Breast implants and the research that is shaping the way we practice
Guest Article by Dr Terrence Scamp
Over the last few years we have become aware of a rare condition called breast implant associated lymphoma. This is also known as ALCL and should not be confused with Breast Implant Illness (BII). An enormous amount of research has gone into ALCL and more is ongoing.
From this research we have learnt that the condition is associated with certain types of implants and the risk profile is proportionate to the implant type. The more heavily textured implants and those coated with polyurethane, have the highest risk of developing this condition. Based on the current information available, the risk of developing ALCL would appear to be about 1 in 2,850.
Implants that have heavy texturing (macro textured) also have a higher risk profile, being about 1 in 4,400. When the texture is lighter in nature (micro textured), the risk drops rapidly to about 1 in 80,000. It seems that implants that have a smooth wall, including the new Motiva implants, have the lowest risk profile of all with no definite cases now linked to patients who have only had these implant types. When trying to put this into perspective, the risk of breast cancer is about 1 in 8. This dwarfs the risk of implant associated lymphoma.
Implant associated lymphoma on average presents at eight or more years after having a breast augmentation operation. Most women will notice the onset of this condition as swelling of one breast. This can be quite profound and happen overnight. An Ultrasound can be performed and will generally show a large amount of fluid around the implant. In order to make a diagnosis, the fluid needs to be sampled via a fine needle aspiration under ultrasound control.
Once the diagnosis of ALCL is made, it is easily cured (if detected early) by removal of the implant and surrounding scar capsule. This has also been referred to as ‘en bloc’ procedure and is well known in the online communities. As already stated, when detected early, the disease is confined to the scar capsule wall (the tissue that immediately surrounds the breast implant) or the fluid around the implant. Removing the scar capsule (and implant) effectively cures the condition.
With a growing body of evidence on ALCL, Trusted Australian plastic surgeons have gravitated towards the lower risk profile implants, in a bid to further reduce the incidence of ALCL occurring. Despite there being only a small risk with any implant, we all naturally have a desire to eliminate as much risk as we can. Because the risks of ALCL is low, wholesale removal of the more heavily textured or polyurethane coated implants has not been recommended. At this stage regular checks and simple observation with or without ultrasound monitoring every couple of years has been recommended.
The natural history of breast implants is that they are not lifetime devices. As time marches on, so does gravity and the effects of gravity on breast implants. Some common milestones may be, Breast augmentation at 21 years of age, removal and replacement (en bloc) after children around the age 40 mark and then removal and replacement again later in life. This is obviously different for everyone but highlights that implants are not designed to remain in the body for ever.
When a patient with more heavily textured implants decides that it is time to remove and replace their breast implant, our practice has been to shift them to a lower risk profile implant. It is also possible to just perform the en bloc procedure without replacing the implants. Sometimes in the older age group, weight gain over the years has seen a natural increase in breast size and therefore an implant may no longer be necessary. In this group, simple removal with or without a breast lift may create a satisfactory breast appearance without the need for the extra assistance of a breast implant. The choice is always individual, but we are always here to provide the relevant information and utilise our years of expertise to help patients make informed decisions. Feel free to call the clinic if you have any concern over your breast implants on 07 5539 1000.
Have you had your breasts checked lately?
Before and Afters of real Dr Scamp patients who have undergone a removal and replacement:
Expert Author Terrence Scamp has been invited regularly to give lectures on Cosmetic procedures within Australia and overseas and involved in the training of other surgeons in cosmetic breast surgery, facial rejuvenation, rhinoplasty and non-surgical techniques. He was also involved in the further development of 3D imaging for rhinoplasty and breast augmentation.
A Platinum member of Trusted Surgeons Dr Scamp is a Fellow of the Royal Australasian College of Surgeons in the division of Plastic and Reconstructive surgery. He is a member of the Australian Society of Plastic Surgeons (ASPS) the Australasian Society of Aesthetic Plastic Surgeons (ASAPS) and a member of the International Society of Aesthetic Plastic Surgeons (ISAPS). He is also a corresponding member of the American Society of Plastic & Reconstructive Surgeons.