Q. I have been keeping up with some of the reports on the association between textured surface silicone implants and the occurrence of breast lymphoma. I have discovered that the implant type that is most associated with this disease is the implant that I have. I am so worried now and wonder if I should have my implants removed?
A. That is a very good question, and I will say at the outset that there is not 100% agreement as to what to do for women in your situation. What you are referring to is a relatively newly recognized disease called breast implant associated anaplastic large cell lymphoma (BIA-ALCL). This disease is a malignancy that originates in the breast of women who have textured implants. It is a malignancy of the T-cell lymphocytes; therefore, it is a lymphoma not a breast cancer. Most of the implants that are associated with this disease are silicone gel implants and all the cases are textured implants. Most of the implants that are associated with BIA-ALCL are manufactured by one company, although the disease has been found in women with textured implants manufactured by other companies as well. The disease typically appears on average about 8 years after placement of the implant but can present earlier or much later. The primary symptom of this condition is unexplained swelling of the breast. For women who experience unexpected swelling, an evaluation should be performed to document whether the swelling is due to fluid around the implant. If there is a significant amount of fluid, it should be aspirated (sampled) and tested for the disease. The lifetime risk of developing this disease in women with textured implants ranges between 1:1,000 to 1:30,000. The reason this range is so wide is that different studies have demonstrated different rates of occurrence. There have now been 186 cases reported in the United States. Unfortunately, there have been 5 deaths from BIA-ALCL in the United States. The treatment for the disease is removal of the implant and the capsule (scar tissue) surrounding implant. The disease is considered curable when the correct treatment is carried out. As for your question about proactively removing your implants, the FDA says that it is not necessary based on the low risk of the disease. My opinion is that if you are worried about the possibility of BIA-ALCL occurring and the implant that you have is the one that is most associated with this disease, then it is reasonable to consider changing or altogether removing your implants. I would urge you to see a board certified plastic surgeon to discuss your concerns.