In March of this year, the FDA claimed that it had identified an association between breast implants and anaplastic large cell lymphoma, a rare type of non-Hodgkin's lymphoma. As you can imagine, this would make anyone with implants — or anyone considering getting them — freak out. The FDA has since updated its stance because, as it turns out, the link is more complicated than just saying that implants cause breast cancer.
Also, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) — the cancer that the FDA was warning people about — isn't a breast cancer, Dr. Johnson says. It's a very rare type of lymphoma, which is cancer that starts in white blood cells. Typically, BIA-ALCL shows up around the scar tissue from the implant, not the actual breast, according to the Mayo Clinic. Additionally, there are two different types of breast implants — smooth versus textured ones — and this kind of cancer is only associated with one of them.
When implants were first designed, they were initially all smooth-walled like a balloon, Dr. Johnson says. But the smooth implants caused a layer of scar that would shrink and make the implant feel firm, which meant they required lots of adjusting.
To avoid this, surgeons began using implants with a textured coating made with a foam spray, she says. "Instead of a smooth scar that could tighten, [this left] kind of an interactive scar more like Velcro." But then some of the materials were linked to sarcoma in rats. "It had never been seen in humans, but the manufacturers at that point said, Oh, this is a scary thing we don’t want to be hurting patients." Next, they began creating implants with "nubby surfaced shells so the balloon surface now was irregular." And here's the problem: breast implant-associated cancer doesn't seem to happen in people with smooth implants.
"We can’t say it doesn’t occur in those women, because it is exceedingly rare, but we’ve not diagnosed a patient with smooth implants with this disease as yet," Dr. Johnson says.
Research has shown that BIA-ALCL is linked to textured implants in particular. "[It] appears to be, from a lot of the data and studies, related to stimulation, chronic inflammation, or chronic irritation of bacteria," says William Adams, MD, a plastic surgeon and director of the American Society for Aesthetic Plastic Surgery, who has studied BIA-ALCL. The reason why it's associated with textured implants is because they have a higher surface area, Dr. Adams says. "It would permit higher numbers of bacteria around those implants," he says. An estimated 12.7% of people with implants have the textured kind, according to the American Society of Plastic Surgeons.
But that definitely doesn't mean those people are doomed to get cancer. According to Dr. Adams, the lifetime risk is about one in 30,000 in people with textured implants. (Because it's so rare, Dr. Johnson and her colleagues have a national registry where anyone who has BIA-ALCL can input their information — including what kind of implants they have and when they were placed — so they can try to learn more about this disease.) Typically, the first symptom that people experience is swelling, so that's a sign no one with implants should ignore. When BIA-ALCL is detected early, it's easily treated, and in most cases, simply removing the implant and scar tissue can cure it, she says.
If you are considering getting implants, talk to your doctor about the rare risk of this disease, what it means, and how it's treated, Dr. Johnson suggests. Even after you've gotten implants, it's important to follow up with your plastic surgeon, Ob/Gyn, or primary care doctor for routine breast checks, she says. "This is not a one and done procedure, so patients shouldn't just disappear."
October is National Breast Cancer Awareness Month. For more stories about detecting, treating, or living with breast cancer, click here.