Implant and tissue expander recall
Recently, the world of plastic surgery has been affected by the sudden implant and tissue expander recall by Allergan due to an FDA request. These products have been found to be predominantly responsible for Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)- a rare form of cancer. In the wake of this recall, many patients have been worrying about the state of their implants and fearing the negative impacts they may have already made on their bodies. At Advanced Plastic Surgery, we feel the need to address these concerns and respond to the many questions posed to our office.
The sources of the concern are Allergan’s “macro-textured” Biocell products, which have proven to be 6 times more likely than other manufacturers to generate BIA-ALCL. No direct links have yet been made between smooth implants and BIA-ALCL. The cause of this disease is not clearly known. It is thought that the capsule itself causes a type of allergic reaction over time which stimulates cancerous growth. BIA-ALCL is a lymphoma-type of cancer of the immune system, not a breast cancer. Additionally, bacterial contamination and genetics have been implemented as causes for neoplastic transformation. The disease appears in patients who have had implants, on average, for 8-10 years, allowing the reaction to develop for many years.
What are the symptoms?
Symptoms of the disease include enlargement of the breast, development of a mass or lump in the breast or armpit, appearance of a skin rash, hardening of the breast, or collection of fluid. If you are having these symptoms, contact your physician immediately. BIA-ALCL cannot always be detected via mammogram, so if you are worrying about your breast health, talk to your doctor about getting your breast examined. In extreme cases, the cancer requires an en bloc resection or a complete removal of the capsule with the implant. If you are NOT experiencing any symptoms, it is not necessary to remove implants, unless strongly desired by the patient.
Do I have any other options?
Alternatives to textured breast implants are smooth saline or silicone implants. Be sure to speak with your plastic surgeon about which implant will be the most suitable, safe, and natural-looking on your body. An alternative to implantation altogether is fat grafting of one’s own fat tissue, or autologous tissue, into the breast. The fat can be taken from a few different places on the body including the abdomen, thighs, flanks, or other areas where you don’t like the fat to be. Fat graft is collected through small 3-5 mm incisions using a technique resembling liposuction. Another strategy to replace removed implants is autologous tissue transfer as a flap from the abdomen, thigh, or back.
DIEP Flap procedures
A type of autologous tissue transfer is the Deep Inferior Epigastric Artery Perforator flap, or DIEP flap. This entails taking fat from the stomach along with blood vessels and attaching them to the blood vessels in the chest. DIEP flap procedures required highly specialized microsurgical training to attach the blood vessels under a microscope. Along with other forms of fat transfer, DIEP flaps offer an option of recreating the breast with one’s own tissue.
Moving large “blocks” of tissue is mostly reserved for implant replacement in a reconstructive setting. For cosmetic purposes of breast augmentation, fat transfer would serve as an autologous option. Autologous tissue transfers harness the benefits of maintaining a non-artificial composition of the breast and preventing reactions to a foreign body. Additionally, the fat will gain and lose weight with the rest of your body because it is all your tissue! Fat transfer is hitting two birds with one stone; not only are you getting a breast augmentation, but you are also getting a flatter belly or sculpted thighs in the same procedure.
Stay conscious and aware
If you have any concerns with the state of your implants, contact your physician. BIA-ALCL is a rare form of cancer, but this does not mean that it cannot happen. Alertness in itself can be a preventative option, for the earlier the cancer is found, the easier it can be to treat.