The association between breast implants and lymphoma was made around 15 years ago. Lymphoma is not breast cancer. Breast-implant associated lymphoma (BIA-ALCL) usually presents as a single-sided swelling or enlargement (unilateral seroma). Other presentations include swelling affecting both breasts, or a breast lump. In such cases, sampling (cytopathology or histolopathology) is required, and if the results suggest lymphoma, then a haematologist ought to be involved. Sampling should be undertaken by a radiologist during imaging, so as not to damage the implant during the sample process.
Over the last three years, there is evidence, albeit weak, that heavily textured implants are implicated in the development of BIA-ALCL, and that this is because a fine bacterial film gets trapped around the texturing and causes chronic inflammation. Many experts disagree with the hypotheses surrounding BIA-ALCL, but we do know that development of this condition occurs around eight years after the implants are placed. We also know that the condition may spontaneously resolve and also that in cases where seroma has been missed, lymphoma has ‘not’ eventuated.
However, a woman with a positive diagnosis must be informed that she has a serious illness, and that the recommended course of action is surgical removal of the implant and the capsule (which is the scar tissue which develops around all foreign bodies). Spread of BIA-ALCL is direct (local) and not distant (metastasis).
Having said this, a leading expert on this condition, Daniel Fleming, gave a talk at Cosmetex 2018 about this. He described a few cases where the disease had essentially resolved spontaneously, and also gave epidemiological statistics about how we might be diagnosing more cases because we are actively hunting for them. He also advised that there might be genetic issues which increase the risk of developing BIA-ALCL.
So, what does all of this mean to you?
- The use of smooth implants is strongly preferred in terms of massively minimizing the already very low risk of developing breast-implant associated lymphoma. Please note that there are good reasons to use finely textured teardrop-shape implants or polyurethane coated implants.
- There is no need for fear. Do not fall prey to predatory practices where some plastic surgeons are spooking patients and encouraging them to remove implants (with Medicare rebates), whilst also performing augmentation procedures with implants in their private practice!
- If a lady with implants, particularly textured implants, were to develop unexplained swelling, then do not delay in seeking a medical opinion.
- Though rare, if BIA-ALCL is diagnosed in one breast, then it is wise to prophylactically remove the ‘both’ implants and capsules.