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Nayela Chowdhury
Breast cancer is a significant health concern affecting millions of people worldwide. In 2023, around 43,000 mortalities are projected to occur in the United States alone. Mastectomy is the primary curative therapy for breast cancer and involves the surgical removal of one or both of the breasts. Millions of women worldwide opt for this approach as it offers the highest chances of recovery and significantly diminishes chances of local cancer recurrence. Nonetheless, mastectomy leaves behind a profound impact that extends beyond any physical alterations. Often, women find themselves delving into new avenues of emotional and psychological struggles stemming from self-perception and body image concerns. Hence, following mastectomy, breast construction offers the best hopes of rejuvenation as it aims to create the likeness of natural breasts and restore quality of life.
Since the first successful breast augmentation in 1962 [1], breast reconstruction has been the most common plastic surgery opted by women. The first reported implants were constructed from silicone and were widely employed for cosmetic procedures as well as post-mastectomy breast reform. Over the next couple of decades, concerns surrounding the safety of silicone implants resulted in the U.S. Food and Drug Administration (FDA) banning the use of silicone implants in primary breast augmentation surgery in 1992. This ban was lifted in 2006 when silicone implants were deemed safe again based on numerous clinical trials conducted to assess the safety of silicone implants.
However, on September 08, 2022, the U.S. Food and Drug Administration (FDA) released an official report citing incidences of squamous cell carcinoma (SCC) and various lymphomas associated with breast implants, arising from the scar tissues encompassing the implants [2]. This was based on medical device reports (MDRs) which narrated about 10 cases of squamous cell carcinoma (SCC) and 12 cases of various lymphomas related to breast implants. At the same time, these reports captured the attention of researchers and physicians worldwide who sought to understand and decipher this risk. However, these reports were discouraging as breast reconstruction is the primary means of restoring quality of life and confidence in many female patients, but now they are having to weigh the benefits of getting reconstructive implants against the risk of developing second cancer.
Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
More and more data has emerged over time associating secondary cancers following breast implants, igniting a crucial conversation surrounding those seeking to reclaim their bodies and lives. Smooth breast implants have an even surface and are known for their ability to provide an even texture for a more natural appearance and feel. However, it offers a higher risk of dislocation or rotation within the breast pocket. On the other hand, textured implants have a more uneven and rough surface engineered to hold the implants in place within the breast tissue. The two most common types of cancers studied in this context of implants are breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and an increased risk of primary breast cancer. Women with textured breast implants are at an increased risk of developing BIA-ALCL, a rare form of non-Hodgkin’s lymphoma. This type of lymphoma usually appears as a late-onset seroma(build-up of fluids around the implant) and patients have been diagnosed anywhere from 2 years-32 years, with a median interval of 8-10 years after getting the implant. Treatment involves the removal of the implants followed by a combination of radiation and chemotherapy.
Although the overall risk of BIA-ALCL is low, studies have shown that people with textured implants are more likely to develop it than those with smooth implants [4, 5]. The exact relationship between textured smooth implants and BIA-ALCL is unclear, but it is thought to be related to the chronic inflammation and immune response that the textured surface causes. Additionally, textured breast implants may increase the risk of primary breast cancer [6]. However, SCC has been reported with both smooth and textured implants. The risk of cancer associated with getting breast implants following mastectomy is a complex and evolving topic. While some studies have associated the risk of cancer with breast implants, other studies have reported that these risks are negligible [9, 10]. A study of retrospective analysis of thousands of breast cancer patients concluded that implant-associated cancer risk is as low as 12 cases per 1 million, which is substantially lower than the risk of experiencing a relapse of primary breast cancer itself [10].
It is important to note that the risks associated with breast implants are still being actively studied. While the overall risk of developing cancer as a result of breast implants remains low, it is essential for women and their healthcare providers to stay informed about the latest research findings and guidelines. Regulatory agencies and medical organizations should continuously monitor the trends and give updated guidelines to ensure patient safety. Also, breast reconstruction benefits and risks after mastectomy should be discussed with healthcare providers. Patients should have a comprehensive understanding of both the advantages and disadvantages of using implants for breast reconstruction to be able to make an informed decision. Continued research efforts are necessary to better understand these risks. Improving our understanding will ultimately lead to safer and better breast cancer treatments, and more innovative medical approaches to breast reconstruction options and alternatives.
Edited by Ifeoluwa Oyelade
1. Perry, D. and J.D. Frame, The history and development of breast implants. The Annals of The Royal College of Surgeons of England, 2020. 102(7): p. 478-482.
2. Food, U. and D. Administration, Breast implants: reports of squamous cell carcinoma and various lymphomas in capsule around implants: FDA safety communication. Safety Communications, 2022.
3. Wang, Y., et al., Current progress in breast implant-associated anaplastic large cell lymphoma. Frontiers in oncology, 2022: p. 5620.
4. Lee, K.-T., et al., Association of the implant surface texture used in reconstruction with breast cancer recurrence. JAMA surgery, 2020. 155(12): p. 1132-1140.
5. Cordeiro, P.G., et al., Risk of breast implant associated anaplastic large cell lymphoma (BIA-ALCL) in a cohort of 3546 women prospectively followed long term after reconstruction with textured breast implants. Journal of Plastic, Reconstructive & Aesthetic Surgery, 2020. 73(5): p. 841-846.
6. Materazzo, M., et al., Case Report: Early Breast Cancer Recurrence Mimicking BIA-ALCL in a Patient With Multiple Breast Procedures. Frontiers in Surgery, 2021. 8: p. 606864.
7. Xia, Z., et al., Breast implant-associated squamous cell carcinoma in a male patient: A case report and review of the medical literature. Frontiers in Surgery, 2023. 9: p. 983611.
8. Materazzo, M., et al., Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) in a young transgender woman: A case report. International Journal of Surgery Case Reports, 2022. 98: p. 107520.
9. Kinslow, C.J., et al., Risk of Squamous Cell Carcinoma of the Breast Following Postmastectomy Implant Reconstruction in Women With Breast Cancer and Carcinoma in Situ. JAMA surgery, 2023. 158(7): p. 769-771.
10. Kinslow, C.J., et al., Risk of Anaplastic Large Cell Lymphoma Following Postmastectomy Implant Reconstruction in Women With Breast Cancer and Ductal Carcinoma in Situ. JAMA Network Open, 2022. 5(11): p. e2243396-e2243396.
Article Image: https://www.newbeauty.com/allergan-recalls-biocell-textured-breast-implants-cancer-risk/
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