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Breast Implants and Cancer Risk

Breast Implants and Cancer Risk

Breast implants are employed to make a positive change in someone's life. Still, medicine wants to ensure they don't cause more harm than good to certain individuals. In recent years, some types of implants have been identified with an exceedingly rare lymphoma that goes by the name of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). This post will go into detail about the presentation of the condition and risk assessment, as well as other ways in which implants can be a challenge. Read on.

Do Breast Implants Increase Cancer Risk?

There is no evidence to point out breast implants raise the risk of developing cancer anywhere in the body, including the breasts. However, some breast augmentation patients get anaplastic large-cell lymphoma (ALCL), a rare form of cancer that is specific to these medical devices.

It's not breast cancer but rather a type of cancer that forms in the surrounding scar tissue. Being a non-Hodgkin's lymphoma, it affects 0.25 per 100,000 people.

Since it has some connection with implants, it's also labelled breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). What's different is that it's contained in the tissue around the implant and does not typically spread. Thus, if the surrounding scar capsule/scar tissue is removed, the cancer cells will be eliminated too. Very rarely, the cancerous tissue could spread to adjacent regions such as the lymph nodes.

Although BIA-ALCL should be taken seriously, it has to be mentioned there is a very low risk of it affecting individuals with breast implants.

Breast Implants

What are the Safest Breast Implants?

Many women consider saline-filled implants a safer option because of the saltwater filling. Saline-filled breast implant rupture and deflation are easily noticed and can be taken care of in due time. Plus, if there's a rupture, the saline fluid will be absorbed and eliminated by the body's waste system.

By contrast, a silicone gel-filled implant rupture is not always detected as soon as it occurs. It takes time for the shape of the implant to get visibly warped, so it calls the attention of the person involved.

Cancer and material-wise, it doesn't matter whether silicone gel or saline solution is used. There are rare instances of lymphoma with both types of implants.

What is the Safest Breast Implant Surface?

Smooth-surfaced implants are far less likely to cause the disease than textured surface ones. The reason is that textured implants are rough to the touch to prevent slippage. However, this appears to trigger a particular response from the immune system. Thus, there is an increased risk of BIA-ALCL. In fact, it has been estimated that between 93% and 96% of patients with BIA-ALCL have certain textured breast implants.

What are the Symptoms of BIA-ALCL?

The most common presentation of the condition is:

  • swelling
  • a mass/lump under the skin (near the breast implant)
  • seroma (fluid collection around the prostheses)

All of these are reported to be persistent. In many cases, the symptoms of BIA-ALCL appear many years after breast implant surgery. Some women with breast implants get diagnosed 15 years after their breast reconstruction. Excess fluid collection is one of the most common signs that should warrant a visit to the doctor.

Case studies have shown that the cancerous tissue with BIA-ALCL can be found in close proximity to the medical device itself. The reason it's not considered breast cancer is because it's not contained in the very breast tissue like other types of cancer; instead, it forms in the scar capsule or the fluid surrounding the implant.

Prevalence of BIA-ALCL

Prevalence of BIA-ALCL

The first thing you should know is that the condition only happens to people with a certain breast implant type. But that is so rare that it affects 1 in every 3,800 to 30,000 with textured implants. Here is the age-related risk:

  • age 50: 1 in 35,000
  • age 70: 1 in 12,000
  • age 75: 1 in 7,000

We need to reiterate that implants for breast augmentation don't increase the risk of breast cancer. They only raise the BIA-ALCL risk to a certain extent. Being a type of rare lymphoma affecting the immune system, it may necessitate additional surgery, and in some cases, even radiation therapy and chemotherapy.

People who have the highest odds of developing this lymphoma are patients who used textured implants or tissue expanders. The latter are sometimes employed in breast reconstructive surgery after a mastectomy, and their purpose is to make room for the implant itself.

Here are some more numbers to dwell upon. According to other studies from 2015 and 2016:

  • 26.8% of plastic surgeons in Australia have seen a case of BIA-ALCL
  • 9.9% of surgeons in the USA have seen one
  • only <1% of surgeons in Germany have seen one

Scientists need to figure out why this is happening in some parts of the world more than in others. One theory is that cases are probably underreported. Most surgeons agree there should be a breast implant registry where both medical experts and patients can input and access related information. It can also be used to protect patients with saline or silicone gel implants.

But that's not the only hypothesis for this regional variation.

Why Does ALCL Happen?

