• Laila Roudsari

Textured Breast Implants Can Cause Lymphoma


Yes, you read that right. I have a message that's really important to get out there to all of the ladies who are receiving or have received breast implants. This message isn't just for breast cancer survivors. It's for everyone. Breast implants have been associated with a type of lymphoma called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), which is in the non-Hodgkin's lymphoma family. BIA-ALCL was officially designated as a disease by the World Health Organization in 2016. The FDA has received over 600 reports of BIA-ALCL since 2010 and 9 deaths. That means a woman who has just battled breast cancer could develop a new cancer from her implants.


BIA-ALCL is more strongly associated with textured implants than smooth implants. So what's the solution? It's easy! Don't get textured implants (especially where there is a perfectly reasonable alternative: smooth implants). But why would someone choose textured? They're thought to integrate better with the surrounding tissue and potentially not move as much. But that small potential benefit holds no weight compared to the risk of developing cancer. The FDA has issued a new statement after a meeting earlier this year which resulted in a letter that has been sent out to all relevant healthcare providers. The warning just focuses on raising patient awareness of the disease for all types of implants. But let's look at some numbers that are pretty convincing of the strong association between the disease and textured implants. In 2017, there were 414 reports. For 272 out of the 414, they had info on the type of surface the implant had. 242/272 were textured and 30 were smooth. That's 90% textured. 90% of the cases with known surface info were from women with textured implants. That's a pretty high percentage. So to say I'm not satisfied with the FDA just sending out a letter encouraging health care providers to inform patients of the risk associated with any implant is an understatement. I have actually been planning to write this article since the end of last year (I'm super behind on all blogging fronts). When I read a few days ago that the FDA had their meeting to discuss the topic, I thought that it was probably being widely publicized and would be resolved. I figured I probably didn’t need to write this post. But alas, I'm here writing it. Because I’m unsatisfied with their lack of emphasis on the association of BIA-ALCL with textured implants. And I think they need to start taking action towards removing these implants from the market. But none of that is happening in the US. Allergan has suspended sales of textured implants in Europe because they were not deemed as safe by French regulatory agents. So let’s get the word out and make that true in the US too. If you are considering breast implants for any reason, I highly recommend you do not choose textured implants. My smooth implants don't move around at all. And they look quite good. So if you want to know more about mine, DM me and I can give you more dets.


So what if you already have textured implants? First and foremost, you don't need to freak out. The FDA is not recommending for women to get prophylactic implant removal surgery if they have textured implants. The risk of developing BIA-ALCL is still pretty low. There's not a lot of data, but the risk is estimated at 1 in 4,000 to 1 in 30,000. The biggest early sign is swelling or fluid accumulation around the implant (known as a peri-implant seroma). So if you experience that (or any change for that matter), it is best to go see your doctor. And what happens if you get BIA-ALCL? Sometimes all you need is removal of the implant and capsule, but sometimes you also need chemo and radiation. So let's recap, a woman who just went through at least a year of multiple surgeries, chemo, and radiation may have to, in the very least, have another surgery, and at the very most, repeat the horrible evil that is chemo and radiation!


Ok, now that the gravity of the situation is apparent and we all know what to do, let's figure out why the hell this is happening. You can probably guess where I’m going next - the science! There are 2 main theories about the link between textured implants and BIA-ALCL: the method to create the textured surface and biofilm formation.

1. Textured surface process: one texturing process is called 'lost salt' and creates small silicone particles that accumulate in the capsule and lead to a chronic immune system response and then malfunction (and since lymphoma is a disease of the immune system, that's the link to cancer).

2. Biofilm: biofilm is the buildup of bacteria on a surface. Because there is more surface area on a textured implant, it can harbor more bacteria than smooth implants and the bacteria causes an enhanced immune system response. Check out a picture of biofilm buildup on implants of increasing roughness below. In one study, a research group performed pig and human studies and found more lymphocytes (the type of white blood cells that get lymphoma) and specifically T cell lymphocytes (the type of lymphocyte associated with BIA-ALCL) on textured implants compared to smooth implants.


Bacteria stained in green on implants ordered from smoothest to roughest demonstrating increasing biofilm formation with increasing roughness (Figure adapted from James, et al., referenced below).

The debate over cause is heated. Ok, heated for a science debate (like the science equivalent of a some solid soap opera drama). And I wonder if any of this debate is related to the fact that some of the studies are being sponsored by implant companies, such as Allergan. There's no evidence of this; it’s just one of my conspiracy theories. Regardless of the cause and if we can say for certain that it is the textured implants, it seems like a safe bet to avoid textured implants altogether.


