Breast Implants and Anaplastic Large Cell Lymphoma(ALCL): Is having a breast implant a cancer risk?

Thursday, January 27th, 2011 by doctor

Although once again news media and governmental reports are bringing attention to Anaplastic Large Cell Lymphoma ALCL, there is not any definitive relationship between having breast implants and developing this rare disease. One study found a lower incidence of this disease in a populations of women with breast implants then would be expected in the normal population. Questions? Post here and reciev a response from Dr. Maercks!

Below are two reviews published in Plastic and Reconstructive Surgery evaluating the data available and again drawing no conclusions that link ALCL and breast implants conclusively:

“1) Breast-ALCL has been reported in women with and without BI [deJong, 2008] and, 2) with and without a prior cancer history [Li, 2009]. The only case-control study examining an association between ALCL and BI to date [deJong, 2008] included 6/11 ALK-negative ALCL cases with no history of BI. Nine of 22 (41%) ALCL cases reported among patients with BI had a personal history of breast cancer (N=8) or lymphoma (N=1) [ Li, 2009]. 3) Authors concluded ALCL in the anecdotal case reports behaves indolently, and spontaneous resolutions have been reported; however, most patients with ALCL received chemotherapy and/or radiotherapy [Roden, 2008]. 4) Device type in case reports is often unknown [Li, 2009]; reports have included saline- and silicone-filled devices [Li, 2009]. 5) Interval between implantation and ALCL diagnosis varies widely in the reports, between 1-23 years [deJong, 2008]. 6) Primary breast lymphomas may be difficult to definitively diagnose and distinguish from secondary involvement of disease originating elsewhere [ Domchek, 2002]. Five of 11 ALCL cases in the case-control study had disseminated disease with involvement of other sites providing uncertainty about the breast as the primary site [deJong, 2008]. 7) BI patients have been reported to have demographic and lifestyle characteristics which may influence their risk of certain cancers [Brinton, 2000]; the relevance of these characteristics to ALCL risk is unknown. 8) While no prospective epidemiologic studies have examined ALCL risk among BI patients to date, several have reported no significantly increased NHL risk [Lipworth, 2009].”

“RESULTS:

1) Breast-ALCL has been reported in women with and without BI [deJong, 2008] and, 2) with and without a prior cancer history [Li, 2009]. The only case-control study examining an association between ALCL and BI to date [deJong, 2008] included 6/11 ALK-negative ALCL cases with no history of BI. Nine of 22 (41%) ALCL cases reported among patients with BI had a personal history of breast cancer (N=8) or lymphoma (N=1) [ Li, 2009]. 3) Authors concluded ALCL in the anecdotal case reports behaves indolently, and spontaneous resolutions have been reported; however, most patients with ALCL received chemotherapy and/or radiotherapy [Roden, 2008]. 4) Device type in case reports is often unknown [Li, 2009]; reports have included saline- and silicone-filled devices [Li, 2009]. 5) Interval between implantation and ALCL diagnosis varies widely in the reports, between 1-23 years [deJong, 2008]. 6) Primary breast lymphomas may be difficult to definitively diagnose and distinguish from secondary involvement of disease originating elsewhere [ Domchek, 2002]. Five of 11 ALCL cases in the case-control study had disseminated disease with involvement of other sites providing uncertainty about the breast as the primary site [deJong, 2008]. 7) BI patients have been reported to have demographic and lifestyle characteristics which may influence their risk of certain cancers [Brinton, 2000]; the relevance of these characteristics to ALCL risk is unknown. 8) While no prospective epidemiologic studies have examined ALCL risk among BI patients to date, several have reported no significantly increased NHL risk [Lipworth, 2009].
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CONCLUSION:

Overall, the evidence regarding a BI- ALCL association is inconclusive.
©2010American Society of Plastic Surgeons”

Read more on the American Society of Plastic Surgeons website for their official ALCL response.

Subfacial Breast Augmentation: What is it?

Saturday, January 22nd, 2011 by doctor

Most commonly surgeons pick ‘below the muscle’ or ‘above the muscle’ positioning when using breast implants. ‘Above the muscle’ augmentations usually look the most natural initially but quickly age especially when a large size is chosen. Quickly the upper pole of the breast looses volume and becomes a silhouette of the implant, in the lower pole the implant is usually very palpable and with capsular contracture, a ‘rock in a sock appearance’ may result.

Implants placed under the muscle have the advantage of using the muscle for some upper pole fullness and hiding the implant. Under the muscle augmentations look less natural and have the tremendous downside that every time a woman moves her arms the implant can change shape, drawing attention to the unnatural form.

Subfacial augmentation avoids the major drawbacks of the two former techniques and has several advantages. The pectoral fascia is a thin but very strong layer of tissue directly above the pectoralis major muscle. In 1998 Dr. Ruth Graf, a talented and internationally famous Brazilian plastic surgeon, developed the subpectoral augmentation technique. The concepts which have now withstood the test of time include a internal brassiere of fascia that participates in carrying the load of the implant. By having a structural support, the breast is protected from accelerated aging from implant load. The intact structure also results in a beautiful distribution of natural breast parenchyma over the superior pole of the implant, blunting the edge of the implant and creating a much more natural appearance.

Having trained with Dr. Ruth Graf, Dr. Maercks’ preferred technique for breast augmentation is subfacial with transaxillary (through the armpit) access. In this manner a beatifully natural appearing breast is created with no distracting scars!

Many patients present to the pracice with large breasts in the subpectoral and subglandular positions that have aged quickly to nonaesthetic forms. It is usually Dr. Maercks’ preference to change planes while reshaping the breast to a subfacial implant location.