Don’t panic, know your body: Local surgeons respond to ALCL concerns in breast implants

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The Food and Drug Administration (FDA) website details that breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is not breast cancer, but rather a type of non-Hodgkin’s lymphoma. It says BIA-ALCL is found in the scar tissue and fluid near an implant but can spread throughout the body. 

FDA officials met this week to discuss the safety of breast implants. The sessions, going for two days, ended with the conclusion that more data is needed before any changes to the implant market should be considered.

The FDA also urges future patients to be informed about the different risks associated with surgery. They’re also asking physicians to report more ALCL implant connections going forward.

In 2018, the FDA received 457 cases of BIA-ALCL. While they’re still working to collect data, evidence points to textured implant and the role of biofilm.

Today, the FDA still sees breast implants as safe overall. The risk is still low, which the FDA has at 1 in between 3,818 to 30,000 of women with textured breast implants. 

Stephen Becker, a plastic surgeon in Alcoa, said Tuesday that ALCL is a risk in textured implants, but also said the risk isn’t the same for all texture types.

He said the texturing technique more commonly associated with ALCL is called salt-loss texturing. Becker offers patients a choice between smooth or textured implantation. He said his textured implant is made with an imprint technique, which he said carried a 1 in 86,000 risks for ALCL.

That risk is so low, he says he’d have no hesitation about his sister or wife opting for that implant type.

It’s something to definitely keep in mind, be aware of and talk to your surgeon about, but does it mean you need to go out and have both of your implants removed? not at all, he said. 

There are two types of implants: smooth or textured. Becker said the choice depends on the patient’s preference and if the patient is a cancer survivor, the type of reconstruction.

The advantages of textured implants, he explained, are their shape and it reduces the risk of a capsular contracture, which can occur in the smooth implants. It’s important to him that patients are informed when they make a choice, and know the risks and benefits. About half of them ultimately choose textured, he said. 

Becker said he gets up and does what he does every day to help people feel better about their appearance. In reconstructive patients, which make up about one-third of breast augmentations nationally, he aims to make patients feel as good about their appearance they did before surgery, hopefully, better.

It’s like a victory against the disease process, he said. 

He doesn’t want the risk to be taken lightly. He said you should know your body. If you see fluid collection around the implant, sudden significant enlarging, or a palpable mass, he said you should be evaluated. 

David Lo, a plastic surgeon in Knox County, said he received three calls Wednesday from patients concerned about ALCL.

The fear and risk is why he does not offer any textured implants. While he agrees a patient with textured implants already shouldn’t be worried and should see a medical provider if they see any changes, he doesn’t think the advantages of the textured implant outweigh their risks.

People are very appreciative and thankful that we’re able to help them, so I definitely want to do right by them and pick what’s the safest. To me, picking the smooth, round, implant is the safest, he said. 

He conceded, the textured implants advantages of appearing more of a natural breast shape and cutting down the risk of any flipping after it’s placed, but because he hasn’t heard of a single ALCL link to the smooth implants, it’s the only one he’ll put in. 

Lo explained the texturing can foster bacterial growth, or biofilm, which can adhere within the nooks and crannies of the implant over time. He also agreed that some types of texturing, as Becker referred to, are more prone to infection. 

He admitted the risk is low and ALCL usually occurs a decade following the procedure. 

If you’ve met Jennifer Olmstead you take away a few key things: She’s tough, she goes after what she wants, and she knows what she’s getting into.

A couple of years ago, she decided to get breast implants. Becker, whom Olmstead works alongside often as a surgical assistant, performed the surgery. Olmstead said he also explained the risks associated with her choice of a textured implant up-front.

I didn’t like take it lightly that’s what I wanted to do. I thought about it, then thought, no I’m not going to do that. But then I thought, if it’s something that makes me feel better about myself and I have the ability to do it, then why not, she said. 

Olmstead stands behind her choice. After doing hundreds of breast surgeries and thousands of operations overall, she feels she definitely made an informed decision.

She said she’s happy with the results. She remembered thinking she didn’t want to settle for something that wasn’t exactly what she wanted. Olmstead, in consultation with Becker, now knows what to keep an eye on if anything goes wrong.

The risk for that is so small, if you think about the risks of things you do every day, 1 in 80,000 is a very small risk, she added. 

More than 10 million women have breast implants around the country. Annually, roughly 300,000 women undergo the procedure. One-third of those women are having reconstructive surgery following cancer. 

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