What You Need To Know About Breast Implants
Diana Zuckerman, PHD Elizabeth Naglin-Anderson, MA and Elizabet Santoro, RN, MPH, National Center for Health Research
In 2019, fewer than 300,000 women and teenagers underwent surgery to have their breasts enlarged with silicone or saline implants, a 4% decrease compared to 2018. In addition, more than 100,000 breast cancer patients had reconstruction after mastectomy in 2019, often with implants.1 While the popularity of breast augmentation has tripled since 1997, when there were just over 101,000 of these procedure,2 recent trends show that fewer women are opting for augmentation.
There were also 54,539 implant removal procedures in 2019, including augmentation and reconstruction patients, compared to 48,385 in 2018 and 47,000 removals in 20171 The increasing number of women removing their implants can be attributed to several factors, including news stories highlighting the risks of breast implants, the growing mass media and social media presence of patient advocates, Allergans recall of their BIOCELL textured breast implants in 2019 and efforts to notify women of the recall, and several insurance companies expanding their coverage to include women whose textured implants were recalled.
However, debate continues to swirl about the safety of breast implants. Here are the facts about what is known and not known about the risks of breast implants.
Should I Still Get Implants If I Have High Risk Of Breast Cancer
Im a asian, 32yo. I was a 32c then become 32b after my first child n I think im a 32a now after my 2nd child. My husband loves big boobs n im really upset that my boobs have shrunk. I wanted to get implants but my elder sis was diagnosed wif breast cancer at 33yo, my cousin at 32yo and I have 3 aunties with breast cancer after 45 yo. Why do my boobs shrink after giving birth? is it risky for me to get implants? Im 162cm, 44kg.
Breast Exam By Your Doctor
The same guidelines for self-exams provided above are true for breast exams done by your doctor or other healthcare professional. They wont hurt you, and your doctor may do a breast exam during your annual visit.
If youre having symptoms that concern you, its a good idea to have your doctor do a breast exam. During the exam, your doctor will check both of your breasts for abnormal spots or signs of breast cancer.
Your doctor may also check other parts of your body to see if the symptoms youre having could be related to another condition.
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What Is Msks Recommendation For The Removal Of Textured Breast Implants
There is no scientific evidence that removing a textured device eliminates the risk of BIA-ALCL. However, some women may choose to remove their textured implant with or without the scar around it to minimize the concern regarding this risk.
Neither the FDA, nor the American Society of Plastic Surgeons, nor the American College of Surgeons recommends that women remove their Allergan textured breast implants.
How Do They Check For Breast Cancer With Implants
Mammography for women with breast implants is described by the American Cancer Society as a challenge, Breast implants are a challenge for mammogram screening.. X-rays used to image the breasts cannot show the breast tissue that lies over or beneath silicone or saline implants because they cannot penetrate them well enough.
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How Do Surgeons Use Implants To Reconstruct A Woman’s Breast
Implants are inserted underneath the skin or chest muscle following the mastectomy.
Implants are usually placed as part of a two-stage procedure.
- In the first stage, the surgeon places a device, called a tissue expander, under the skin that is left after the mastectomy or under the chest muscle . The expander is slowly filled with saline during periodic visits to the doctor after surgery.
- In the second stage, after the chest tissue has relaxed and healed enough, the expander is removed and replaced with an implant. The chest tissue is usually ready for the implant 2 to 6 months after mastectomy.
In some cases, the implant can be placed in the breast during the same surgery as the mastectomythat is, a tissue expander is not used to prepare for the implant .
Surgeons are increasingly using material called acellular dermal matrix as a kind of scaffold or sling to support tissue expanders and implants. Acellular dermal matrix is a kind of mesh that is made from donated human or pig skin that has been sterilized and processed to remove all cells to eliminate the risks of rejection and infection.
What Is Breast Implant Associated Cancer
Breast implant associated cancer, which is also known as breast implant associated anaplastic large cell lymphoma , is a rare cancer of the immune system. It is not breast cancer, which forms from cells in the breast, but instead a cancer that grows in the fluid and scar tissue that forms around a breast implant. Less commonly, BIA-ALCL can take the form of a lump in the breast or a lump in the armpit.
BIA-ALCL has been known to occur as soon as one year after the operation and as late as 37 years after the operation. The average time to diagnosis is within 8 years of the operation.
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You Cannot Usually Get Breast Enlargement On The Nhs
You’ll usually have to pay to have breast implants.
There are some circumstances where you might be able to get breast enlargement on the NHS for example, if you have very uneven breasts or no breasts.
It often depends on the area you live in. Your GP should be able to tell you more about the rules in your area.
