Breast augmentation consistently ranks among the most performed cosmetic surgeries worldwide. The vast majority of patients who have this elective surgery have problem-free procedures that also produce outstanding results, often surpassing the client’s expectations. The popularity of these procedures is no surprise. Few aspects of a woman’s body convey her femininity and sense of identity as much as her breasts, and breast augmentations have been performed by surgeons for decades, making them among the most well-understood cosmetic procedures offered.
While the popularity of these procedures continues to grow, so too do reports of symptoms by women who have had breast implant surgery. Symptoms associated with “breast implant illness,” as it has been called, have raised concerns about the safety of certain types of implants, causing women to wonder whether they should delay a planned procedure or consider breast implant removal if they have already had one. The most pressing concern among women is reports of a rare type of cancer (called anaplastic large cell lymphoma, or ALCL) associated with textured breast implants.
While the relationship between silicone breast implants and ALCL is becoming better understood, we have yet to fully predict who is most at risk and what specific risk factors foretell who will develop the disease. There are some things we do know. ALCL is associated with textured implants and almost exclusively with a particular type of texturing used by one of the three breast implant manufacturers in the United States. As new information becomes available, one of the most important things both surgeons and patients can do in responding to these concerns is to examine the facts and case study evidence carefully, rather than allowing fear or misinformation to drive their decision-making. By doing so, patients, guided by their surgeons, can make informed decisions that will best suit their circumstances, preserve their safety, and achieve their desired outcomes today.
What is meant by “breast implant illness?”
Breast implant illness is a broad term that refers to a number of individual illnesses that women believe are associated with their breast implants. Illnesses which are frequently categorized underneath this blanket term include:
- Anaplastic large cell lymphoma (ALCL) — a rare cancer of immune system cells
- Capsular contracture — firm scar tissue that forms around an implant after breast pocket placement
- Chronic fatigue syndrome
- Cognitive issues
- Muscle pain around the implants
- Chest pain
- Chronic pain
It is believed that breast implants may contribute to or cause these illnesses through a number of pathways, which include:
- Breast implant breakage or rupture
- Breast implant micro-leakage (release of small amounts of silicone outside the shell)
- Silicone leakage to the lymphatic system
Capsular contracture and micro-leakage may involve the scar tissue capsule, breast implant capsules, and the tissues surrounding the implant, which can contribute to symptoms. Heavy metal toxicity has also been proposed as a possible, but unproven, mechanism.
While the symptoms that women report are real and should be taken seriously by their doctors, the presence of symptoms in women who have breast implants does not necessarily prove or establish a link between these symptoms and the implants themselves.
There is currently no proven link between breast implants and systemic illness or autoimmune disease. However, it can be challenging to differentiate breast implant illness from similar symptoms caused by autoimmune conditions, autoimmune disease, and connective tissue disorders, such as rheumatoid arthritis. It is important to rule out other health conditions that may present with similar symptoms.
What is ALCL?
Among the most concerning of the illnesses potentially associated with breast implants is ALCL, or anaplastic large cell lymphoma. ALCL is a rare form of cancer that affects the cells of the immune system; however, this cancer is not a form of breast cancer since it does not affect the native breast tissue, even though it forms near breast implants.
The most common finding in a woman who has ALCL is the development of a seroma, a pocket of clear fluid that has formed between the implant and the scar tissue capsule surrounding the implant. However, the disease can present with a lump in the breast. Symptoms like these do not confirm an ALCL diagnosis; however, any changes in the size of your breasts or the development of a lump should always be reported to your surgeon. Implant rupture can also cause changes in breast size or lumps and should be considered as a possible cause.
Who is at risk for ALCL, and is it treatable?
The factor common to all ALCL diagnoses to date is the use of textured breast implants, regardless of whether those shells are filled with a saline solution or silicone gel.
The standard treatment for ALCL is to remove breast implants and the surrounding capsule. Some women choose to remove implants and undergo implant exchange with smooth implants to reduce their risk. When implants are removed for ALCL or other reasons, fat grafting may be performed to restore breast contour.
Two encouraging facts: if a woman has her textured implants replaced with smooth implants, the risks for ALCL can be significantly reduced or even eliminated. Second, for women who have had a breast augmentation using textured implants, there is no need for action unless there are problems; and if ALCL is diagnosed, it is typically highly treatable through surgery alone if caught early.
What has been the FDA’s response to women’s reports of breast implant illness symptoms?
Today, the FDA recognizes the need for more research to vet these claims before conclusions can be drawn and recommendations to women can be made with confidence. As recently as March 2019, the FDA said that it is too soon to ban silicone breast implants, which may have a link to ALCL due to a lack of scientific, independently verified information. At the same time, the FDA has issued warning letters to two major breast implant manufacturers for “failure to comply with their requirements, under their premarket approval orders, to conduct post-approval studies to assess the long-term safety and risks of their silicone gel-filled breast implants.”
These studies, which manufacturers must undertake to be in regulatory compliance, should soon provide additional, valuable information which can be used to assess the safety of saline breast implants and the course women interested in having them should take. Ongoing research is also examining the composition of breast implant capsules to determine if they contain heavy metals or other substances that could be linked to patients’ symptoms associated with breast implant illness. The FDA’s response to reports highlights the importance of considering patients’ symptoms in regulatory decisions. Meanwhile, patients should rely on the expertise and experiences of their surgeons to guide them through their decision-making.
For trusted, fact-based advice, visit Dr. Kahlil Andrews of Dr. Andrews Plastic Surgery
The decision whether or not to have breast augmentation can be a daunting one for many women because of the number of choices presented to a woman considering the procedure. The potential risks of breast augmentation further complicate this choice, but these factors should not deter women considering surgery from having a consultation or their procedure. The bottom line is that the vast majority of surgeries pose minimal risk, and these risks can be further lowered through strategic choices that can be made in consultation with the surgeon. The high-quality results that most women enjoy also have a priceless effect on their sense of self and confidence.
If you still have questions about having a breast augmentation or the safety of the procedure, schedule an in-person consultation with Dr. Andrews in Cedar Rapids and Coralville, Iowa, today by calling 319-318-6625. If you are anxious about scheduling a consultation or looking for a trusted expert to answer your questions in a low-pressure environment, Dr. Andrews hosts complimentary breast augmentation seminars at his Coralville office. Stay tuned for the latest dates. We look forward to answering all of your questions and are committed to helping women achieve their ideal outcome safely.
