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ALCL Tumors Linked to Breast Implants

Last January the cosmetic surgery community received some significant information, about the detection of a certain incidence of a particular cancer in women with breast implants.

The FDA is knowledgeable of some 60 accounts of anaplastic large cell lymphoma (ALCL) in women with breast implants.

ALCL is considered as a very rare disease that nearly never begins in the breasts. Even so an amassing total of case reports indicate that ALCL in the breast may be an uncommon side effect of breast implants. Although ALCL is not a breast cancer, it is a form of lymphoma that induces white blood cells called T cells.

The ALCL tumors associated to breast implants appear in the scar tissue that borders the implant, not in the breast itself. Although ALCL can be a fatal disease, case reports imply that ALCL connected to breast implants is less disturbing and more easily treated, usual ALCL.

Stuart Linder, MD, FACS of Beverly Hills can share his knowledge about this finding.

Dr. Linder is a board certified plastic surgeon and author of The Beverly Hills Shape. His work in breast augmentation and revision breast augmentation are world-renowned.

Dr. Linder is known to be a ?super-specialist? in this field and thus has long and rich experience with the subject. These are his comments he shared with WebMD:

Today the FDA has announced a possible association between breast implants ? both saline and silicone ? and anaplastic large cell lymphoma, also known as ALCL.

This form of lymphoma, a malignant tumor of lymph nodes and related tissues, is an extraordinarily rare type of cancer. 60 cases of the disease worldwide have been discovered among an estimated 5 to 10 million women with breast implants. The FDA stated that most of the cases were reported after patients sought medical care for pain, lumps, swelling and other problems around the surgical site.

It is obvious that 60 cases out of 10 million women is a very, very small percentage of women who have acquired the anaplastic large cell lymphoma. Each year, ALCL is diagnosed in approximately one out of 500,000 women in the United States. To find 60 cases out of 10 million women worldwide is not alarming to me whatsoever. The majority of the cancers have been found in capsules surrounding the implants.

Recommendations by the FDA include women paying close attention to their breast implants and that 1) all healthcare providers report all confirmed cases to the FDA; and 2) that healthcare professionals should consider the possibility of ALCL in patients with late onset or persistent fluid around an implant (seroma). The FDA says there is no need for women with implants to change their routine medical care with follow-up, because ALCL is extraordinarily rare. Women should continue to monitor their breast implants, contact their doctor with any noticeable changes and any future patients undergoing breast augmentation should discuss the risks and benefits with their healthcare provider.

A further review by the FDA should occur in the spring of 2011. Both Allergan Pharmaceuticals and Mentor Corporation (now Johnson & Johnson) will continue to update their labeling for products to reflect the possibilities of this cancer.

In my opinion, these numbers are very, very small and although possibly significant, it is much more likely for women to develop breast cancer (1 out of 8) than for a woman to develop ALCL from having breast augmentation with either silicone or saline implants. It is important that patients not be scared from either elective or reconstructive breast enhancement surgery for fear that they may develop ALCL in the future.

In my many years of breast revision surgery, removing thousands of capsules and sending them to the Department of Pathology at UCLA, we have thankfully never seen a single case of ALCL.

Most importantly, all women should be informed of all possible risks of silicone and saline implants no matter how large or small the risk may be.

- Stuart Linder, MD, FACS

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