Anaplastic Large Cell Lymphoma in Breast Implant Patients

ALCL arising around breast implants

Breast Implant-associated ALCL

Although breast cancer is a relatively common disease (1 in 8 women, lifetime risk), less than 0.5% of these cancers are Non-Hodgkin’s Lymphomas. Historically, the few rare cases of breast lymphoma that have occurred have been B-cell Lymphomas. In the last few years, there have been about 42 cases diagnosed of T-cell Lymphomas in women with breast implants in place.  Thirty-five of these cases have been the rare ALCL type, Anaplastic Large Cell Lymphoma, found within the breast capsules surrounding breast implants. ALCL has been previsously shown to occur as a primary entity within the skin. Those particular types of Lymphomas have a fairly good survival rate: the ten year survival is over ninety percent. Investigators think that this new breast implant-associated ALCL may behave in a similar fashion as the cutaneous types have. A recent article (Taylor, Webster and Prince, Anaplastic Large Cell Lymphoma and Breast Implants: Five Australian Cases,Plast Recon Surg, Vol 129, No 4, p808, April 2012) has provided an update to this new entity.

According to the article, the diagnosis of ALCL should be considered in any patient who presents with a peri-prosthetic seroma formation six months or longer after they had their implants put in.  Historically, there have been no studies that have linked any types of breast cancer to breast implants. However, older studies that looked at breast cancers that occurred in patients with breast implants did not report on the occurrence of lymphomas in the breast.Currently, there have only been about 42 cases of T-cell lymphoma associated with breast implants reported in the literature. Thirty-five of these cases were ALCL, Anaplastic Large Cell Lymphoma. Of cases that have been reported, they have occurred in patients with both saline and silicone implants. However, in one of the studies all of the patients who had developed ALCL did so in the presence of textured implant devices. Of the previously reported patients who developed breast implant associated ALCL (37 cases, of which only 31 had complete data) available in the literature, 13 of the cases occurred in patients with SALINE implants. In all of the cases that were reviewed that had accurate data available, textured surface implants were used. Although inconclusive, these cases suggest that the entity of breast implant associated ALCL occurs only in the presence of textured surface breast implants, irrespective of being filled with saline or silicone. Importantly, all but two of the patients that have developed this diagnosis have had a good prognosis.

If you have developed swelling of one breast more than six months after breast augmentation surgery and are considering breast implant removal, you should contact Dr. Brenner.

Breast Implant Exchange: 5 Reasons you may need Removal & Replacement

1. Implants too old: The lifespan of a breast implant is generally thought to be about 10 to 12 years. However, age of an implant alone is not necessarily a reason to remove them. Especially with respect to saline implants, if a patient is not having any issues with the implant, it is likely safe to leave the implant alone. Conversely, silicone gel implants may require imaging once they reach a certain age. This is best done with an MRI, which has the best detail  and the most sensitivity for detecting damage to the outer shell. If a silicone implant is noted to be damaged, then breast implant exchange is indicated.

2. Implants ruptured or leaking: Breast implants are mechanical devices and will develop “wear and tear” over time. When a breast implant sustains an injury to its shell (i.e.a tear) it will begin to leak its contents. With respect to saline implants, the saline will leak out slowly and be absorbed by the capsule and into the blood stream. Silicone implants can leak as well. However, silicone implants (in particular the new cohesive gel silicone implants) will tend to maintain their shape, even when the shell is compromised. When an implant leak leads to a change in shape of the breast, this is known as symptomatic rupture. When an implant leak is undetectable to the eye or on physical examination, this is known as silent rupture.

3. Want an implant size change: Some women have breast implants that they are very happy with; they just simply would like a size change. For most patients that fall into this category, they have grown familiar with their size and would prefer to exchange them for a bigger size. For the minority of women who desire a smaller size, they may choose to “downsize” their implants.

4. Want to change from saline to silicone breast implants: Both saline and silicone are great choices when it comes to breast augmentation. However many patients were implanted with saline implants prior to silicone implants becoming approved by the FDA in 2006 for cosmetic use. Therefore, there is a large subset of women who want to switch to silicone simply for the advantage of having breast implants that feel more natural.

5. Capsular Contracture: Breast implants are mechanical devices. Following implantation, the body forms a capsule around the breast in order to “wall off” the implant as a foreign body. Rarely, people will have an overwhelming inflammatory reaction within the breast capsule that causes it to tighten around the implant. When severe, this may require removal of the breast capsule along with removal and replacement of the involved implant.