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The Link Between Breast Implants and Cancer

A recent analysis of medical device reports submitted to the FDA has associated a rare cancer, Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), with textured breast implants and tissue expanders. One of the largest manufacturers of breast implants, Allergan®, is recalling its BIOCELL® textured breast implants and tissue expanders following a request from the FDA. The FDA is currently not recommending removal of these devices in patients without symptoms. Textured breast implants are typically used in teardrop-shaped implants. Although textured implants can be used with round breast implants, and is used as such frequently in Europe, it is rather uncommon in the United States.

The symptoms for BIA-ALCL are typically swelling or enlargement of a breast anytime 2-28 years post surgery. The breast can enlarge significantly over a period of days to weeks. Other symptoms for BIA-ALCL can include a lump in the breast or armpit, firmness of the breast, or pain. The risk of developing BIA-ALCL is extremely low, somewhere between 1 in 3,200 women to 1 in 30,000 women with textured implants. There have been only 573 confirmed cases of BIA-ALCL globally, and of these, 481 have been attributed to Allergan textured implants. There have been no reported cases of BIA-ALCL in patients with smooth breast implants. In the 20 years since BIA-ALCL was first described, only 33 deaths worldwide have been attributed to it. Patients with sudden enlargement of their breast should see their plastic surgeon. Early diagnosis of BIA-ALCL is associated with a very high cure rate. The treatment in these patients with early diagnosis is a capsulectomy, a simple operation that is the same procedure used in patients with broken implants or significant capsular contracture. Patients with advanced disease may require a combination of surgery, radiation and/or chemotherapy

Currently there is no recommendation from the FDA to preventatively remove textured implants to prevent BIA-ALCL because of the extremely low risk of developing BIA-ALCL. However, for those women who do not have symptoms but who are overly concerned about their textured implants, there are a number of revision breast surgery options available. (1) The textured implants can simply be removed, (2) the textured implants can be removed and a capsulectomy can be performed, (3) the textured implants can be exchanged for smooth implants, or (4) the textured implants can be exchanged for smooth implants and a capsulectomy can be performed.

All women with textured implants should talk with their plastic surgeon to discuss their risk and to understand the options that are available to them.

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