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Breast Implant Associated Anaplastic Large Cell Lymphoma

Friday, December 23, 2016

An important read for anyone with or considering implants:

On the 19th December 2016 the Therapeutic Goods Association (TGA) provided updated information regarding breast implant associated Anaplastic Large Cell Lymphoma.

At Avenue Plastic Surgery we have previously written extensively about the emerging risk of Anaplastic Large Cell Lymphoma and specifically its association with textured breast implants.

At Avenue Plastic Surgery we have always placed the safety of our patients as our first priority and have thus never recommended the use of textured breast implants. We have always preferred to use smooth-walled breast implants because of their long established safety. Therefore, if you have had breast implants inserted at Avenue Plastic Surgery then you are not at risk and this information does not apply to you.

As more cases of Anaplastic Large Cell Lymphoma are diagnosed and the known risk appears to be increasing (it has increased from 1 in a million to approximately 1 in 5000 in the last 2 years!) the question arises as to what you should do if you currently have textured breast implants.  The advice provided by the Therapeutic Goods Association is that you should discuss the matter with your surgeon – but what is he or she likely to advise?

Everyone having breast implants in recent years has been told that “these are not lifetime devices and it is likely that the implants may require removal or replacement in the future”.  Anaplastic Large Cell Lymphoma is the most serious, but not the only, risk associated with breast implants.  If your implants are silicone gel filled then there is also the risk of leakage with silicone travelling to other parts of the body (especially the lymph nodes in the armpits).  Patients with silicone gel implants have been advised by the FDA in the United States to have an MRI scan 3 years following insertion of the implants and then every 2 years thereafter.  The latest data indicates that by 8 years up to 40% of silicone gel implants show signs of rupture on the MRI examination.

Both the risk of silicone gel implant rupture and the risk of Anaplastic Large Cell Lymphoma increase with the passage of time.  I have seen silicone gel implant rupture as soon as 1 year following implantation.  It appears that Anaplastic Large Cell Lymphoma usually does not develop before 8 years (although it may occur in as little as 5 years) after implant insertion.

The reality is that there are safer methods of breast augmentation.  At Avenue Plastic Surgery we have long preferred the use of smooth-walled saline-filled breast implants.  When expertly performed, it is difficult to tell the difference between these implants and silicone gel implants.  We have inserted over 5000 smooth-walled saline implants over the last 25 years and have had fewer than 10 leakages.  Should a saline implant leak then the salt water is absorbed by the body and no harm is done.  Changing the implant is like changing a tube in a tyre.  The surgeon removes the empty shell and replaces it with another implant which is then inflated with saline solution.  The smooth surface of these implants has not been associated with Anaplastic Large Cell Lymphoma.

So, a woman with textured silicone gel implants who is worried about the risk both of Anaplastic Large Cell Lymphoma and/or silicone gel leakage may elect to have her implants removed and replaced with smooth-walled saline-filled implants.

An even better option may be to remove the implants and to restore breast volume by the use of autologous fat transfer (AFT, otherwise known as Breast Augmentation with Fat Transfer).  AFT refers to using your own fat, harvested from the hips, thighs, abdomen etc.) which is then, after preparation, grafted into the breast tissue.  At Avenue Plastic Surgery we have had extensive experience of autologous fat transfer over the last 3 years and the results are excellent, with high retention rates of the grafted fat.  In fact we can almost always produce at least a 1 cup size breast augmentation by AFT – even in women with body weights below 50 kg.  Of course, for larger women, where more fat is available, a greater increase in breast volume can be obtained.  The main benefit of autologous fat transfer is that the breasts look and feel completely natural, the fat lasts forever and, of course, an implant is avoided.

A third choice for women with textured silicone implants is to simply remove the implants.  A decision would have to be made as to whether or not the capsule surrounding the implants needs to be removed.  This will depend on the nature and thickness of the capsule, whether it is on top of or behind the muscle and how firmly adherent the capsule is to the surrounding tissues.  Sometimes, removal of the capsule can result in significant damage to the breast, the pectoralis major muscle and the underlying chest wall.  Of course the capsule is always biopsied but if there is no evidence of ALCL then no harm is done by leaving an adherent capsule insitu.

We recognise that each women’s requirements and concerns are different and therefore we encourage you to seek a professional consultation with a surgeon well versed and experienced in all the above techniques.

To read more about removal and replacement of breast implants at Avenue Plastic Surgery click here:

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