Getting breast implants can change a person’s life for the better. But in recent years, a rare lymphoma called Breast Implant-Associated (BIA) Anaplastic Large Cell Lymphoma (ALCL) has come to light that can be associated (at low risk) with some breast implants.
We did a Q&A session with Dr Aggarwal recently about this topic and what is known about it by the Australian Society of Plastic Surgeons (ASPS) and we received a lot of follow up questions. In this blog, we are going to address those and answer again by sitting down with Dr Aggarwal. If you are just reading this blog as your first knowledge on the subject please read our first blog for more background knowledge on the topic.
If you have any further questions please don’t hesitate to contact us by emailing firstname.lastname@example.org.
Q: Should women with breast implants be screened for rare cancer called Breast Implant-Associated Anaplastic Large Cell Lymphoma ALCL (or BIA-ALCL)?
A: Given the rarity of the disease, regular screening is not yet recommended by the TGA (Therapeutic Goods Administration). At Mode Plastic Surgery, we offer lifetime yearly checks of your implants and if, as with any procedure, you have any issues or concerns you should notify us to see Dr Aggarwal.
Q: Are some women more at risk of breast implant-associated ALCL than others?
A: BIA-ALCL has occurred in women who have had breast implants for both cosmetic and reconstructive reasons, however currently there are no reports in Australia of BIA-ALCL occurring in women who have only ever had smooth implants. Only textured implants carry some risk for the disease (although the absolute risk is small).
At the time of preoperative consultation, you should discuss this with Dr Aggarwal.
Q: What is the prognosis and treatment of breast implant-associated ALCL?
A: Most cases are cured by removal of the implant and capsule surrounding the implant. If a patient was to develop BIA-ALCL on one side we would generally recommend removing the implants and capsules on both sides. All cases are discussed in a multidisciplinary setting with the involvement of a haematologist with experience with ALCL. Occasionally chemotherapy or radiotherapy is needed – usually when there is a solid lump (not just fluid-filled).
Q: I have Allergan breast implants – should I go to a free breast implant check clinic?
A: They say in life there is no such thing as a free lunch. If there is a ‘free’ implant check service, you need to question what is the catch?
A specialist who may not have put your implants in, will not need to do anything if there is nothing wrong with your implants: however their time is worth something, and they are accepting some medicolegal responsibility in reassuring you that there is nothing wrong.
In Dr Aggarwal’s opinion, the best place to go for reassurance would be the specialist who first put your implants in. Be very careful in going to a free implant check clinic, as you may get the advice to undergo complex surgery involving implant removal or replacement of your implants when you may not need this surgery.
If the specialist who originally put in your implants cannot give you the long term reassurance you need, or you require a second opinion, get in touch with a trusted Specialist Plastic Surgeon (and you may have to pay a consult fee to get this opinion, but think to yourself that a piece of mind may be worth the consult fee).
Q: Are there any implants that do not cause cancer or lymphoma?
A: Nanotextured or smooth breast implants are not associated with BIA-ALCL (lymphoma). This means that smooth implants from Mentor, Allergan or any other company do not cause lymphoma or any increased risk.
One of the newer manufacturers on the market is Motiva, and their implants are nano-textured to provide some of the benefits of texturing but they are classified by the TGA as smooth implants, and currently (like all other smooth implants) carry no associated risk of BIA-ALCL.
Q: What implants should I have for breast reconstruction?
A: Your Specialist Plastic Surgeon will be able to decide which implants are best for you if you decide to have implant-based breast reconstruction.
Mentor anatomical or tear-drop implants remain the first choice at Mode Plastic Surgery as they provide the form to the breast that has been removed, and there is often only thin skin hiding the implant. This means that the underlying implant imparts the entire shape to the breast, and therefore a tear-drop implant is the best choice for reconstruction.
Motiva Implants are being increasingly used for breast reconstruction. The two main types of Motiva round implants are the Progressive Gel (true round implant) or the Ergonmix breast implant (which although it is round, behaves like an anatomical implant when held vertically due to softness of its gel). The latter would be suitable for breast reconstruction, minimising the risk of rotation related problems that can occur with tear-drop implants. These implants also currently carry zero risks of anaplastic large cell lymphoma.
Q: What implants should I have for breast augmentation?
A: You should consult with your Specialist Plastic Surgeon as to which implants are best for you depending on the size, shape and look that you are after.
Motiva implants are the first choice for breast augmentation at Mode Plastic Surgery. Motiva round implants come in the Progressive Gel (true round implant) or the Ergonmix gel (which although it is round, behaves like a tear-drop implant when held vertically due to softness of its gel). We offer either implant in our base fee for breast augmentation at $10990 (as at August 2019), even though the Ergonomix breast implant is marketed at a higher price by Motiva.
The reasons we like Motiva implants are as follows:
- The quality and softness of their gel: they are an extremely high-quality breast implant, and probably the best breast implant currently on the market.
- They are a true monobloc design meaning their configuration links all components of the implant to the same tensile strength. This allows the shell to act as a whole structure, making insertion easier and improving the implant mechanical qualities under stress.
- They have an inbuilt microchip which can be read by a Q-reader device: This means that should you lose your implant information, this information can be ready by a device held up to the breast which scans the microchip inside revealing the size, shape, type of breast implant and its serial number making future tracking of breast implants easier.
- There is a lifetime guarantee – providing replacement of breast implants should there be a major failure of the device.
- There is optional insurance at the cost of USD$200 offering funding of surgical costs should implants require replacement. This sort of insurance is the first of its kind to be offered by an implant manufacturer.
- These implants also currently carry zero risks of anaplastic large cell lymphoma.
We also use Mentor smooth or textured implants at Mode Plastic Surgery. Teardrop implants are particularly useful for patients needing a firmer gel, with less rippling and in particular needing expansion of the lower pole such as in the tuberous breast.
The advantages of Mentor implants include:
- High-quality breast implants with a long proven track record.
- Have remained the first choice for breast reconstruction for many Specialist Plastic Surgeons, and still do for many till date.
- The lowest risk of BIA-ALCL of any textured device.
- Lifetime warranty allowing replacement of breast implants in the case of major device failure.
Q: Can I come to Mode Plastic Surgery to get my implants checked?
For more information about BIA-ALCL you can visit the Australian Society of Plastic Surgeons website.