Yesterday, the FDA released a White Paper and Advisory Statement on Anaplastic Large Cell Lymphoma (ALCL) in women with breast implants. It is important that all patients and plastic surgeons understand the current state of knowledge surrounding this condition.
What Are My Chances of Getting ALCL if I Get Breast Implants?
This condition is incredibly rare. In fact, the known ALCL cases are too few to say conclusively that breast implants cause the disease. Efforts over the past 25 years by all the worlds major plastic surgery societies to raise awareness among members and to identify patients with ALCL have identified 34 unique cases worldwide among an estimated 10 million+ implanted devices. That’s about 1 in 300,000. To put this in perspective: the chance that you will get hit by lightning at some time during your lifetime is 1 in 6250. The chances are the same of you knowing 50 people who have been hit by lightning or one person with breast implant associated ALCL. On the other hand, the chance a developing a “real” breast cancer is 1 in 9.
So it’s Rare … but What if it Happens to Me?
As opposed to the systemic, nodal pattern of ALCL, in published reports, ALCL seen in the presence of breast implants has demonstrated an indolent course. In other words, it doesn’t spread. The women who developed ALCL, were cured with treatment. While ALCL seen in the presence of breast implants does fulfill the current WHO classification for ALCL, a form of Non-Hodgkins Lymphoma, the type of ALCL associated with breast implants potentially represents a distinct clinical entity. This condition is clearly NOT breast cancer.
Because of the extreme rarity of this condition, at this point no standard treatment has been determined. ALCL has been treated with everything from simple explantation (removal of the breast implant) and capsulectomy (removal of the scar around the breast implant) to aggressive systemic therapy. With either treatment, the condition was resolved.
Where Does the FDA Stand?
The FDA has not changed the status or availability of breast implants and has reaffirmed that the devices are safe and effective. In order to better understand this rare condition, the FDA has entered into an agreement with the American Society of Plastic Surgeons (ASPS) to create a registry for ALCL cases in the presence of breast implants. Until this registry is up and running, any clinical case will be reported directly to FDA. The FDA documents provide instructions for how to report any clinical cases to FDA. The American Society for Aesthetic Plastic Surgery fully supports the FDA and ASPS in this endeavor.
It’s Rare … But What Should I Look For?
Despite what you may have heard on the nightly news, the vast majority of breast implant patients will never have this problem. Moreover, most plastic surgeons will never see a single case in a lifetime of practice. The occurrence of ALCL with implants is so rare that routine screening of asymptomatic patients is not indicated; however, we all need to know what signs to look for.
The Presentation of ALCL with Breast Implants
This unusual tumor presents in two main ways:
A collection of fluid (a seroma) that develops well after breast implant placement
A mass involving the scar around a breast implant (the capsule)
Non specific findings: pain, lumps, swelling, or asymmetry, have also been associated with the above findings, and some cases have been associated with capsular contracture (firmness of the breast). If you think there is a problem, contact your Board Certified Plastic Surgeon today for follow-up.
ALCL Does Not Act Like Breast Cancer and There is More Good News
Knowledge is power. Raising awareness should be empowering and not frightening. Recent news reports on ALCL and breast implants seem a bit overblown; however, they do serve as a reminder that all women, with and without breast implants, need to be concerned about breast health. While ALCL is unlikely, the incidence of breast cancer is one in nine, and the vast majority of women who develop breast cancer do not have a family history of the disease.
The good news it that breast health is being discussed openly. I encourage you to do monthly breast exams, and to obtain routine mammography. The sooner a breast cancer is found, the easier it is to treat, and the better the quality of the life saved. Routine screening may seem a bother, but the life you save, will be yours to enjoy.
The ASAPS, the ASPS and Board Certified Plastic Surgeons around the world are all working together on this and other issues to keep cosmetic plastic surgery safe and predictable for everyone. For more information on ALCL and breast implants follow these links:
The 2010 Patients’ Choice Awards were just announced and we did it again. Joseph A. Mele, III, MD, Inc, has again received the Patients’ Choice Award. The award is rated and awarded by patients, and is based on patient satisfaction.
Here is an excerpt from the award letter:
Congratulations on receiving the Patients’ Choice Award again in 2010!
Dr. Mele,
Your patients have selected you for the Patients’ Choice Award for 2010. You are a member of an elite group. More than 100,000 patient reviews and ratings are gathered each month, and this top rating has only been awarded to you and a select few of the nation’s most beloved doctors. Congratulations.
While physicians generally receive positive feedback from their patients, only a select few receive rave reviews. Of those with high praise, only physicians like yourself – with near perfect scores – have been voted by their patients for this honor.
In fact, of the nation’s 720,000 active physicians, less than six percent were accorded this honor by their patients in 2010.
You are, indeed, the Patient’s Choice; a physician so highly regarded by their patients that they feel the need to talk to others about the positive influence of your work.
