ANNOUNCEMENT FOR PATIENTS WHO HAVE SILICONE BREAST IMPLANTS OR PLANNING BREAST AUGMENTATION SURGERY
There have been some reports in the media that silicone breast implants cause some kind of cancer in the breast. This makes us confronted with the question “Does silicone implants cause breast cancer?” I have prepared this article to inform you about this confusing subject.
BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma) is not a cancer of the breast tissue itself. BIA-ALCL is a rare type of lymphoma and, when caught early, it is curable in most patients. It is a very rare (between 1 in 1.000 and 1 in 40.000 people with breast implants) type of lymphoma in the scar capsule adjacent to the implant. This disease has been seen in patients who have used a breast prosthesis (silicone, implant) with a textured surface so far.
What is BIA-ALCL? Is it breast cancer?
A thin layer of scar tissue, which we call a capsule, is formed around the silicone implant. BIA-ALCL is not breast cancer, it is a very rare type of lymphoma that develops completely in this scar capsule. When diagnosed early, it can be treated; however, if neglected, there is a possibility of spread throughout the body. Although it is known that approximately 35 million silicone prostheses have been sold in the world market since 1997, the number of patients reported to have this disease to date is less than 600.
Is BIA-ALCL a serious disease?
When BIA-ALCL is diagnosed early, it is usually a curable disease. 33 of the 573 patients reported in the world were lost due to this disease. The death of patients due to BIA-ALCL is thought to be due to delay in diagnosis or inappropriate treatment due to neglect of the symptoms.
What are the symptoms?
The most common finding of BIA-ALCL is diffuse swelling in the breast. In addition, less common findings such as stiffening of the breast, unusual and persistent rash, palpable mass in the breast or armpit may be present. If you have any of these symptoms, make an appointment with your doctor for examination and further tests as soon as possible.
What should I do if there are no symptoms?
To date, no health institution or health authority in the world recommended removal of silicone implants in women who have no symptoms. So, if there is no symptom, silicone implants do not need to be removed. However, you should be cautious for the symptoms.
Should women with breast implants be screened for BIA-ALCL?
The FDA recommends that asymptomatic women without breast changes do not require more than routine follow-up. If a patient experiences a change in her breasts (especially if there is swelling or a lump) she should undergo examination and appropriate imaging, including ultrasound and fine needle aspiration of any peri-implant fluid.
You should monitor your breast implants with routine breast self-exams and follow standard medical recommendations for imaging (e.g. Mammography, Ultrasound, and MRI). Tests and procedures could include but may not be limited to: obtaining breast fluid or tissue for pathology and laboratory evaluation and surgery to remove the scar capsule around the breast implant, implant removal or implant replacement.
Are all silicone implant types carry this risk?
Silicone breast implants are produced in two types as surface structure, smooth and textured. Among all available prosthesis types, only prostheses with a textured surface have been reported to be at risk of BIA-ALCL. To date, there is no reported case of BIA-ALCL of purely smooth implants. Although it is rare, BIA-ALCL appears to currently develop exclusively in women with textured implants. To date there has not been a case of BIA-ALCL in a patient with only smooth implants. Proposed theories of the primary potentiator of BIA-ALCL include textured implant particulate, mechanical friction, and/or bacteria/biofilm. The exact cause of this disease is still unknown.
Cihan ŞAHİN, M.D., Professor