Although the exact cause of this rare cancer is not known yet, different assumptions have arisen. When they dug deeper, health care providers found out the prevalence of certain bacteria in patients who got lymphoma. It created a thin coating, or biofilm, on the implants and caused chronic stimulation on the body after sitting there for many years.

It appears that bacteria can better attach to textured breast implants and grow in abundance, thereby creating inflammation and constant lymphocyte stimulation.

Again, this is just a hypothesis, and more research has to be done on it, but that's just one of the theories as to why ALCL is happening.

Should You Remove Breast Implants?

It's worth noting the FDA does not recommend patients to undergo implant removal routinely unless they have any of the symptoms mentioned above. People, however, should be aware of the symptoms so that they know what to watch out for. If you notice anything suspicious, please consult a doctor to investigate the matter further before you rush to have your breast implants removed.

Also, remember that implants are in no way lifetime devices. There is a reason they should be replaced every 10 years. Oftentimes people see breast augmentation as an extension of injectables or other beauty treatments, but it is a surgical procedure that comes with risks.

Motiva Implants Cancer and Safety after Breast Implant Surgery

Now, let's look at the most popular companies selling breast implant products. Among the innovations in implant development is a new type of surface that feels like a textured one but is classified as smooth. It is called a nano-textured implant. Motiva is one of the first manufacturers to offer nano-textured implants. Due to their texture, they are less likely to lead to BIA-ALCL, and there is currently no data to point out that they do.

Are Motiva Implants Safe?

When it comes to the overall safety of the Motiva implants, a 3-year study found they carry low rates of reoperation (0.76%) and complications (0.76%) like capsular contracture. Two different textures were assessed: micro-textured and nano-textured surfaces. The study looked into 5,813 cases and reported a total of 44 complications. 

Moreover, the findings showed nano-textured surfaces result in fewer complications in people who got big implants of 300 to 499 cc in volume.

Do Motiva Implants Ripple?

Motiva implants use lots of gel that ensures they don't cause a rippled appearance when the breasts are moving.

Allergan Breast Implants Cancer

A few years ago, the FDA acknowledged a link between BIA-ALCL and Allergan's textured breast implants; hence, the company had to recall them from the market alongside their textured tissue expanders. This was only around 5% of the devices sold in the USA. Mind you that the company's smooth implants were not part of the recall.

It took several years for the FDA to investigate different cases of BIA-ALCL around the world and conclude that Allergan's textured implants were at fault. Over the course of 20 years, experts kept reviewing the scientific literature and study reports on the incidence of complications and breast implant removal, and they constantly provided updates on their work.

Do Breast Implants Interfere with Mammograms?

Now, what about breast cancer in the traditional sense of the word? Breast cancer happens much more frequently than ALCL. It is estimated that one in eight women will develop some form of breast cancer throughout their life. This makes screening crucially important.

However, if you have implants, it may be more difficult to detect cancerous tissue because implants get in the way during mammography.

One thing that can significantly interfere with the radiologist's ability to read the mammogram image is the implant's location. Most medical devices are inserted above the muscle, which can obscure some of the tissues.

There are certain steps you can take to ensure you are getting the best patient care.

  • Examine your breasts regularly
  • Always inform your doctor that you have breast implants
  • Aside from the routine check-ups, make sure to schedule a physical exam if you notice sudden changes in your breasts
  • Choose a facility that is specifically targeted at women with breast implants; you need someone with considerable experience
  • Ask if other tests need to be ordered, such as magnetic resonance imaging (MRI) and ultrasound

You need not forget that regardless of whether you undergo breast surgery after a mastectomy or for purely cosmetic reasons, you should still have your breasts screened for cancer every year.

FAQ on Breast Cancer and Implants

FAQ on Breast Cancer and Implants

Bottom Line

BIA-ALCL is an extremely rare situation and one that will not necessarily happen to you. Once again, the likelihood of lymphoma development is smaller than that for real breast cancer.

It's vital you stay educated about it. Get your physical check-ups as your doctor, or the FDA recommends, don't panic and don't lose sleep over it.

If you are determined to go ahead with your breast augmentation but would like to prevent worries related to cancer, later on, we encourage you to discuss your treatment plan with our plastic surgeon on your next visit. More specifically, you should talk about implant types and placement options, plus patient care following breast implant surgery.

Shens Clinic, 3 Killiney Road, Winsland House 1, #09-08, Singapore 239519

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