Dr. Chen in menopause monday
Breast Implant Awareness
By Ellen Dolgen, September 4, 2017
Many women have breast implants and read the recent article in the New York Times about the rare malignancy of the immune system that can be caused by implants called breast implant-associated anaplastic large-cell lymphoma.
Time Health reported:
Nine women in the U.S. have died due to d0 to rare cancer associated with their breast implants, federal officials announced on Tuesday.
The U.S. Food and Drug Association (FDA) reported that as of Feb. 1, the agency had received 359 reports of a cancer of the immune system, called anaplastic large cell lymphoma (ALCL), linked to breast implants. According to the FDA, the risk for cancer appears to be higher with textured breast implants as opposed to smooth ones, but the agency is not yet sure why.
The FDA was able to determine whether the surfaces of the implants were textured or smooth for 231 of the implants. Among those, 203 were textured, compared to 28 that were smooth.
About 300,000 women in the U.S. get breast implants each year, and cancer from the implants is rare. However, the potential risks raise questions.
For many women who have breast implants either due to cancer reconstruction or elective cosmetic surgery, this article was a bit frightening, to say the least.
I reached out to Dr. Constance M. Chen, a plastic surgeon who specializes in breast reconstruction, to help answer some of your questions and perhaps calm your concerns. Dr. Chen is a Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine. She is also Chief of Microsurgery at New York Eye and Ear Infirmary of Mount Sinai.
Here is my Q & A with Dr. Chen:
1. The article says that most of the cases were linked to women whose implants had a textured or slightly roughened surface, rather than a smooth covering. Is it customary for a women’s surgeon to keep records on the type of implants in this detail so that a woman could ascertain if they have they indeed have textured/roughened surface implants? “Most surgeons will dictate the type of implant in the operative report, including the texture, fill, and shape. Patients are also often given a device identification card by their surgeon. Patients should contact their plastic surgeon with any questions about their implants.”
2. Do smooth and textured implants both look the same aesthetically? “Yes, smooth and textured implants look the same aesthetically when they are in the patient’s body. When the implant is removed from the patient’s body, you can see what type of surface the implant has.”
3. Is there a difference in scar tissue (Capsular Contracture)? “Scar tissue formation happens to everybody who undergoes any surgery, including breast implant placement. Capsular contracture is scar tissue that can become hard and painful over time. Capsular contracture is more likely to occur around smooth implants. Multiple operations at the same site can also increase the chances of developing capsular contracture.”
4. Is there a cost difference? “The cost for saline implants is slightly less than for silicone implants.”
5. What is the primary difference between a smooth and a textured implant? “The smooth implant is usually a round shape and is available in silicone or saline. The smooth round shape allows it to rotate around in the breast pocket. Smooth implants may be more prone to capsular contracture. The textured implant is often teardrop shape, is also available in saline or silicone, and has a rough surface. Textured implants adhere more to the breast tissue so it’s less likely to rotate but if it does, it may be more noticeable because of its shape. The textured implant may also be more prone to infection and rippling.”
6. How is the type of implant generally chosen? Is there a conversation with the patient or is this selected by the surgeon alone? “It’s important for patients to have an open conversation with their doctor about goals and preferences. Taking an active role in decision-making is key to a successful outcome. During a consultation, the doctor should discuss the pros and cons of each type of implant to allow the patient to make the best decision for herself. Together, the doctor and the patient can determine the size, shape, and type that will be appropriate for her body habitus. In my practice, I encourage patients to come in several times before an operation so they can be sure about the sizing. During the operation, I order a range of sizes close to the desired outcome to ensure the best fit.”
7. If both textured implants can be filled with silicone or with saline (salt water) – do they both hold the same risk? “Textured implants have a slightly higher risk for infection. Although it is extremely rare, ALCL appears to develop more frequently in women with textured implants than in women with smooth implants.”
8. How often should a woman get your implants re-done “Implants only need to be removed if there is a problem – most commonly capsular contracture, rupture, or infection. If a woman is happy with the way an implant looks and feels, and there is no known rupture or infection, then there is no real reason to remove the implant. On the other hand, if a woman simply no longer wants an implant in her body, she can have them removed but she should be aware that if she has large implants and minimal breast tissue, her breasts can end up looking quite disfigured. Women do not need to “get implants redone” based on an external timeline because every surgery can cause problems, and it’s best not to have unnecessary surgery.”
9. If a woman knows she has textured implants, should she have them replaced? “Not necessarily. She does not need to undergo surgery for implant removal or replacement unless she is having problems.”
10. To add further insult to injury the woman in the article had Blue Cross Blue Shield of Montana and they have refused to cover the removal of the implants. Any suggestions as to how to help ensure a woman can get coverage for the removal of implants that have caused lymphoma? “If a woman has a tissue diagnosis of ALCL from cytology that was taken from fluid around the implant, then I think it would be very difficult for a woman to be denied coverage for implant removal. On the other hand, if a woman simply has breast implants and lymphoma, but there is no tissue diagnosis of ALCL in fluid around the implant (or there is no fluid around the implant), then it may be difficult for her to prove that her implants have caused lymphoma. Finally, if a patient presents with other complications associated with implants, such as rupture or severe capsular contracture, she should be able to seek coverage for removal of implants based on these conditions.”
11. What kinds of symptoms would a woman experience that would give her an indication that this kind of lymphoma caused by implants might be brewing? Do you get a rash? Redness? Hardened breasts? Soreness? Fever? “A causal connection has not been established between implants and ALCL. Often, the first sign of ALCL is swelling in the neck, armpit or groin, and a patient may also have symptoms like fatigue, fever, loss of appetite, night sweats, and weight loss. With cutaneous ALCL, patients can develop raised, red bumps on the skin that may itch, form open sores, and don’t go away. On the other hand, some of these symptoms can also be associated with other problems (like the flu, a skin infection, etc), so it is best to see a doctor to try to determine the source of the problems.”
12. For women who are about to go through breast augmentation would you recommend that she speak to her plastic surgeon about doing a smooth implant? “Smooth implants are not necessarily better than textured implants. Each has associated risks and benefits and a woman should speak to her plastic surgeon about her goals. Together, the patient and doctor can decide what the best options might be for her.”
Thank you, Dr. Chen for your generous time and expertise. This information is very helpful to women who are contemplating breast reconstruction as well as those who were worried about their current implants.