ALCL: Are your breast implant patients worried?

If recent consumer news of a link between having breast implants and getting anaplastic large cell lymphoma (ALCL) is prompting calls to the office from worried patients, there are things you can tell your patients that will put the headlines into perspective and might allay their fears.

In a study published this month, researchers conducted a retrospective review of documented cases of breast implant-associated ALCL in the U.S. from 1996 to 2015. They found a statistically significant link between textured breast implants and breast implant-associated ALCL. The risk among women with textured breast implants is low but notably higher than the risk of developing primary ALCL of the breast in the general population.

In March of this year, the FDA released an update (it has been providing data updates since 2011) stating that the FDA concurs with the World Health Organization’s designation of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The FDA went on to say that BIA-ALCL is a rare T-cell lymphoma that can develop after getting breast implants.

Dr. WongSo, what does this mean to the millions of women with breast implants? Alex K. Wong, M.D., associate professor of clinical surgery in the Division of Plastic and Reconstructive Surgery at Keck School of Medicine, University of Southern Calif., tells Cosmetic Surgery Times, that the U.S. FDA and other similar regulatory agencies around the world, such as the Australian Therapeutic Goods Association, have reported a possible association — with emphasis on “possible” — between silicone breast implants and anaplastic large cell lymphoma.

“While both surgeons and patients should be aware of this type of lymphoma, the number of cases reported is still very low (359 total, reported by the FDA) and, thus, it is a rare disease,” Dr. Wong says. “Current data suggests that textured implants are more commonly associated with ALCL, relative to smooth surface devices. At present, there is no definitive statistical proof that silicone breast implants cause anaplastic large cell lymphoma, and, thus, they remain approved for use in the United States and abroad.”

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The Patient Impact

Once surgeons put the news in perspective with facts, they should encourage patients with breast implants to be aware of this disease. If patients notice the development of a fluid collection adjacent to their implant, they should have their breasts evaluated by their physicians without delay, according to Dr. Wong.

“If detected early, breast implant associated ALCL is commonly cured by removal of the implant and surrounding capsule tissue,” he says.

Plastic and cosmetic surgeons should also address the issue of ALCL in the consult, making patients who want breast implants aware that there is an association between silicone breast implants and ALCL, which is a very rare disease.

“I believe this should be listed as a possible ‘risk’ on the surgical informed consent,” Dr. Wong says. “However, there is no current scientific data to suggest that breast implants cause any type of cancer, whether it is ALCL or the more commonly known breast tumors, such as ductal or lobular carcinomas. This is supported by several peer-reviewed published meta-analyses.”^1-3

Despite the media attention and real need to continue to monitor reported cases of BIA-ALCL, surgeons and their patients should know that silicone breast implants remain safe for use in breast augmentation. The emphasis should be on awareness and quick action in the rare case that this cancer occurs, according to Dr. Wong.

“Post-operatively, patients should perform routine self-exams of their breasts and, if they notice irregularities of any kind, this should be presented to their surgeon for evaluation,” he says.

Disclosures: Dr. Wong reports no relevant conflicts of interest.

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