Breast Implants cause Cancer? Dr Dona discusses ALCL

Blog |  Dr Eddy Dona

image

Anaplastic Large Cell Lymphoma (ALCL) is a rare type of cancer that is associated with textured implants.

Implants have been around for over 50 years but ALCL is relatively new.

Breast Cancer

  • Breast implants do not cause breast cancer
  • With or without implants, the risk of women developing breast cancer during their lifetime is unfortunately 1 in 8
  • If you are 40 years old, the risk of developing breast cancer over the next 10 years with or without implants is 1 in 69
  • If you are 30 years old, the risk of developing breast cancer over the next 10 years with or without implants is 1 in 230
  • Because of this, every women is encouraged to undertake routine monthly breast self-examination, and having implants does not stop you from performing breast self-examination nor does it make it more difficult to detect changes in your breasts.
  • If you detect a change in your breasts, then you see your doctor to have it further investigated.
  • Depending on your family history, the current recommended age to undertake routine breast cancer screening, ultrasounds and mammograms, is from 50years of age. This is the same, implants or not.

What is ALCL?

Implants come in both smooth and textured. This basically refers to the outer lining of the implants. Smooth means it’s exactly that, a smooth surface. Textured means the surface is rough like sandpaper. Regardless of the shell, the contents, or what’s inside, is the same silicone gel.

Smooth shell implants are not associated with ALCL. ALCL is only associated with textured implants and the rate varies depending on the type of texturing.

ALCL is basically a cancer associated with the scar tissue that naturally forms around implants. It is not a cancer of the breast tissue which is breast cancer, and once again, implants do not cause breast cancer.

The risk of developing ALCL based on the most recent published data from May 2019 varies from 1 in 2,800 to 1 in 86,000, depending on the type of textured implant.

What Are Textured Implants?

Textured implants were introduced many years ago and they provide several benefits including reducing the risk of capsular contracture or hardening of the implant. Capsular contracture is one of the well-established potential problems that can occur with implants, and texturing has been thought to reduce the risk of this occurring. Due to this believed benefit, up until relatively recently the majority of surgeons have preferred textured implants.

Texturing also helps the implants stay in position which is why teardrop implants are only textured. This is because the texturing effectively acts like Velcro and helps stabilise the implant position and thus reduce the risk of them rotating, which is one of the possible problems with teardrop implants. So if you have teardrop implants, then that means you have textured implants.

Round implants come in both smooth and textured variety, because if they spin around it does not distort the breast appearance.

Were Implants Recalled?

  • Up until recently the two leading implant suppliers worldwide were Allergan and Mentor. Allergan macro-textured implants have an ALCL risk of 1 in 3,300, whilst Mentor textured implants have a risk of 1 in 86,000.
  • In late 2018 Allergan macro-textured implants were taken off the market in Europe.
  • Based on these issues, the TGA made an announcement in July 2019 that they were considering removing ALL textured implants from the market. They have yet to make a decision on this.
  • However, on the back of this possible decision, Allergan decided to voluntarily remove its macro-textured implants from the Australian market on 2 August 2019.
  • Unfortunately they used the “recalled” when simply explaining they were no longer going to sell the implants. The implants were being recalled from shelves and stock. Absolutely no patients are being recalled!
  • Just to clarify this important point that has caused a great deal of anxiety amongst thousands of women, absolutely no patient is being recalled.
  • Absolutely no recommendations exist to remove implants.
  • The TGA does not recommend any patient have implants removed.
  • No responsible surgeon is recommending removing implants.

How Do You Know If You Have ALCL?

The average time of developing ALCL from the time of original surgery is approximately 8 years.

The signs of ALCL are usually very obvious. In approximately 90% of the cases the breast swells up. It swells up because fluid collects around the implant – this is called a seroma.

However, whilst seromas are relatively common, it is extremely rare for this to mean the person has ALCL.

I have been in private practice for many years and I’ve seen many late onset seromas, and as of this date, I’ve never seen a case of ALCL.

So if you notice an obvious swelling, you see your doctor, and you’ll get an ultrasound and have the fluid drained and tested. On the rare occasion, that fluid will show that the person has ALCL.

Other ways it can manifest in the breast include breast lumps or skin changes.