Your patients have taken the time to compliment you in areas such as: your bedside manner, the amount of time you spend with them, the courtesy of your staff, appropriate follow-up, and their overall opinion of you as a physician. Quite simply, you are one of the best!
So, a big thank you to my patients for taking the time to rate us, and a congratulations to my staff for providing superior service in our extremely competitive Walnut Creek Plastic Surgery market.
Breast implants are used to increase the size of the breasts. If you are happy with the shape of your breasts, but desire increased volume, breast augmentation with a breast implant may be a good choice. Cosmetic breast enhancement includes other breast procedures also. For overly large breasts, breast reduction is an option. For deflated breasts, breast augmentation and breast lifts are the preferred treatments. Many of these options are outlined in detail on the San Francisco Breast site.
Last month, on KRON4′s Body Beautiful, I had the opportunity to discuss cosmetic surgery of the breast. Below is an excerpt from my interview with the Bay Area’s News Station’s Vicki Liviakis. This segment includes more caller questions. Please note, the 800 number in the video was used exclusively as part of the live show. If you have questions, or would like to schedule a consultation appointment, please call my office directly at (925) 943-6353, or use the contact form on the left side of this page.
This breast augmentation video includes answers to viewers questions about:
Breast implant revision surgery
Capsular contracture
Breast implant complications
Silicone breast implant leaks and MRI
Breast reduction insurance coverage
Breast feeding after breast augmentation
Transgender breast augmentation
Gynecomastia and male breast reduction
Finding the Right Breast Augmentation Surgeon
If you are considering breast augmentation, be certain to review the benefits, and the risks, with a Board Certified Plastic Surgeon like myself, as part of your breast augmentation consultation appointment. If you have developed problems with your breast implants, a consultation with a Board Certified Plastic Surgeon is the best first step toward finding relief.
Additional Information on Cosmetic Breast Enhancement
Cosmetic surgery of the breast encompasses many varied procedures. Breasts can be enlarged with breast implants via breast augmentation, or reduced in size with breast reduction or a reduction mammoplasty. If you are happy with the volume, but not the shape of your breast, a breast lift, or mastopexy, may help by lifting and firming the breast. Even problems with the size and shape of the nipple and areola can be addressed via breast enhancement surgery.
I recently had the opportunity to discuss the many aspects of cosmetic breast surgery, on KRON’s Body Beautiful. A portion of the show is dedicated to viewer questions, which are answered live on the air. Below is an excerpt from my interview with the Bay Area’s News Station’s Vicki Liviakis, which includes several interesting viewer questions. Please note, the 800 number in the video was used exclusively as part of the live show. If you have questions, or would like to schedule a consultation appointment, please call (925) 943-6353, or use the contact form on the left side of this page.
This breast augmentation video includes answers to viewers questions about:
When is it safe to replace breast implants to change size?
What problems can occur with breast augmentation to sizes larger than a D-cup?
Can breast size be matched to maintain proportions?
Is it safe have elective cosmetic surgery with diabetes or other medical illnesses?
Can breast implants really lift the breasts? (Click for additional information about Breast Augmentation Lift)
Finding the Right Breast Augmentation Surgeon
If you are considering breast augmentation, be certain to review the benefits, and the risks, with a Board Certified Plastic Surgeon like myself, as part of your breast augmentation consultation appointment. If you have developed problems with your breast implants, a consultation with a Board Certified Plastic Surgeon is the best first step toward finding relief.
Additional Information on Cosmetic Breast Enhancement
If you were peaking ahead, the preview screen on the video shows a side-by-side comparison of before and after pictures for breast reduction (reduction mammoplasty). I perform many different aesthetic breast enhancement surgeries. Sometimes reducing the volume and lifting the breasts is the best course of action. For patients with large breast and symptoms like lower neck and upper back pain, shoulder rutting from the bra straps and even recurrent rashes beneath the breasts, breast reduction surgery can provide an improved quality of life. It goes beyond being able to find clothes (and bras) that fit, but my patients are happy about that too.
Breast Reduction, Breast Augmentation and Breast Implant Revision Before and After Pictures
The 800 number in the video was used as part of the live show to allow viewers to have their questions answered by me, live, during the original broadcast. If you have questions, or would like to schedule a consultation appointment, please call (925) 943-6353, or use the contact form on the left side of this page.
Bay Area Breast Implants – Part 2 or 4
This cosmetic breast enhancement video includes information about:
Cosmetic breast enhancement including before and after pictures
I cannot emphasize this enough. If you are considering breast augmentation, be certain to review the benefits, and the risks, with a qualified Board Certified Plastic Surgeon, like myself. This is an important part of any breast augmentation consultation appointment. This is equally important if you have developed problems with your breast implants. A consultation with a Board Certified Plastic Surgeon is the best first step toward finding relief.
Additional Information on Cosmetic Breast Enhancement
