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February 07, 2011

Breast Lymphoma Associated with Implants: Worth Being Scared About or Scare Tactic

On January 26, 2011, the U.S. Food and Drug Administration warned about a potential association between anaplastic large cell lymphoma (ALCL) and breast implants.

  • If you have breast implants, should you be worried?
  • Should you call your plastic surgeon to have them removed?

No & No.

ALCL is considered a rare but aggressive type of lymphoma.  Only one in 500,000 American women develop ALCL.  It is even rarer in the breast itself--3 in 100 million women (without implants).  Fortunately, most forms of ALCL are treatable with a cocktail of chemotherapy.

Over the past two decades, implants have not been definitively linked to rheumatalogical diseases, breast cancer, leukemia, or lymphoma.  On the contrary, the safety of breast implants has been proven in a number of North American and European studies.

Like any foreign body, implants elicit a scar capsule.  The body doesn't know what the artificial substance is; the immune system cannot break it down and destroy it.  So, the body creates scar around the implant.  That scar is known as a capsule.

In some capsules, cells have been identified that look awfully similar to ALCL--34 identified cases out of an estimated number of 5 to 10 million women with breast implants.  However, none of those patients has subsequently developed the traditional constellation of findings consistent with ALCL.  None have died of lymphoma/cancer.

Moreover, surgical removal of the scar capsules has definitively removed all evidence of the abnormal cells.  No chemotherapy was ever necessary.

This is awfully strange.  Surgery is not at all effective for traditional ALCL.

So, did those 34 women ever have ALCL or a variant of ALCL?  Or did they have funny reactions to the implants in their scar capsules, which looked a lot like ALCL, but which were never ALCL in the first place?

A shark looks like a dolphin.  They are both sleek and grey.  They both swim and hunt fish.  But they are awfully different.

ALCL is clearly a shark.  It's a bad actor.  But the implant-ALCL (if I should even call it that) may be a dolphin.  It can look scary at first glance, but, in fact, it may not dangerous at all.

If you have breast implants, there is no need to change your routine medical care and follow-up.  ALCL is very rare; it has occurred in only a very small number of the millions of women who have breast implants.

What to remember to do: 

  • Monitor your breast implants.
    • If you notice any changes, contact your health care provider promptly to schedule an appointment.
    • The (supposed) cases of breast-implant-associated ALCL all presented with the late onset of symptoms such as pain, lumps, swelling, or asymmetry. 
  • Get your radiologic imaging.
    • Routine mammograms.
    • If you have silicone breast implants, do consider periodic magnetic resonance imaging (MRI) to detect ruptures.  (The FDA suggests that patients with silicone breast implants should obtain MRIs after 3 years and then every 2 years thereafter.  Personally, I think that this is excessive, but you might decide for yourself what is appropriate.)
  • Don't panic.  The FDA may be acting overly cautiously.  Just be aware.

 

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