Breast Implant Safety Update

There has been increased media attention towards breast implants and their safety in recent months. The main concerns relate to a rare form of lymphoma (BIA-ALCL).

Breast Implant Associated Anaplastic Large Cell Lymphoma (ALCL) a rare form of lymphatic cancer that can develop near breast implants. To date there have been less than 800 reported cases worldwide out of an estimated 35 million women with implants. This condition appears to be associated only with textured implants and the risk of developing ALCL ranges from 1:3000 to 1:80000 depending on the type of textured implant. To date there are no reports of ALCL developing in a woman with only smooth implants. Because this is such a rare disease the worldwide consensus is that women who have a textured implants do not need to have their implants removed unless they have other specific problems. ALCL is not to be confused with breast cancer, which is a separate condition that affects approximately 1 in 9 New Zealand women in their lifetime.

Research into ALCL is ongoing but the evidence points to a combination of patient bacteria, implant texture and patient genetics as contributing factors. The signs to look for with this condition are a sudden swelling or enlargement of your breast or the development of a lump in your breast. If you notice these changes please see your family doctor urgently or call my office if you are a patient of my practice.

Most cases of BIA-ALCL are cured by removal of the implant and the capsule surrounding the implant. Agencies around the world continue to investigate the safety of breast implants following the increasing number of cases of BIA-ALCL being reported. I have closely monitored the information and worldwide research efforts on ALCL since it was first raised in 2010. I stopped using Allergan Biocell textured implants in late 2010, and Polyurethane coated silicone implants in 2017. Today I recommend smooth silicone implants for almost all patients having either cosmetic procedures or reconstructive surgery after breast cancer treatment. There is still a role for some textured implants in very specific circumstances. This is always discussed with patients thoroughly before surgery.

Breast Implant Illness a general term used in reference to women who have breast implants and who describe symptoms of illness that they relate to their implants. It is a ‘catch-all’ diagnosis and the list of symptoms reported includes fatigue, allergies, chest pain, difficulty sleeping, migraine, joint pain, hair loss and depression. Of course many of these symptoms will occur in the absence of breast implants but social media is helping to fuel anxiety levels so that it is becoming increasingly difficult to untangle truth from fiction. Currently there is no strong scientific evidence for a link between breast implants and a defined illness. However we must recognize that some women are feeling unwell and it is important that their concerns are taken seriously. Research is underway to try and better understand breast implant illness

An article published in the journal of the American Society of Plastic Surgeons in July 2019 states there is presently ‘overwhelming evidence to support the safety of silicone breast implants…. To the best of our body of scientific knowledge to date, there have not been any concrete or evidence-based studies or peer-reviewed data concerning the formation of a new syndrome: “silicone implant illness”.’

I have worked with silicone implants since the mid 1990’s and have confidence in the research that silicone is a biologically safe product. However, I hear and understand the concerns of women about potential breast implant illness. If you are concerned about having this condition and have been a patient of my practice for breast augmentation or breast reconstruction, you are welcome to call and speak with my staff about your concerns. My staff can provide you with all the details of your implant surgery and arrange a medical consultation if you have further questions.

Women who have had their surgery elsewhere are encouraged patients to see the original surgeon who performed their breast augmentation or reconstruction. If you are not a patient of my practice but wish to speak with me about your concerns, I recommend you first see your family doctor and request a medical referral be sent that includes all of your medical notes and operative records relating to your implant surgery.

For further information please see the NZ Association of Plastic Surgeons website for up-to date information for patients and doctors. Information for BII is here and for BIA-ALCL is here.

Rohrich, Rod J. M.D.; Kaplan, Jordan M.D.; Dayan, Erez M.D. Silicone Implant Illness: Science versus Myth? Plastic and Reconstructive Surgery: July 2019 - Volume 144 - Issue 1 - p 98-109 , doi: 10.1097/PRS.0000000000005710