So essentially, the signs of ALCL are typically very obvious. Also, because of the unfortunately high rates of breast cancer, every women should be performing routine monthly breast self-examinations because the signs of breast cancer are typically far less obvious than that of ALCL.

The treatment of ALCL is relatively straight forward and it involves removing the implant and the breast implant capsule – this is typically curative. In fact, when detected early the treatment of ALCL is generally far easier than treatment of breast cancer, far more successful, and the condition is far rarer. However, if diagnosed late then other adjuvant treatments may be required. Due to the sometimes late diagnosis of ALCL, a number of deaths have occurred due to its spread beyond the breasts.

Which Implants Do I Use?

Australia, like everywhere else in the world, have a number of different implant brands available all of which are of course TGA approved.

The implants with the greatest risk of ALCL are the polyurethane coated or Brazilian furry type, which many surgeons have of course used but it’s not a brand I have ever used.

Like the majority of busy plastic surgeons, I too have used the Allergan textured implants. However, for a number of years the main brand of choice for myself has been Mentor. It turns out that Mentor is the brand that was subsequently shown to have the least risk of developing ALCL, and based on current data only 1 in 86,000.

What Do You Do If You Have Textured Implants?

The commonest question that has been raised is “if I have textured implants, should I have them removed?” At present, there are zero recommendations to have implants removed regardless of the type of textured implants that you may have. However, many women are advocating for the complete removal of implants irrespective of any signs of disease. However, this is not the official recommendation by the implant company’s, the TGA or by any responsible surgeon.

Once again, implants or not, routine monthly breast self-examinations are required and if any concerns arise you have them reviewed appropriately.

Also, despite the fact that it carries an extremely small risk, some women with textured implants just want them out so they don’t have to think about it. This is not unreasonable. If having the implants is causing significant anxiety then removing the implants effectively cures the anxiety. Of course, removing them completely or exchanging them for smooth implants are the options to consider here.

You Want to Get Implants but Are Scared of ALCL

Another comment made by those wanting to have implants is that “I only want smooth implants so I don’t have to worry about ALCL”. This is also perfectly reasonable, but this would be done with the understanding that the person can only have round smooth implants, which have a higher risk of developing capsular contracture and possibly a higher risk of dropping.

For many surgeons this will not change their practice or what they offer their patients a great deal because most surgeons have spent their entire career only using round implants. But for those surgeons that use anatomical implants, and for those patients wanting anatomical implants, then this will be an issue. Those patients will have to be prepared to accept the look only achievable with round implants.

How Regularly Should You Check Your Breasts?

The formal recommendations to every women, with or without implants, is to continue routine monthly breast self-examinations and if any concerns at any time, see your doctor or surgeon for further review.

And remember, breast cancer has a risk of 1 in 8, and that usually manifests as a small lump that you may or may not be able to feel. In contrast, ALCL has a worst case scenario risk of 1 in 2,800, and the person typically develops an obvious visible breast swelling that is easy to detect and therefore easy to have treated early.

In other words, as long as you are always reviewing your breasts normally every month, as you should be doing with or without implants, then you are given yourself the best chance of detecting ANY issues that may arise early, and therefore being treated early.

Ultimately, regardless of the type of implants you may have, nothing needs to change. Breast cancer is many times more common than ALCL, and for that reason you must always be “self-aware” and perform routine monthly breast self-examinations.

If the reasons you originally got implants still remains, and they are not causing you any problems, then why would you have them removed.

I Also Suffered From Cancer!

Finally, it is my intention that this content sheds light on a very important topic that has had some media attention with poorly worded press. As many of my regular followers will be aware, I too suffered from cancer earlier this year and had to undergo two significant operations.

It was an absolutely terrible experience and even as a doctor myself, the word “cancer” is terrifying! And it is that reason I am creating this content, so those countless thousands of women with textured implants DO NOT WORRY! Yes it does occur. It is rare. It is curable. Breast cancer has a risk of 1 in 8. For that reason and that reason alone, you should ALWAYS perform monthly breast self-examinations. I said this when I first discussed my own personal medical problems. I urged everyone, that you must always be self-aware. You know your body better than anyone else, including your doctor. So if anything ever changes, that is when you get that investigated by the appropriate doctor. And whilst most of the times everyone will be normal, on those small occasions it is a problem, then it has been picked up early, so it can be treated early, so you give yourself the best chance of the best outcome.