Plastic surgeons use breast implants to reconstruct the breasts after mastectomy or increase breast size for cosmetic reasons. Approximately 102,000 women had breast reconstruction last year, and 313,000 women underwent breast augmentation.
However, a growing body of evidence has linked some breast implants to an uncommon cancer of the immune system, called breast implant–associated anaplastic large cell lymphoma, or BIA-ALCL. The odds of developing this cancer are extremely rare—some preliminary studies estimate it affects only one in 30,000 American women with breast implants. As of July 2019, 573 cases and 33 deaths from BIA-ALCL had been reported worldwide. Although the cancer is serious, it’s highly curable when found early.
BIA-ALCL isnot breast cancer—it’s a form of non-Hodgkin’s lymphoma, a type of cancer that generally develops in the lymph nodes and lymphatic system. BIA-ALCL is typically found in the scar tissue that forms around the breast implant after surgery, called the scar capsule. It usually affects one breast but can affect both. The main symptoms are persistent swelling and pain caused by fluid buildup, a solid lump in the area of the implant, or both. Additional signs might include breast enlargement, breast asymmetry, a rash, and a hardening of the breast.
BIA-ALCL occurs on average about 10 years after implant surgery, although it’s appeared in women as few as two years after surgery and, in at least one case, 28 years after.
About breast implants
Implants—silicone shells filled with silicone gel or saline—come in different shapes and sizes, and their surface can be smooth or textured. The type of fill doesn’t appear to affect the cancer risk, but an implant’s texture does. While only 10 percent of implants sold in the United States are textured, nearly all cases of BIA-ALCL arise from textured implants.
In July 2019, the FDA asked pharmaceutical company Allergan to voluntarily recall its unused Biocell textured breast implants. The implants were implicated in 91 percent of BIA-ALCL cases where the implant manufacturer was known.
The FDA first reported the link between breast implants and anaplastic large cell lymphoma in 2011. Since then, BIA-ALCL hasn’t been well studied, leaving many unanswered questions about its causes and risks. Scientists are studying why textured implants are riskier than others. Among their theories: BIA-ALCL might be caused by textured implant particles that break off, an inflammatory reaction, or bacteria on the implant.
If you already have breast implants
If you don’t have any symptoms, you don’t need to have your implants removed, says the FDA, since the cancer is so rare and curable when found early. You should also regularly examine your breasts for signs of BIA-ALCL. If you see or feel any changes in the breast area, consult your doctor promptly for an evaluation.
If you’re diagnosed with BIA-ALCL, you’ll undergo surgery to remove the implant and scar capsule, which should cure the cancer. Less often, it can spread to the lymph nodes or elsewhere, and you could need chemotherapy or radiation therapy.
If you’re considering breast implants
Be fully informed of the risks of implants; the FDA has proposed that doctors review a patient-decision checklist with women before they consent to surgery. You should also ask for a copy of the implant’s patient labeling and educational materials and keep a record of the implant’s manufacturer, model, and unique device identifier.
It’s important to understand that, regardless of cancer risk, breast implants don’t last a lifetime, and a second surgery to replace or remove implants is more likely the longer you have them. Other noncancerous complications are associated with implants and include:
- Capsular contraction, which is a hardened capsule of scar tissue that forms around the implant, potentially causing pain and distorting the breast’s shape
- Rupture or deflation
- A wrinkling or rippling appearance
- Breast asymmetry (uneven in size, shape, or level)
- Scarring from the surgery itself
- Changes in nipple and breast sensation
What Is Breast Implant Illness?
Some women with silicone gel implants report experiencing chronic fatigue, cognitive difficulties, and severe joint and muscle pain, which certain experts refer to collectively as breast implant illness. But whether it is a real condition is controversial.
This article first appeared in the February 2020 issue of UC Berkeley Health After 50.
Also see 9 Dangerous Beauty Trends.
Published February 24, 2020