There are now 150 reports worldwide of ALCL – Anaplastic Large Cell Lymphoma caused by breast implants. The number of cases found has been increasing as doctors are more aware of this condition. It mainly occurs in women with textured implants and presents as a seroma or fluid collection, around the implant. When the fluid is aspirated and sent for cytological examination cancer cells are found within the fluid. Although the cancer is often confined to the capsule which surrounds the breast implant, there have been cases where the cancer has spread to other parts of the body.
The incidence of this cancer is currently estimated at 1 in 20,000 but it may become greater as more cases are discovered. The mechanism is unknown but it is possible that the textured surface of the breast implant, acting like sandpaper, irritates the tissues around the implant causing a chronic inflammation which ultimately progresses to this type of cancer.
So, if you are considering having breast augmentation using implants then you should think seriously about whether you would prefer your implants to have a smooth wall or be textured. Remember that texturing was introduced in about 1991 to reduce the risk of capsule contracture – a firm fibrous capsule forming around the implant and making the breast feel hard. We now know, however, that capsule contracture is caused by bacterial contamination with staphylococcus epidermidis. This causes a biofilm which progresses into a firm capsule. At Avenue Plastic Surgery in Melbourne Australia we have found that by avoiding contamination of the implant during insertion and by providing patients with antibiotics for 2 weeks following surgery, we are able to avoid the problem of capsule contracture. Because of this we prefer to recommend that patients considering breast augmentation with implants have smooth-walled rather than textured implants. In addition, inserting the implants under the pectoral muscle is also associated with a much lower rate of capsule contracture. If one knows that breast implants inserted in front of the muscle can interfere with subsequent mammography whereas implants behind the muscle can actually enhance mammographic examination of the breasts, then the decision is clear. Breast implants should almost always be placed behind the pectoral muscle.