How To Find More Information
I hope you feel more informed about BIA-ALCL after reading this article. However, if you would like to learn more about BIA-ALCL, I encourage you to review the FDA website, which links to a number of studies on the subject.
If you have concerns about your breast implants or suspect something may not be right, please contact your plastic surgeon immediately or locate a board-certified plastic surgeon with BIA-ALCL experience in your area.
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This story was initially published on 6/30/19. It is being republished today because of breaking news about Allergans worldwide recall of certain textured implants.
Should I Not Get Breast Implants Should I Have My Textured Implants Removed
Ultimately, this is your decision. While breast augmentation has helped millions of women enjoy a better quality of life and feel more confident with their bodies, it is not a medically necessary procedure. Which means its up to you to weigh the risk versus reward.
Speak with your surgeon about your concerns, learn about all of your options, and take some time to think. If youve come across this information while researching breast augmentation, remember there is no need to rush to a decision.
For women who currently have textured breast implants, the FDA states that there is no need to adjust your routine medical care and follow-up if you do not present with any symptoms. And, in fact, they do not recommend prophylactic breast implant removal if you are asymptomatic. That being said, this is your body. If you feel unsure or have found that worrying about BIA-ALCL is impacting your life, talk to your plastic surgeon about your options.
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How Are Implant Procedures Done
You might have a choice between having breast reconstruction at the same time as the surgery to treat the cancer or later .
Immediate breast reconstruction is done, or at least started, at the same time as surgery to treat the cancer. The implant is put in the same time as the mastectomy is done. After the surgeon removes the breast tissue, a plastic surgeon puts in a breast implant. The implant can be put under the skin or muscle on your chest. An absorbable mesh is sometimes used to hold the implant in place, much like a hammock or sling.
The benefit of immediate reconstruction is that breast skin is often preserved, which can produce better-looking results. Women also do not have to go without a breast shape.
While the first step in reconstruction is often the major one, many steps are often needed later to get the final shape or appearance. If youre planning to have immediate reconstruction, be sure to ask what will need to be done afterward and how long it will take.
This method allows time for other cancer treatment options to be given. For example, the expander can be filled during chemotherapy, but the final placement of the implant is put off until radiation treatment is complete. If radiation is not part of the treatment plan, the surgeon can start filling the tissue expander after surgery.
Two types of expanders are available:
You might choose to delay breast reconstruction if:
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What Types Of Implants Are Used For Breast Reconstruction
Several different types of breast implants can be used to rebuild the breast. Implants are made of a flexible silicone outer shell, and can contain:
- Saline: These implants are filled with sterile salt water. These types of implants have been used the longest.
- Silicone gel: Gel implants tend to feel a bit more like natural breast tissue. Cohesive gel implants are a newer, thicker type of silicone implant. The thickest ones are sometimes called gummy bear implants. They are more accurately called form-stable implants, meaning that they keep their shape even if the shell is cut or broken. They are firmer than regular implants and might be less likely to rupture , although this still might happen.
There are different shapes and sizes of saline and silicone implants and they can have either smooth or textured surfaces. Any type of implant might need to be replaced at some point if it leaks or ruptures. 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. But 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.
Can I Get Medicare Benefits For Tests And Treatment Of Breast Implant Associated Cancer
Even if your breast implant procedure did not attract a Medicare benefit at time of implantation, services for investigation and treatment of breast implant associated cancer, as with any other cancer, are eligible for payment of Medicare benefits. In addition to benefits for diagnostic imaging and pathology services, there is also a Medicare benefit specific for magnetic resonance imaging investigation of patients diagnosed with BIA-ALCL .
A Medicare benefit is payable under MBS item 45551 for removal of each breast implant and its surrounding capsule. Other MBS items are available for lymph node procedures and for other types of breast surgery if required. Your surgeon will choose the appropriate items depending on the procedure that is clinically necessary for you.
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Getting Help With Breast Implant Cancer And Illness
Women with any breast implantssaline or silicone, textured or smoothshould be aware of the risk of cancer. If you have breast implants, take some time to . When this cancer is caught early, .
This form of cancer occurs around 8 to 10 years after implant surgery. So, even if youve had your breast implants for years without a problem, notify your doctor immediately if you notice any new symptoms.
Women who develop cancer because of their breast implants dont deserve to get sick. If you receive a diagnosis of breast implant-associated cancer, Contact Breast Implant Cancer Advocates for support and a free legal case review.
Are Your Breast Implants Poisoning You? National Center for Health Research. Retrieved from http://www.center4research.org/breast-implants-poisoning/. Accessed on April 12, 2019.
Breast implants: Saline vs. silicone Mayo Foundation for Medical Education and Research. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/breast-implants/art-20045957. Accessed on April 12, 2019.