Risks Of Illness From Breast Implants
In the past, there were concerns about possible health issues from ruptured silicone-filled implants, such as connective tissue disease, breast cancer, or reproductive problems. So far, studies show that silicone implants do not increase the risk of these health problems. Some people with breast implants may have symptoms of joint pain, memory loss, or fatigue. It is not clear if these symptoms are related to the breast implants and more research is being done.
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Are There Newer Safer Implants
As part of new research studies, plastic surgeons sometimes offer gummy bear breast implants, named after gummy bear candies because the implants are a thicker, more cohesive silicone gel. Since the shell and gel in these newer models are thicker than most other silicone gel implants, it is possible that they might be less likely to break or leak into the body.
Despite only 3 years of data provided by Silimed on relatively small numbers of patients, the FDA approved their gummy bear implants in 2012. New implants often have risks that are not immediately obvious, and even after only 5 years of data were available, it was obvious that these gummy bear implants had similar types of complications to other silicone implants. Only when the cohesive gel implants are in women for more than 10 years will we know whether and how the implant deteriorates or changes when it is in the human body.
Why long-term safety studies matter. In addition to silicone and saline implants, three other kinds of implants were developed and used primarily outside the United States: Trilucent implants , and Novagold and PIP hydrogel implants, which were filled with a plastic gel. They provide examples of why long-term safety studies are so important.
Does Health Insurance Cover The Cost Of Risk
Many health insurance companies have official policies about whether and under what conditions they will pay for prophylactic mastectomy and bilateral prophylactic salpingo-oophorectomy for breast and ovarian cancer risk reduction. However, the criteria used for considering these procedures as medically necessary may vary among insurance companies. Some insurance companies may require a second opinion or a letter of medical necessity from the health care provider before they will approve coverage of any surgical procedure. A woman who is considering prophylactic surgery to reduce her risk of breast and/or ovarian cancer should discuss insurance coverage issues with her doctor and insurance company before choosing to have the surgery.
The Womenâs Health and Cancer Rights Act , enacted in 1999, requires most health plans that offer mastectomy coverage to also pay for breast reconstruction surgery after mastectomy. More information about WHCRA can be found through the Department of Labor.
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Risk Factors Symptoms And Treatment
Some breast implants slightly raise the risk of an uncommon type of lymphoma. Implants dont increase the risk of developing breast cancer.
If you have breast implants, read on to find out how certain implants are connected to a rare cancer, why they dont necessarily need to be removed, and why you should consult with a doctor if you have any unusual symptoms or concerns.
The U.S. Food and Drug Administration first noted a possible link between breast implants and cancer in 2011. Its not breast cancer, but an immune system cancer called anaplastic large cell lymphoma .
ALCL is a type of non-Hodgkins lymphoma. Its rare, with an annual incidence of 0.25 cases per 100,000 people.
Breast implant associated ALCL develops in scar tissue and fluid near the implant. Like any cancer, it can spread. Without treatment, it can be a deadly cancer.
A 2018 study found an association between breast implants and increased risk of BIA-ALCL. Study authors wrote that the absolute risk is small, estimated at:
- 1 in 35,000 at age 50
- 1 in 12,000 at age 70
- 1 in 7,000 at age 75
In 2019, the FDA alerted healthcare providers about a link between all breast implants, regardless of filling or texture, and BIA-ALCL. The agency informed doctors of 573 cases of BIA-ALCL worldwide, with 33 deaths. Of the 573 cases, 481 people had Allergan breast implants at diagnosis.
Who Can Get Breast Implant Associated Cancer
All reported cases of breast implant associated cancer in Australia involve patients who have had a textured implant at some point in their life. Based on current evidence, experts do not think breast implant associated cancer is related to either the contents or shape of the implant.
Breast implant associated cancer is rare. The recent review by the TGA has found between one in 2,500 and one in 25,000 people with breast implants are diagnosed with the condition in Australia based on confirmed cases of BIA-ALCL where only one brand of implant had been used. The risk of developing BIA-ALCL increases with increasing texturing of the implant. Implants which have a smooth surfaced have not been associated with BIA-ALCL. Breast implant associated cancer can occur after either reconstruction or augmentation surgery, with 95% of cases occurring between three and 14 years after the insertion of an implant.
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Types Of Implants And Likelihood For Alcl
Dr. Jones: However, it’s a scary thing because many women who are having implants are maybe not doing it for cosmetic purposes but for reconstructive purposes, and they already have cancer on their brain and their heart. What kinds of breast implants are the most likely?
Dr. Agarwal: So what we’ve seen, first of all, there have been about 400 to 500 cases of this ALCL reported to the FDA. And after looking back at those patients and the types of implant they’ve had, it appears that the highest association is with textured breast implants.
