cases occurring between 3 and 14 years after the insertion of an implant. The risk for Australian women of breast cancer (not BIA-ALCL) is about 1:8. These are separate diseases.

What Causes It?


The unifying theory cites four inter-related factors;

  • Textured implants (with a higher risk for high surface area textures)
  • Bacterial contamination at the time of surgery to reach a threshold to cause inflammation
  • Patient genetic predisposition
  • Time for the process to develop

Bacteria have been identified in association with these tumours, similar to the association between gastric lymphoma and Helicobacter pylori.

Experts do not think breast implant associated lymphoma is related to either the contents (saline/silicone) or shape (round/teardrop) of the implant.

Due to one of the main theories of causation being contamination at time of implantation, it is very important to ensure that your surgeon carries out certain steps to combat bacteria growth. One easy way to check whether your surgeon will carry out the necessary steps is to see whether they have made a commitment to the 14 point plan.

Dr Briggs abides by all of these steps and has done since he first began as a surgeon. Many of these steps are apart of basic surgical training as a Specialist Plastic Surgeon. Patients of Dr Briggs can be assured that he has taken every step possible to prevent the risk of contamination during their surgery.

Dr Briggs does not use textured Silmed or Allergan implants that have been featured in the media and linked to ALCL. These implants have also been subject to bans overseas.

Dr Briggs uses microtextured breast implants from Mentor, one of the world’s leading implant manufacturers. Additionally, Mentor micro-textured implants reportedly have the lowest rates of implant-related complications surrounding ALCL.

How Is It Treated?

In most cases, removal of the implants and the scar tissue that forms around the implant is all that is necessary to treat the lymphoma. If the lymphoma has spread to other areas of the body, further treatment is likely to be necessary, such as chemotherapy, radiotherapy or additional surgery. However, nearly all cases will show obvious symptoms before the lymphoma spreads.
The most common presentation is a fluid swelling around the breast implant and in the space between the implant and breast implant capsule. The diagnosis of the tumour is made by examination of the seroma fluid.

How do I Spot the Symptoms?

It is important to know the symptoms of breast implant associated lymphoma. The most common symptom is swelling of a breast caused by fluid build-up, but in some cases it may appear as a lump in the breast or armpit.

As this is a rare disease, changes in your breast are unlikely to be breast implant associated lymphoma. For example, swelling immediately after your breast implant surgery is normal. But you should raise all concerns with your surgeon, including the possibility of breast implant associated lymphoma.

Breast implant associated lymphoma is not detected by a mammogram. If you develop swelling of an implanted breast, your doctor will send you for an ultrasound scan to see if the swelling is due to fluid build-up. If the ultrasound shows that fluid is present, a sample of the fluid will be removed and sent to a laboratory for analysis. This analysis will help identify if the fluid build-up is caused by breast implant associated lymphoma. Most fluid build-ups are not caused by breast implant associated lymphoma.

What if I have no symptoms at all?

Because breast implant associated lymphoma is rare, experts do not recommend removal of implants in a healthy person with no symptoms.

 

Some key facts to note:

  • It is not a breast cancer. Breast cancer is a separate disease that affects 1 in 8 women regardless of if they have breast implants
  • According to the most recent Australian research, this lymphoma is associated exclusively with those patients that have had exposure to textured implants. Textured breast implants have a rough surface that adheres to the tissue surrounding them. Although there have been cases identified in patients with smooth implants by the US Food & Drug Administration no cases have been reported of this nature in Australia.
  • ALCL has been linked to bacterial contamination at the time of surgery
  • It takes an average of 7-10 years after implant insertion before it develops
  • The most common symptoms and presentation has been through swelling of the breast and fluid accumulating around the breast implant between the implant and capsule.
  • Diagnosis is made by examination of the seroma fluid
  • Early stage disease is curative with surgery alone

 

The Good News:

  • Of the estimated 35 million women with textured implants worldwide, the incidence of ALCL has occurred in less than 660 cases.
  • Of the 92 incidences of ALCL within Australia and New Zealand, is has been reported that the vast majority were cured through the removal of the implant and capsule alone
  • Dr Briggs does not use textured Silmed or Allergan implants that have been featured in the media and linked to ALCL. These implants have also been subject to bans overseas.
  • Dr Briggs uses micro-textured breast implants from Mentor, one of the world’s leading implant manufacturers. Additionally, Mentor micro-textured implants reportedly have the lowest rates of implant-related complications surrounding ALCL.
  • Dr Briggs is committed to Macquarie University’s 14 point plan to reduce infection risk and prevent the formation of bacteria and biofilm associated with ALCL.

 

If you have noticed changes in your breasts, particularly swelling or hardening, seek medical advice via your GP or if you are a patient of Dr Briggs, contact our office to book a consultation. Please rest assured that most cases of swelling are not related to ALCL.

Dr Briggs is a member of Australasian Society of Aesthetic Plastic Surgeons (ASAPS) and Australian Society of Plastic Surgeons (ASPS) which have released official statements addressing the facts and nature of ALCL. Their latest media release can be found here.

Further information regarding this issue can be found via the Therapeutic Goods Administration website.