Risks of Breast Implants U.S. Food and Drug Administration. Retrieved from https://www.fda.gov/medicaldevices/productsandmedicalprocedures/implantsandprosthetics/breastimplants/ucm064106.htm#Risks_of_Breast_Implants. Accessed on April 12, 2019.
Breast Implant Illness + 6 Other Breast Implant Dangers Dr. Axe. Retrieved from https://draxe.com/breast-implant-illness/. Accessed on April 12, 2019.
What If I Have Implants But No Symptoms At All
Get to know the normal look and feel of your breasts. Self-examine your breasts regularly, such as in the bath or shower, and include your armpits and up to your collarbone.
If you think there are any changes, or if you have any concerns, see your doctor.
Discuss with your surgeon how often in your case there should be monitoring over the longer term.
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What You Need To Know About Breast Implants
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.
Tissue Support For Implants
Tissue support is sometimes needed for breast reconstruction, especially when implants are used. This tissue can provide added coverage over the implant, hold the implant in place, or position the muscle where it needs to be.
One way to do this is to use a womans own body tissues as part of a flap procedure. Tissue from another part of the body, such as the tummy or back, is used to create a kind of pocket to hold the implant in place or for added skin coverage over the implant. See Breast Reconstruction Using Your Own Tissues for more information.
Some products use donated human skin or pig skin to support implants or transplanted tissues. These are known as acellular dermal matrix products because they have had the human or pig cells removed. This reduces any risk that they carry diseases or that the body will reject them. They are used to extend and support natural tissues and help them grow and heal.
The use of acellular matrix products in breast surgery first started in the early 2000s. Studies that look at outcomes are still being done, but they have been promising overall. This type of tissue is not used by every plastic surgeon, but it is becoming more widely available. Talk with your doctor about whether these materials will be used in your reconstruction and about their benefits and risks.
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What Happens Before This Procedure
Breasts continue to develop in women into their late teenage years or early 20s. As a result, you have to be at least 18 years old to get saline-filled breast implants. The FDA recommends that you are at least 22 years old to get silicone-filled breast implants.
Your healthcare provider will assess many factors, including your mental health and any social conditions. Your healthcare provider may ask the following questions:
- Why do you want breast implants?
- What are your expectations?
- Do you think a lot about imagined or very small defects with your body?
- Is a spouse, partner or friend encouraging you to get breast implants?
Your physical health and body type are also important. Your healthcare provider will examine your body to help you choose the right implant. They will measure your height and weight, and they will also study your overall body structure. For example, larger implants are often necessary for patients with broader shoulders or wider hips. If you have a smaller body structure, larger breast implants may cause health issues, including back, neck and shoulder pain.
You and your healthcare provider will also consider whether saline or silicone breast implants are best for you. Youll also consider breast implant shape , shell texture and placement.
Chemicals In Cosmetics Food And In Plastic
There is some concern that exposure to phthalates, specifically, may increase a woman’s risk of developing breast cancer, but the data on this issue aren’t clear.
Phthalates can be found in medical supplies, food containers, cosmetics, toys, some medications. Aside from this, there is no evidence that exposure to other chemicals increases a womans risk of developing breast cancer.
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What Should You Do If You Have Breast Implants
At this time, the FDA does not recommend removal of these or other types of breast implants for patients who have no symptoms due to the low risk of developing BIA-ALCL.
So, the FDAs recent announcement should not change anything for the overwhelming majority of patients who have smooth-surfaced implants or textured implants by other manufacturers, says Henry Hsia, MD, a Yale Medicine plastic surgeon.
Dr. Hsia strongly advises, though, that no matter what kind of implant a person has, its important to be breast aware and report any persistent symptoms to your doctor. Anyone with pain or discomfort or other concerning changes in her breasts should get in touch with her plastic surgeon, he says. Changes include swelling, lumps, or painall are symptoms of BIA-ALCL to look out for.
For years, all of our breast reconstruction patients at Yale Medicine have been counseled extensively when they come for their initial preoperative consultation visit about the BIA-ALCL risks , and the FDA announcement should hopefully only reinforce the counsel and advice that they originally received from their providers, Dr. Hsia says.
Here are some tips to keep in mind if you have implants or are considering them:
Follow FDA advice. If your physician deems that there is BIA-ALCL, you should undergo implant removal as well as removal of the surrounding scar capsule. It may be possible to replace the device with one not associated with BIA-ALCL.
Can I Lower My Risk Of Getting A Second Cancer
There’s no sure way to prevent all cancers, but there are steps you can take to lower your risk and stay as healthy as possible. Getting the recommended early detection tests, as mentioned above, is one way to do this.
Its also important to stay away from tobacco products. Smoking increases the risk of many cancers, including some of the second cancers seen after breast cancer.
