Breast implants, despite their tremendous popularity amongst women and plastic surgeons alike, is a medical device that does have complications. The vast majority of these are the typical problems that can occur with any synthetic implant such as infection, malposition and device failure. The risk of any true medical or health risks resulting from them raised its head in 1992 with the potential association with autoimmune diseases and silicone implants. After fifteen years of study that association became dispelled and silicone breast implants were re-introduced for everyday patient use in 2006. Today, both saline and silicone implants are widely used.
In the past year reports have emerged that have associated breast implants with a very rare form of lymphoma known as anaplastic T-cell lymphoma. (ALCL) The number of reported cases is incredibly small (less than 100 cases) compared to millions of women who have undergone breast augmentation and breast reconstruction with implants over the past 25 years. The most consistent factor in this cases has been that the implant had a textured surface. (smooth surfaces make up the majority if breast implants used today) No one yet knows why or how this is caused.
These rare breast implant-associated lymphomas do present in very characteristic ways. They appear with the development of a fluid collection known as a seroma that presents long after the implant has been placed. (known as a late seroma) Capsular contracture or hardening of the implant usually occurs and there may be an actual tumor mass on the implant’s capsule. Its diagnosis is made by an analysis of the seroma fluid. The ALCL disease is fairly weak, largely non-aggressive and has a very favorable prognosis. It is treated by removal of the implant and the surrounding capsule. There is no need for any other therapies such as radiation or chemotherapy, in essence the ALCL is completely curable in most cases that are known.
Given the past history of the potential association of a medical disease with breast implants in the early 1990s, plastic surgeons and manufacturers have taken a very proactive position on evaluating this recent ALCL phenomenon even though it appears to be very rare. In the September 2011 issue of Plastic and Reconstructive Surgery, three articles appear that comprehensively cover what is known to date about this apparent implant-associated tumorincluding a literature review and an expert panel’s assessment. While there remains no clear understanding of how the breast’s tissues response to an implanted material turns into this rare form of a non-Hodgkin’s lymphoma, its surgical and medical management has a near uniform consensus. The FDA will be working with the American Society of Plastic Surgeons and the two manufacturers to form a patient registry for further study of involved patients.
Silicone and saline breast implants remain safe for human implantation. The finding of implant-associated ALCLis viewed as very rare and has an effective treatment and a good prognosis. While there is an association, whether the implant has actually caused the disease is still suggestive but not proven.
Dr. Barry Eppley
Indianapolis, Indiana