Tag Archives: Breast Reconstruction

Breast Implants and Anaplastic Large Cell Lymphoma (ALCL): Should I be Concerned? —by Ryan Polselli

There are an increasing number of reports in the media lately about a new relationship between breast implants and an extremely rare form of cancer showing up in the breasts. Notice that I did not say breast cancer. That is because although this cancer is found in the breast, it does not appear to arise from breast tissue.

ALCL
ALCL surrounding the breast implant in the right breast

This cancer, known as Anaplastic Large Cell Lymphoma and commonly referred to as ALCL, started showing up in cases of women that had persistent fluid accumulation within the fibrous capsule that the body forms when the implant is placed within the breast. Although fluid collections around the implant sometimes occur when the implant is initially placed, this fluid was showing up years after placement and seemed to persist despite typical treatment. As a result, some of these women underwent a second surgery in an attempt to correct the problem. When the fluid was sent for analysis, the cancerous cells were detected.

Reports of this phenomena started showing up in the literature until there were enough eyebrows raised to launch an official investigation by the FDA. Until recently, ALCL was known to be an extremely rare cancer that could involve the breast, but was better known for showing up in other areas of the body. Although it was known to occur in approximately 1 in 500,000 women each year, it only showed up in the breast 3 times for every 100 million women each year. The compilation of all the cases reported however, showed that it had shown up in the breasts of women with implants approximately 60 times worldwide when the total number of implants was estimated between 5 and 10 million.

So what has been concluded from these 60 cases worldwide? Only 34 of these cases had data reported that was deemed reliable enough to be included in the FDA’s study of cases from 1997 though 2010. From a statistical standpoint, there was not enough data to reliably determine any defining characteristics. ALCL occured in both implants with silicone and saline that had been placed for the purpose of reconstruction and augmentation.

There are some reports in the media stating that it is likely that the cancer is being caused by implants that are textured. This is because of the 4 cases of cancer in which the implant shell texture was known, they all happened to be textured. However, this could still be coincidence. We still don’t know what type of shell was involved in the remaining 30 cases.

Because more information is still needed, the FDA has formed a registry in association with the Society of Plastic Surgery to record all cases of ALCL. The FDA is requesting all confirmed cases of ALCL in women with breast implants to be reported to the FDA. The FDA has agreed to keep the reporter and patient’s identity confidential.

So what does all this mean for the average woman with breast implants. In short, don’t be alarmed. The incidence is so low and still so little definite information is known at this point that there is no need to run to your local surgeon to have breast implants removed. In fact, it is the official recommendation of the FDA at this point that implants should not be removed unless there is medical reason. The FDA continues to stand by the overall safety of breast implants when used appropriately.

Ryan Polselli, MD, Diplomate of the American Board of Radiology, Fellowship Trained Breast Imaging Radiologist

Note, this article is for general informational purposes only and is not intended to be medical advice

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Mastectomy for Genetic Defects and Angelina Jolie

Ryan Polselli
Ryan Polselli

The discussion resulting from Angelina Jolie’s decision to undergo elective mastectomy has generated a few questions that should be clarified.

Angelina Jolie has a known defect in her genes that puts her at a higher risk for developing breast cancer than most women. The defect occurs in a part of her genetic makeup that has been labeled BRCA1. The BRCA1 genetic defect carried by Angelina Jolie gives her up to an 80% chance of developing breast cancer at some time in her life.

There are many other known genetic defects that can put a person (including males) at a higher risk for developing breast cancer. All of these defects are relatively uncommon. Roughly, the defects occur in less than 2-3% of the population, although there is variation between different races. The presence of the genetic defect does not imply that a patient will definitely get cancer. Likewise, the absence of any known genetic defect does not imply that a patient will not get breast cancer.

Genetic testing for the presence of the more common known genetic defects in the sequence BRCA1 (and BRCA2) can be determined with a blood test. However, this test typically costs several hundred to a few thousand dollars. Without a very strong family history of breast cancer (breast cancer in multiple first degree relatives) or breast cancer diagnosed at a young age (typically under the age of 40-50), it is very difficult to get insurance to pay for the test.

One option to manage this high risk is known as prophylactic bilateral mastectomy. A breast surgeon can remove the majority (but not all) of the breast tissue in both breasts. Because the majority of the breast tissue is removed, there is significantly lower risk for developing breast cancer. However, breast tissue that is too close to the skin, muscle or other vital structures cannot be completely removed. Therefore, there is still a small risk of developing breast cancer after the surgery. Also, the surgery is much more complicated than most breast surgeries such as breast augmentation and carries a higher risk of serious complication.

Once the majority of breast tissue has been removed and the area has healed (many months), there are options to reconstruct the breast and give a more normal appearing breast contour which include breast implant augmentation. However, this reconstructive process is much more complicated than typical breast augmentation and the end result is never as aesthetically pleasing.

I commend Angelina Jolie for publicly sharing her experience with us and undoubtedly inspiring many women facing similar decisions.

I hope this helps answer a few questions!

Ryan Polselli, M.D.