So in addition to this story hitting home since I'm a survivor and a scientist that has read the facts, there's a personal component for me. I want you to officially meet my kickass, original breastie, Jenna. Jenna and I went to middle and highschool together. Fun fact, she was my brother's first girlfriend (I think I've got the timing right - Jenna and Jill, you can weigh in!). Point is, we go way back. Jenna is the type of person that’s always so much fun to be around. She is the caring, thoughtful wife and mom of a beautiful little girl. This breastie will stand up for her friends and what she believes in and go to bat in an instant if needed. She was diagnosed with breast cancer almost exactly one year before me. And right after I was diagnosed, Jenna was the only friend I could talk to. I was so upset at everyone who was healthy and didn't have cancer and she was there for me. Just knowing she was my age and had gotten through it was incredibly helpful for me. So when Jenna told me she was having implant issues, my heart immediately sunk. Hearing her story made me so fired up to get the word out about this horrible issue so I've asked Jenna to share her story with all of you.



Message from Jenna:


In March of 2017, at the age of 27, I was diagnosed with stage 2 breast cancer. My oncology

team immediately started me on a difficult chemo regimen. Then I had a double mastectomy, which was followed by radiation. When going over my options for reconstruction I knew that I wanted to have implants put in so that it would limit the amount of surgeries I would have to go through versus going the route of a flap reconstruction which would require multiple surgeries. My surgeon informed me that he would do his absolute best to put in the implants right away so that I would not have to have a second surgery but it would be very difficult. I was pleasantly surprised to wake up from my mastectomy with my new implants in. For over a year, I never had any issues.





In September of 2018 I noticed swelling in my right breast. This seemingly happened over night and although it wasn’t particularly painful, I was immediately scared. Being that I was more than a year out from surgery, I knew something was not right. I called my doctor and after going over my symptoms he asked me to come in. He quickly requested blood tests and an MRI. All of the initial blood work came back negative but the MRI showed a large amount of fluid behind my implant. A few days later, a needle aspiration was performed. They removed over 120 cc’s of fluid out of my breast and sent it off for testing. A couple of weeks later, while still waiting on the test results, the swelling in my right breast came back. I went back for a follow-up appointment, and it was not until then that I learned about textured implants. I knew that I had gel implants and what size they were but I was not aware that they were textured or that new studies have shown that these textured implants can cause lymphoma and that the symptoms I was having were the same as the early signs of the implant-associated lymphoma. Imagine my shock and surprise when my surgeon informed me about this. Thankfully, my initial tests for lymphoma came back negative. After going over my options, I decided to remove the textured implants and have them replaced with non‐textured. This was the last thing I wanted. It was what I had been trying to avoid all along: another surgery. During surgery, the fluid was once again removed and sent for testing. I recently learned that the fluid was negative for lymphoma.



Our friend group that goes all the way back to middle school


Although I am absolutely thrilled to learn I am not one of the cases of lymphoma caused by textured implants, the thought that it was even a possibility was absolutely terrifying. I keep trying to go back over my conversation with my doctor in my initial appointments and as far as I can remember, we never once talked about this being a concern. I trust my doctor more than anything but the thought of having an implant in me that could have caused a secondary cancer is just not okay. I feel that I can say with confidence that any breast cancer patient (or any woman really) would not want that risk. I just can’t understand why this isn’t being talked about more. Why are the doctors not making a bigger deal about this? If I had known about the risk from the very beginning I would never have chosen the textured implants to begin with. After everything I have been through, I want to do everything possible to avoid any further issues or complications.



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Message from your favorite survivor scientist:


So to recap, if you are getting reconstructed or augmented, avoid textured implants. Ask your surgeon about only using smooth implants. If you already have textured implants, keep an eye on them. Issues are uncommon but they might cause you some trouble. Ultimately, these implants should be banned. Plastic surgeons need to warn patients not only about the risk of the BIA-ALCL from all implants, but also about the specific association between textured implants and the disease. The FDA needs to call for more research and independent studies to be performed that are not sponsored by implant companies. And lastly, breasties need to share this information with other breasties to make sure no one chooses textured implants. Let's get the word out so no other breasties have to deal with a second unnecessary cancer.


Read the FDA's recent release here.



REFERENCES:


Hammond, D. “Chronic Biofilm Infection in Breast Implants Is Associated with an Increased T-Cell Lymphocytic Infiltrate: Implications for Breast Implant-Associated Lymphoma.” Letters. Plast Reconstr Surg. 2015. 135(6): 1057e-1058e.


Hu, H, et al. “Chronic Biofilm Infection in Breast Implants is Associated with an Increased T-Cell Lymphocyte Infiltrate: Implications for Breast Implant-Associated Lymphoma.” Plast Reconstr Surg. 2015. 135(2): 319-29.


James, G, et al. “Bacterial Adhesion and Biofilm Formation on Textured Breast Implant Shell Materials.” Aesth Plast Surg. 2018. [Epub ahead of print].


Webb, L, et al. “Textured Breast Implants: A Closer Look at the Surface Debris Under the Microscope.” Plastic Surgery. 2017. 25(3): 179-183.


Guest blogger: Jenna Baskin (@jenna.baskin on Instagram)


#breastcancer #texturedimplants #breastimplants

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