Breast augmentation is one of the most popular cosmetic surgeries. Breast implants themselves have been used since the 1960s and are one of the most heavily scrutinised and investigated medical devices in history.
The types of implants available today, combined with continual refinement of breast augmentation surgery, make the procedure more reliable than ever before. All surgery, however, carries some risk and both regulatory agencies and practitioners continue to ensure the safety of the patient remains paramount.
There has been renewed discussion surrounding the safety of breast implants, stemming from the global recall of Allergan’s textured Biocell breast implants. The recall of the Allergan Biocell implant was due to findings that this particular implant is associated with the risk of breast-implant associated anaplastic large cell lymphoma (BIA-ALCL), a rare but highly treatable form of immune system cell cancer. Since then, all breast implants with a higher risk of BIA-ALCL have been removed from the Australian market.
What is BIA-ALCL?
BIA-ALCL is a rare and highly treatable cancer of the immune system that can develop around breast implants; it is not breast cancer. When diagnosed early and treated properly, this disease is curable.
According to the Therapeutic Goods Administration (TGA), current expert opinion puts the risk of ALCL at between 1-in-1,000 and 1-in-10,000. Based on currently available data, most (95%) of cases of breast implant-associated ALCL occur between 3 and 14 years after the implant (median: 8 years; range: 1-37 years). The TGA says that over the past 10 years, three Australian women have died from breast implant-associated ALCL.
All reported cases of breast implant-associated cancer in Australia involve patients who have had a textured (vs smooth) implant at some point in their life. Based on current evidence, experts do not think breast implant-associated cancer is related to either the contents (saline/silicone) or shape (round/teardrop) of the implant.
Breast implants with a higher risk of BIA-ALCL have either been removed or suspended from the Australian market. In addition, some suppliers have also decided to remove particular types of breast implants from the market. For up-to-date information on which breast implants and tissue expanders are affected, see tga.gov.au/hubs/breast-implants.
Should you remove your breast implants?
The international consensus is that there is no evidence supporting the removal of breast implants in the absence of properly diagnosed BIA-ALCL. If you don’t have symptoms, you don’t have to remove your implants.
Because breast implant-associated ALCL is rare, experts do not recommend removal of breast implants for women who have no problems with the implant. The risk of undergoing surgery to remove your implants could be higher than the risk of developing BIA-ALCL.If you are concerned you should discuss your options with your doctor.
How do I know if I have BIA-ALCL?
If you develop swelling of an implanted breast your doctor will send you for an ultrasound scan to see if this is due to a fluid collection. If fluid is present it will be removed and sent to the laboratory for analysis. Most fluid collections are not ALCL, but the laboratory test will be able to tell for sure. Mammograms are not helpful for diagnosing ALCL. Other investigations such as MRI and CT-scans would typically be done if the laboratory analysis of the fluid confirms a diagnosis of ALCL.
Most cases of BIA-ALCL are cured by surgery alone, with removal of the implant and surrounding capsule. If there is a breast implant in each breast, then both implants are removed even if symptoms are only on one side.
Is breast implant illness real?
There have been anecdotal accounts of breast implants causing a variety of general health issues, known as “breast implant illness.” Symptoms are non-specific and include general fatigue, joint aches, headaches and brain fog. To date, there is no distinction between the types of breast implant and the likelihood of a patient developing an autoimmune response to the medical devices being inserted, and there is no known link between these symptoms and BIA-ALCL.
KEY TAKEAWAYS
- BIA-ALCL is extremely rare.
- BIA-ALCL is not breast cancer but a type of immune system cell cancer.
- Experts do not recommend removing breast implants in patients who have no symptoms (persistent swelling or pain in the area of the breast implant usually years after surgery) due to the low risk of BIA-ALCL.
- “Breast implant illness” is separate to BIA-ALCL and evidence is lacking whether it is connected to a variety of general health issues such as muscle aches and fatigue.
- Breast implants shouldn’t be viewed as lifetime devices regardless of breast implant-associated ALCL. Typically they are removed after 10-15 years.
For more information and support, the TGA has set up a breast implant hub, which is updated when new information arises.