Dr. Jones: So tell me about that. I don’t get textured. Is textured meaning its outside is kind of rough, or what do you mean by textured?
Dr. Agarwal: That’s correct. So breast implants come in a variety of styles. The first you may know is saline-filled implants or silicone-filled implants. And then another characteristic can be whether they have a smooth outer surface or a textured outer surface.
We started using textured implants because there was a thought that maybe it decreased the amount of scar tissue that formed around the implant or what we call capsular contracture. Sometimes we use implants that are slightly shaped, and the texturing helps prevent the implant from turning. But the association with the ALCL is the highest with the ones that have a texture on the outer surface.
Dr. Jones: Well, that has some biological possibility. I mean, it could cause a different kind of reaction than a smooth, slippery one.
Possible Causes Of A Lump With Breast Augmentation
If you can feel a lump in your breast implant, it may be related to a fold or crease in the actual implant shell. This will be more common in women who have a contracture or a firmness to their implants. This firmness around the implant can cause it to change shape and form a buckle that might feel like a mass on the implant. Pain can be associated with implant lumps because they can be sharp and cause inflammation.
The first concern about a mass is the possibility of cancer. This is one of the leading causes of death in the female population and will affect an astounding 1 out of every 8 women in their lifetime. As your age increases, so does your risk of cancer. Most breast cancers are found in women older than fifty, and they are rarely found in patients younger than 25. Regardless of your age, there are steps you should take.
How Effective Are Risk
Bilateral prophylactic mastectomy has been shown to reduce the risk of breast cancer by at least 95 percent in women who have a deleterious mutation in the BRCA1 gene or the BRCA2 gene and by up to 90 percent in women who have a strong family history of breast cancer .
Bilateral prophylactic salpingo-oophorectomy has been shown to reduce the risk of ovarian cancer by approximately 90 percent and the risk of breast cancer by approximately 50 percent in women at very high risk of developing these diseases .
What Is The Treatment And Prognosis For Breast Implant Associated Cancer
It is usual that care is provided by a multi-disciplinary team. A treatment plan may be developed with advice from a blood disease specialist with experience in lymphoma, a cancer specialist, and a surgeon with breast implant experience.
In about 80% of cases, the disease is detected in the early stage, with cancer cells found only in the fluid surrounding the implant. Most of these cases are cured by removal of the implant and surrounding capsule. Over the last 10 years, four Australian women have died from breast implant-associated lymphoma.
Usually, both implants are removed even if breast implant-associated ALCL has only occurred in one breast. This is because there is a small but real risk that breast implant-associated ALCL can develop in the opposite breast. If there is a solid lump or the cancer has spread, the patient may require additional treatment such as chemotherapy, radiotherapy or additional surgery. Follow up monitoring may require additional CT scans.
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Monitor Your Breast Implants
In general, follow your surgeons instructions on how to monitor your breast implants.
If you notice any unusual signs or symptoms, report them promptly to your surgeon or health care provider. Health care providers and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program.
Also, follow your health care providers instructions for imaging for screening for breast cancer as this may be different for those patients who had breast augmentation and for those patients who had breasts reconstruction. If you are making an appointment for mammography, inform the mammography facility that you have breast implants, and ask them what you can expect regarding mammography with breast implants.
Your surgeon or health care provider may also recommend other tests, such as ultrasound or magnetic resonance imaging . The FDA recommends that patients with silicone implants get regular screenings to detect silent ruptures.
If you have specific questions about breast implants, ask your surgeon or health care provider.
Can You Get Breast Cancer After Breast Implants
No. According to the breast cancer non-profit organization Susan G. Komen®, implants have not been linked to an increased risk of breast cancer. That said, Allergan manufactured textured implants among others have been connected to BIA-ALCL.
Although the reasons are unclear, the risk of BIA-ALCL is higher with textured breast implants than with smooth implants.
Susan G. Komen
BIA-ALCL is not breast cancer. It is a T-cell type of non-Hodgkins lymphoma, a cancer of the immune system. BIA-ALCL is highly treatable but if it is not detected before it spreads to other parts of the body, it can be deadly.
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Answer: Should I Still Get Implants If I Have High Risk Of Breast Cancer
You can still consider breast augmentation surgery with increased family risk of breast cancer. You are very wise to ask the question ahead of time and this will help in going through the consultation and planning process in order to decide if this is really the correct decision for you. I suggest, as others, that you get tested, such as the BRCA genes before you proceed with the augmentation. Furthermore, understand that there is an extra view that is done on mammograms for you in the future if you have implants in place. This is to get a complete view of the breast tissue. I applaud your work on the front end of this process and believe that you will make the right choice for yourself since you will be so well informed. Best wishes.For more information, please go to my website at:WirthPlasticSurgery.com