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.
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
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.
Linder, MD, FACS