To help maintain good health, breast cancer survivors should also:
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Main Risk Factors For Bia
Breast implants have a silicone outer shell that can be either smooth or textured, and the main known risk factor for BIA-ALCL is having a textured implant.
The risk factors for BII arent as clear but are likely to include having a personal or family history of autoimmune conditions, allergies, and conditions such as irritable bowel syndrome, migraines, chronic fatigue, or fibromyalgia.
Both smooth and textured implants are filled with either silicone gel or saline . Silicone gel-filled implants are the most common in 2018, 88% of breast implants sold in the U.S. were silicone gel-filled.3 Much of the attention and research related to the question of whether breast implants can cause autoimmune symptoms or other health problems has centered on silicone gel-filled implants in particular.
While more research is needed on whether implant fill type is linked to a higher risk of BII or BIA-ALCL, its important to know that both conditions have occurred in women who got silicone gel-filled or saline-filled implants for reconstruction or for cosmetic augmentation. A history of breast cancer also doesnt, in itself, appear to increase the risk for BII or BIA-ALCL.
Learn more about each condition, including specific risk factors and possible causes, number of cases, diagnosis, treatment, and more:
Risks Of Breast Implants
Certain types of breast implants can be linked to a rare kind of cancer, known as anaplastic large cell lymphoma . It is sometimes referred to as breast implant-associated anaplastic large cell lymphoma . It is not a type of breast cancer. This lymphoma happens around 8 to 10 years after the implant was placed and more often if the implants have textured surfaces rather than smooth surfaces. If BIA-ALCL does show up after an implant, it can show as a collection of fluid near the implant, a lump, pain, swelling or asymmetry . If you have any concerning symptoms, you should discuss them with your doctor.
Early-stage disease is often treated with surgery to remove the implant and capsule. More advanced disease requires chemotherapy. Radiation may be used in certain cases. Prognosis is usually better for women with early-stage disease.
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What A Breast Enlargement Involves
Breast implant surgery is carried out under general anaesthetic.
The operation involves:
- making a cut in the skin next to or below the breast
- positioning the implant either between your breast tissue and chest muscle, or behind your chest muscle
- stitching the incision and covering it with a dressing
The operation takes between 60 and 90 minutes.
You may be able to go home the same day, but may need to stay in hospital overnight if the operation was scheduled late in the day.
You’ll be given pain relief if you experience any discomfort afterwards.
What Should You Do If You Have Implants
Talk to your doctor. Most experts dont recommend removing textured implants just because of their link to ALCL. But if you do have textured implants and youre concerned, talk with your doctor.
Its important to watch for the signs of ALCL. It can show up anywhere in your body. But most women with breast implants get it near scar tissue where their implants are.
Check your breasts regularly for:
- New swelling
- Lumps or other changes in the shape of your breast
- Pain in or near your breast thats regular or constant
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Why Does It Take So Long For Bia
Most people who are diagnosed with BIA-ALCL have their cancer develop 8 to 10 years after breast implant surgery. Although the exact cause of BIA-ALCL is not known, it is believed that some breast implant material can cause lasting irritation inside the body and cause the immune system to overreact.
Medical professionals are still doing research into what mechanisms cause BIA-ALCL and why. What researchers do know is that the cancer is exceedingly rare. Right now, there are about 10 million women worldwide with breast implants. But there are only about 10 women per year that get diagnosed with BIA-ALCL.
What makes BIA-ALCL notable is that it is not actually a form of breast cancer. It develops in the scar tissue between the breasts and implants themselves before spreading to other parts of the body. If the cancer can be caught before it spreads throughout the body, the prognosis for recovery is generally good.
Alcl’s Severity And Ability To Spread
Dr. Jones: Right. Well, when we’re talking about breast cancer, even a very rare one, people think about this being lethal. So, when this presents, is this usually a cancer that’s spread already? Do most people die from this cancer? What happens when people find this cancer?
Dr. Agarwal: Most of the time with ALCL that’s associated with breast implants, the cancer resides locally in the tissues around the implant. And for most of the cases, removal of the implant and removal of the capsule, the scar tissue around the implant can cure the patient of the lymphoma. In rare instances, the lymphoma can spread to the lymph nodes or elsewhere, but the most common presentation is a local one.
Dr. Jones: Well, that’s actually great news for a rare cancer, for it to be actually mostly curable with the surgery, just remove the implant and capsule. To me, as a provider and as a woman, that’s very reassuring to me.
Dr. Agarwal: Yes. Nobody wants to have an increased risk of anything if they’re having a medical device placed. The good news is it’s very rare, and if caught within an early period of time, it can be cured by removing the implant and the capsule. If there’s something good about it, I’d say.
Dr. Jones: That’s right. I think that’s good news about bad news.
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