Why Do Surgeons Still Use Textured Implants? And 8 More Questions You Have About BIA-ALCL, Answered by a Board Certified Plastic Surgeon

surgeon holding two textured breast implants

In 2011, the plastic surgery community and the FDA noted a possible link between a rare form of cancer called ALCL, or anaplastic large cell lymphoma, and breast implants. Back then, we didn’t even know whether breast implants were a real risk factor. There simply were too few cases to make a connection.

Today, while there are still many questions, we know a lot more about the prevalence, risk factors, and treatment options for breast implant-associated ALCL (BIA-ALCL). I’d like to share some essential information with you today.

What is BIA-ALCL?

BIA-ALCL is a very specific and rare form of non-Hodgkin’s lymphoma, which is an immune cell cancer. It is found specifically within the fluid and natural scar tissue surrounding the breast implant, which is called the capsule. It’s important to stress that while BIA-ALCL is located in immune system cells in the breast, it is not breast cancer.

What causes BIA-ALCL?

There appears to be a very strong link between textured implants and BIA-ALCL. A strong majority of reported BIA-ALCL cases have occurred in patients who have textured implants at the time of diagnosis, or who have had them in the past. A 2017 study showed that “macro” texturing methods (namely Allergan’s “Biocell” process) carry a significantly higher risk of BIA-ALCL than other methods, as they result in a higher surface area that can harbor more bacteria.

Implant shell type is not the only factor at play, however. The presence of certain bacteria in the implant’s biofilm (the normal collection of microbes surrounding an area) are also associated with higher BIA-ALCL risk, especially with macro-textured implants. The patient’s genetic predisposition may also play a role.

How many people have BIA-ALCL?

According to the most recent published data (July 2019), the FDA has received 573 unique medical device reports (MDRs) of BIA-ALCL. Consider that about 450,000 women get breast implants each year for augmentation or reconstruction in the United States alone. Worldwide, 717 cases have been reported.

Am I at risk of getting cancer from my breast implants?

There is a risk, but it is very small. Based on current FDA numbers and breast implant data collected over the past 20 years, the lifetime risk lies between 1:3817 and 1:38000 for women who have or have had textured implants. The risk is even smaller if you have only ever had smooth implants. Note that the type of cancer associated with implants is a type of lymphoma affecting immune cells in the breast implant capsule, and not a form of breast cancer.

What are the symptoms of BIA-ALCL?

One good piece of news about BIA-ALCL is that it usually shows symptoms in the early stages, when it can be fully treated. These include:

  • Swelling in one or both breasts
  • Seroma (fluid accumulation) around the breast
  • Breast pain that cannot be attributed to hormonal shifts)

In most cases, these symptoms will present at least one year after breast augmentation, with the average patient reporting symptoms at 8 years post-surgery. If you experience these symptoms at any time, see your doctor promptly. These can also be symptoms of other issues or complications, but should always be checked to rule out BIA-ALCL.

How is BIA-ALCL treated?

BIA-ALCL is highly treatable, especially if detected in the earlier stages. In most cases, removing the breast implants and surrounding scar tissue capsule completely eliminates the ALCL cancer from the body. If deemed safe for the patient, most plastic surgeons will perform an en bloc capsulectomy, which removes the capsule with the implant still sealed inside, to remove BIA-ALCL. In some cases, additional treatment such as chemotherapy or radiation may be indicated to fully treat the disease.

A note on en bloc capsulectomy

It’s important to understand that en bloc capsulectomy is not the only safe breast implant removal procedure, despite what some websites say. In fact, in some cases, it is not safe or possible to keep the capsule tissue intact when removing it from the body. For instance, if the capsule tissue has adhered to the rib cage, we will need to remove the implant (and most of the capsule) first, and then carefully remove remaining fragments of capsule tissue so as not to harm vital organs.

Can you die from BIA-ALCL?

Worldwide, there have been 33 confirmed deaths associated with BIA-ALCL, including 12 cases in the United States. Based on the reports we have, these patients received late diagnoses and So far, patients who have received prompt diagnosis and treatment have fully recovered from the disease.

Why do surgeons still use textured implants?

Following the discovery that macro-textured breast implants have the highest BIA-ALCL risk, several countries, including the United States and Canada, have pulled Allergan Biocell textured implants from the market.

Many plastic surgeons have discontinued their use of all textured implants—they can achieve an excellent aesthetic result with smooth implants, so why take the extra risk? For the most part, this is my line of thinking, too. I have long preferred smooth, round silicone gel breast implants for my breast augmentation patients. In addition to having a lower risk for BIA-ALCL, these implants achieve a beautiful shape and a more natural feel than firmer “gummy bear” textured implants.

Still, some may argue that it makes sense to keep textured implants as an option for specific patients whose anatomy calls for a shaped implant, such as breast reconstruction patients who have very little natural breast tissue left. In such cases, textured implants will provide an aesthetically pleasing shape and also stay in place as they “grip” the breast tissue..

Should I have my textured breast implants removed?

If you are not experiencing symptoms, it is not recommended to have breast implants removed prophylactically for a few reasons. First, if you are otherwise happy with your implants, the risks associated with additional surgery to take out implants are likely greater than your risk of BIA-ALCL. Second, removing textured implants and replacing them with smooth ones is unlikely to eradicate your risk for BIA-ALCL, as the disease has been found in patients who had a previous history of textured implants, even if they currently have smooth implants.

That said, if you simply no longer want your breast implants, that is reason enough to talk to a board certified plastic surgeon about your options for breast implant removal.

Have more questions? Please contact us at The Parker Center.

I am always happy to talk to patients about plastic surgery safety. If you are concerned about BIA-ALCL, or you are exploring your options for breast implant removal in New Jersey, please call us a 201-967-1212 or contact us online. I offer free cosmetic surgery consultations and will be glad to help you understand your options and help you achieve your aesthetic goals.

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