ALCL and Breast Implants

By on 03/23/2017 in ASPS, Blog, Board Certification, Breast Augmentation

You may have read recent media reports about a rare cancer possibly related to breast implants. This is called anaplastic large cell lymphoma or ALCL. This is not a breast cancer, and its relationship to breast implants is under current study.

 

This is a slow growing, rarely fatal disease. It is typically discovered many years after surgery with findings of significant swelling of a breast, a mass, or as an incidental finding during surgery for capsular contracture. Treatment is removal of the scar tissue capsule surrounding the implant and exchanging the implant.

The FDA first brought up concerns regarding ALCL in 2011. Since then, the number of patients who have been diagnosed with possible ALCL has been so small, that clear statistics are not available. The data that the FDA has, approximately 258 patients have been reported to possibly have ALCL. Importantly, this data is inconclusive, because a number of these patients did not actually have a biopsy proven diagnosis, but had something that the surgeon called “possibly ALCL.” This means the actual number of  ALCL cases is likely even lower. These 258 possible cases is out of more than 10 million women who have breast implants. An epidemiological study has reported the possible incidence of being diagnosed with ALCL at 1 in 300,000, or .0003%, and once again, this is only for women with textured implants per current studies.

To put that percentage into perspective, your lifetime risk of developing lung cancer if you smoke is 6.5%, or 22,000 times more likely than developing ALCL.

Your lifetime chance of dying from heart disease is 20%, or 67,000 times more likely than developing ALCL.

Your lifetime chance of dying from the flu is 1.5%, or 5000 times more likely than developing ALCL.

Most importantly, with the most recent data and research available, and I have personally questioned the researchers involved, all cases of ALCL have occurred in patients who had textured implants. There is not a single known case of ALCL in a woman who has only had smooth implants. There is one known case of ALCL in a woman who had smooth implants, but she had previous textured implants prior to the smooth implants.

Dr. Wiener only uses, and has only used in the past, smooth implants.

There are some theories being studied by some colleagues of mine regarding how ALCL develops. One of the main theories is that it may be related to the same theory of how capsular contracture develops, the biofilm theory. Dr. Wiener's important publications on reduction of the risk of capsular contracture has contributed to this research.

So, as a woman with breast implants, what should you do? First, keep your routine follow-ups with your plastic surgeon. Do your monthly self exams, as recommended for detection of breast cancer. If you discover a mass, or develop large swelling of one or both breasts, have it checked out. Even though this is primarily for women with textured implants, it is always a good idea to have any significant change in a breast evaluated. Remember, the chance of a woman with or without breast implants developing breast cancer is 12%, or 40,000 times more likely than developing ALCL, so your monthly self exams and annual visit with your family doctor for your well woman check is important.

Taking the above statistics regarding the chance for ALCL in a woman with textured implants, the chances of contracting lung cancer, dying from heart disease or the flu, the reality is that if you are afraid of getting cancer or dying, do the following:

  • quit smoking
  • eat healthy and exercise
  • get your flu shot
Really.