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Cause of rare implant disorder is understood.

Byline: Mark Jewell For The Register-Guard

Breast implant-associated anaplastic large cell lymphoma in patients who have textured breast implants is a very rare disorder - yet it is a cause for concern, as mentioned in the June 26 Register-Guard ("A shocking diagnosis: Breast implants 'gave me cancer,"' by Denise Grady of The New York Times).

Some comments are in order regarding this disorder and its management from the perspective of a plastic surgeon who has been involved with investigating this disorder for more than six years.

BIA-ALCL has been reported worldwide, with around 350 cases since it was recognized as a distinct disease. It is associated with textured breast implants of all types, from all approved manufacturers. It has been reported in all areas of the world except the Asia-Pacific and Africa-Middle East regions.

The current theory of causation is surface contamination with an unusual bacteria that produces inflammation over years' time. This leads to a fluid accumulation around the breast implant that contains lymphocytes that have been transformed into a lymphoma (CD30 positive, a type of immunologic test to diagnose lymphoma).

Grady's article is correct in saying that removal of the implant and its surrounding capsule is largely curative of this disorder. It does not need to be treated with aggressive chemotherapy or radiation, as this approach did not improve survival and only harmed patients.

Late-term fluid accumulation around breast implants can occur for many reasons, including trauma, infection or malignancy. This is a rare problem for which colleagues and I described an evaluation method more than 13 years ago, with updates in 2011 for BIA-ALCL.

The use of textured breast implants for cosmetic and reconstructive applications, when clinically indicated, remains a decision between a patient and her plastic surgeon. A discussion of risks and alternatives is needed.

In my particular situation of using silicone breast implants for more than 40 years, I have taken precautions all along to reduce the risk of infection and biofilm contamination. In September, some of my colleagues and I will publish a peer-reviewed, international, multicenter scientific study on 42,000 textured breast implants that were implanted with a protocol to prevent infection and biofilm contamination. Patients had a mean follow-up of 8.8 years, and there was zero incidence of BIA-ALCL.

Risk occurs in everything we do on a daily basis. To put risk into perspective, the risk of BIA-ALCL is 1 in 30,000 or greater. The risk of a woman developing breast cancer is one in eight, or 12.5 percent. The risk of death from stroke and cardiovascular disease is one in three, or 33 percent.

Given the rarity of BIA-ALCL, the Food and Drug Administration has not issued an advisory for women to have textured breast implants removed. BIA-ALCL is not associated with smooth-surface breast implants.

Fortunately, with BIA-ALCL, we have an understanding of causation, and a process to evaluate and treat it. More importantly, from scientific research, we have data indicating that improvements in surgical technique to reduce bacterial contamination appear to limit this disorder.

If patients with breast implants develop late-term fluid around their implants, they should see their plastic surgeon for evaluation and management.

Mark Jewell, M.D., a plastic surgeon practicing in Eugene, is past president of the American Society for Aesthetic Plastic Surgery and an associate clinical professor of plastic surgery at Oregon Health & Science University.
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Title Annotation:Guest Viewpoint
Publication:The Register-Guard (Eugene, OR)
Date:Jul 1, 2017
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