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The link between breast implants and a rare form of cancer

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A rise in the incidence of anaplastic large-cell lymphoma is being linked to textured silicone breast implants.

Breast implants have been making headlines as both France and Canada ban use of textured versions of the devices because of concerns about risks to health.

Textured silicone implants, which are common in New Zealand, have a roughened surface that adheres to surrounding breast tissue, lessening the likelihood of their becoming dislodged.

But the textured surface also creates a friendlier environment for a biofilm of bacteria to cling to. Australian research has shown this biofilm, most likely caused at the time of insertion, creates low-grade inflammation in the body and can lead to capsular contracture (hardening of the scar tissue around the implant), the most frequent cause of breast-implant failure.

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Although some women have reported a variety of other symptoms – including fatigue, brain fog, muscle weakness and memory loss – that disappeared once the implants were removed, so-called “breast-implant illness” is not the reason some countries are starting to suspend use of the devices. The major concern is a rise in the incidence of a rare cancer, anaplastic large-cell lymphoma (ALCL), which has been linked to textured implants.

According to Medsafe, there have been six confirmed cases of implant-associated ALCL in New Zealand, although it is possible the disease has been under-reported, since its symptoms can be confused with the more common capsular contracture.

So, is it time to ban textured breast implants here? Brandon Adams, of the Association of Plastic Surgeons, doesn’t think so, saying ALCL is “a real but very small risk” and that a blanket ban might disadvantage women who would benefit, such as those who have had radiotherapy following breast cancer and typically tend to suffer a high rate of capsular contracture using the smooth-walled implants.

“New Zealand plastic surgeons are highly aware of this issue,” he says. “Anyone who has had breast implants in the past five to seven years should have had a discussion about ALCL. We think it’s important to put the risks to women. Some will choose to go ahead with implants and others will opt for an alternative.”

The implant-free option for breast augmentation is fat grafting. This involves creating volume with fat that has been harvested from various sites on the body and gives a more natural result. However, it is a longer procedure with a tougher recovery period and sometimes takes two or three operations. If a woman is already dealing with breast cancer, says Adams, she may not want to go through that.

It is not known how many women in this country have breast implants, as some will have gone overseas for their cosmetic surgery. But these are not lifetime devices and eventually they can deteriorate, rupture and leak. The longer a woman has had an implant, the more likely it will need to be removed.

In Australia, breast-implant check clinics are starting to open to make monitoring easier. In this country there is no recommendation for regular screening. Adams’ advice to women with implants is to seek help if they notice any unexplained change in the size, shape or texture of the breast, such as lumps or swelling. A plastic surgeon can perform a physical exam and, if there is any concern, follow up with an ultrasound and possibly an MRI, and have any fluid present sampled and sent to the lab to check for ALCL.

The US Food and Drug Administration has recently reviewed the use of textured implants and decided there isn’t enough evidence that the health risks are high enough to warrant a ban. However, in the US, less than 10% of implants sold are textured.

In Australia, where there have been 78 cases of ALCL and four deaths reported to date, an expert working group is reviewing the risks associated with each type of implant. New Zealand is involved in the discussion.

If a woman is anxious about her breast implants, it may be time to think about what has become known as “explant surgery”.

“That’s especially so if it is a young person who had the surgery for cosmetic reasons and believed it would make them happy,” says Adams. “If they get to the point where these devices are making them less happy, they should consider getting them removed.”

This article was first published in the May 25, 2019 issue of the New Zealand Listener.