EDIT: A new post on the subject was added in April, 2017, here: BIA-ALCL is Breast Implant Associated Anaplastic Large Cell Lymphoma. For the latest updates on the San Francisco Plastic Surgery Blog, search ALCL in the search box. Be aware, ever newer information may be available than what you find here. Most importantly, if you suspect you have ALCL, contact your plastic surgeon today for a proper workup.
Do Breast Implants cause breast cancer? At the risk of ruining the suspense, the answer is still no. Breast Cancer affects 1 in 8 women over their lifetime, and women with and without breast implants have the same risk. If your mother or sister have breast cancer your risk of having breast cancer is increased; however, only 20% of breast cancer patients have a family history of the disease. In other words, 80% of breast cancer is spontaneous.
The Best Cancer Defense is Finding it Early
Like most cancers, Breast Cancer is easier to treat if found early. Early detection means smaller tumors which are less likely to spread, and more likely to let you live a long life. If you find a lump in your breasts, get it checked out by your doctor. The only way to know what a breast lump is for certain is to sample it. Needle biopsies have come a long way, and diagnosis of a suspicious lump can be quick and easy in many cases.
What About the Breast Cancers We Can’t Feel?
The best screening test for breast cancer remains the Mammogram. New techniques can detect smaller tumors earlier, and reduce unnecessary biopsies. The current recommendation for healthy women without a family history of Breast Cancer is to get your first mammogram at age 40. Amy Robach (pictured above) learned the value of the screening mammogram when she received her first mammogram at age 40 as part of a story about Breast Cancer Screening. The test potentially saved her life by detecting a breast cancer before there was any evidence of the disease.
When to Get Your First Mammogram
The American Cancer Society, The American College of Surgeons, The American College of Obstetricians and Gynecologists, The American College of Radiology and The Society of Breast Imaging all recommend that routine mammograms begin at age forty for women with an average risk of breast cancer. Women with a strong family history of breast cancer should have their first mammogram 10 years prior to the age that their relative was when they developed breast cancer. On the other hand, the federal government’s USPTF recommendations are to wait until age 50, no breast ultrasounds and no mammograms after age 75. Unfortunately, the USPTF’s recommendations are based on older methods of mammography, and fly in the face of the recommendations made by doctors who care for women every day. The same doctors who continue to make strides battling breast cancer.
ALCL and Breast Implants
A few years ago, I wrote a series of posts about Breast Implants and an extremely rare form of lymphoma. For more details click on the previous link, but here’s some background:
Worldwide, there have been 71 documented cases of patients with anaplastic large cell lymphoma (ALCL) in women who have breast implants. This type of ALCL found around Breast Implants is completely different than the usual ALCL, in that it usually has a more benign course, and that removing the breast implants and their capsules has been curative with and without other treatments.
ALCL is normally found in the lymph nodes, as well as in skin, lung, liver and soft tissue, but not usually in the breast. This is a previously unrecognized, new subtype of ALCL. Cases in which ALCL developed in the breast region often involved patients who have had breast surgery, and arose in the scar tissue. Often, many years were required for the tumor to develop, and in the case of Breast Implants, a collection fluid around the implant, rather than a mass, leads to the diagnosis.
ALCL is not Breast Cancer
ALCL arises from lymphocytes (white blood cells), not breast tissue, so mammograms are not useful for diagnosis. Breast Implants are generally safe and studies have found no association between breast surgery and other forms of cancer. ALCL itself is also an extremely rare occurrence. Among three million breast implants, there are between one and six reported cases of ALCL.
What Causes ALCL of the Breast?
Determining the cause of ALCL is made difficult because it is so rare. While the tumor has been found associated with breast implants, it is unclear if Breast Implants are the cause, or if breast implants make the diagnosis apparent. Several mechanisms are under investigation including an abnormal immune response from the body. American, National and International Plastic Surgery Societies are raising awareness for this rare disease among their members, and are repeatedly soliciting their members for new or suspected cases, and compiling a database to help investigators get to the root of the problem. Breast implants, medical implants in other parts of the body and even dentures are being investigated for any link to this rare tumor.
Plastic Surgery and Breast Cancer
Fortunately, plastic surgeons get to help with the healing after the Breast Cancer is removed. As the results of Breast Reconstruction improve, the procedure becomes more popular. Some women, like Amy Robach and Angelina Jolie, are even electing to have both breasts removed and reconstructed. This is usually done when women are at higher risk for breast cancer in the other breast. Since genetic screening for breast cancer is relatively new, not enough time has passed to show any survival benefit to bilateral mastectomies. However, it does provide peace of mind for women who feel their breast is ticking time bomb.
Breast Implants Help After Breast Cancer
The most common way to reconstruct the breast after a mastectomy is with a breast implant. In the year 2000, 78,832 women underwent breast reconstruction, and in 2014 the number will be closer to 100,000. Millions of women have benefited physically and emotionally from these procedures. But with early detection, we can reduce the number of mastectomies performed, and increase the survival for breast cancer patients.
Breast Augmentation vs. Breast Reconstruction
Breast Implants are used three times more often for elective Breast Augmentation than for Breast Reconstruction. Breast Augmentation helps with the fit of clothing, provides high patient satisfaction and has been shown to provide significant improvement in quality of life for both elective breast augmentation and breast reconstruction after breast cancer. While breast implants do not cause breast cancer, there are risks and benefits that need to be discussed with a qualified Board Certified Plastic Surgeon. In most cases, the benefits will outweigh the risks, but the decision should always be individualized.
Breast Implant Consultations
If you are considering Breast Augmentation, and live in or near the San Francisco Bay Area, give us a call at (925) 943-6353. An in-person, confidential consultation is the best way to find out if Breast Augmentation is right for you.