Once again we have had a great deal of media publicity about textured implants causing cancer. Some Journalists even stated that “cheap” breast implants were associated with cancer. As a result of this publicity, plastic surgeons have recently been inundated with calls from worried patients. One call that we received was from a young woman who had travelled to Thailand for a breast augmentation operation a few years ago. She was absolutely distraught as she discovered that her implants were 400 cc Mentor textured breast implants. She now has a small child and she would love to have her implants removed but she was concerned that she couldn’t afford the cost.
So what are the facts?
Breast implants come in various sizes, shapes and styles. One variation is in the surface of the implant. Originally, all breast implants were manufactured with a smooth-walled silicone surface. In the early 1990’s manufacturers began experimenting with the surface of the implant by introducing “textured” breast implants. Rather than being smooth-walled, these implants had a rough or textured surface. These implants were supposed to reduce the incidence of capsule contracture by integrating with the tissues and limiting the scar response to the breast implant.
At the time, it was known that capsule contracture mainly occurred around breast implants that were inserted on top of the pectoral muscle. In fact one study showed that the incidence of capsule contracture for implants placed in front of the muscle was 60% compared to less than 5% for implants placed behind the muscle. This study referred to the use of smooth-walled implants.
So textured implants were really only developed for use in front of the muscle. Placing a textured implant behind the muscle would not offer any advantage in terms of reduction of capsule contracture. Nevertheless, many surgeons felt that the textured surface represented an “advancement” in the design of breast implants and started using them both in front of behind the muscle.
In recent years it has become known that textured implants can induce a certain form of cancer in the capsule surrounding the implant. This cancer is known as Anaplastic Large Cell Lymphoma (ALCL). Originally the risk was stated as 1 in a million. Then, a year later, the risk increased to one in a hundred thousand and the following year to about one in three thousand. As a result of this risk, most surgeons have stopped using textured surface implants although some continue to use them as they consider the risk of ALCL to be low in comparison to the risk of breast cancer which is about one in eight.
In Australia we have had 55 cases of ALCL and 2 of these patients have unfortunately died. The disease usually presents at least 7 or 8 years after the implants have been inserted. It starts as a swelling around the breast when it can be diagnosed by the aspiration of some of the fluid which will show malignant cells. The disease is then treated by removal of the implant and the entire surrounding capsule. Some patients also require chemotherapy and/or radiotherapy.
The disease seems to be confined mainly to patients who have had implants with a “macro” texture rather than implants with a “micro” texture. The 2 main companies that have been implicated in the production of these macro textured implants are Allergan and Silimed. Mentor breast implants have a micro texture and the risk of ALCL developing in patients with these implants appears to be significantly less than those with the Allergan or Silimed implants.
At Avenue Plastic Surgery we have never used Allergan or Silimed breast implants. Almost all our implants have been smooth-walled and on the very rare occasions where the patient specifically requested a textured implant, then a Mentor micro textured implant was used.
So what should you do if you have had breast implants inserted? The first priority is to find out exactly which implant you have. If it has a macro texture (manufactured by Allergan or Silimed) then you can have some reassurance in the fact that ALCL does not usually develop before 7 or 8 years. As patients are commonly advised that breast implants are not lifetime devices and will require change, if your implants are several years old then you may decide to have them removed with or without replacement with either a smooth-walled implant or by the newer method of fat grafting.
At Avenue Plastic Surgery we have always placed patients’ safety as our priority. Over the years we have inserted more than 5000 smooth-walled saline filled implants behind the muscle with excellent results. As these implants are filled with salt water they do not require checking or replacement unless they deflate. Implant deflation has been an extremely rare event in the 25 years that we have been using these implants. Over the last 4 years, in an effort to improve results even further, we have developed breast augmentation by fat grafting. This is called “autologous fat transfer” and involves harvesting fat from the hips, thighs, abdomen etc. and then, after preparation, grafting the fat into the breasts. We are currently achieving excellent results with this technique as it produces breasts which are completely natural without the need for implants.
Many women are electing to have their old breast implants removed and replaced with their own fat. We predict that this will become the standard method of breast augmentation as other surgeons adopt this procedure in the years to come.