The Link Between Breast Implants and Lymphoma

Throughout the years, implants have risen in popularity. On an annual basis, about 400,000 women in the United States get breast implants – around 300,000 for cosmetic enlargement and around 100,000 for breast reconstruction after cancer. In the year 2015, it was estimated that 1.4 million women from all around the world underwent breast augmentation. The same year, only 30% of plastic surgeons reported having routinely discussed the dangers of cancer with their patients.

The link between breast implants and lymphoma was first reported by the Food and Drug Administration in 2011. Up until recently, very little was known about this connection. As of February 1st, 2017, the FDA received a total number of 359 cases of the cancer associated with breast implants – including 9 deaths. The deaths were not caused by breast cancer, but rather a rare cancer of the immune system, known as anaplastic large-cell lymphoma (ALCL).

Lymphoma is a type of blood cancer that affects the lymphatic system. Lymphocytes, also known as white blood cells, help to form the immune system. When lymphocytes begin to grow abnormally and multiply, lymphoma develops in the lymph nodes, bone marrow, blood, or other organs. There are two common types of lymphoma: Hodgkin lymphoma and non-Hodgkin lymphoma. Breast implants have been linked to a form of non-Hodgkin lymphoma known as anaplastic large-cell lymphoma (ALCL).

Evidence showed that the onset of lymphoma was most likely due to problems with the implant surface. Of the 359 cases that were reported, 231 involved problems with the implant surface, where 203 were textured and 28 were smooth. The difference between the two has yet to be determined, but the body’s reaction to textured implants is rather different from that of its reaction to smooth ones. The FDA claimed that the exact number of cases could not be determined due to limited reporting of problems. However, all the data gathered to date suggest that women with breast implants have a low, yet small increased risk of developing breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) in comparison to women who do not have breast implants.

The exact cause of ALCL remains unknown, although a couple of theories have surfaced. One theory suggests that bacteria makes its way to the textured implants and forms a coating called biofilm. This coating causes the immune system to weaken, thus triggering inflammation and eventually leading to lymphoma. Another theory suggests that some women have specific genetic traits, which in combination with breast implants, could trigger the onset of lymphoma.

Experts have agreed that further research efforts need to be conducted to reveal the following:

1. Breast implants appear to be linked to a rare form of lymphoma known as anaplastic large-cell lymphoma (ALCL); however, more evidence needs to be uncovered in order to identify the exact cause or risk factors associated with the cancer.
2. Experts believe that ALCL can be eliminated by removing the affected implant and surrounding tissue. However, if the cancer has spread, rounds of radiotherapy and chemotherapy may be required.
3. Experts believe that the fluid that accumulates around the breast implant a few months after surgery can, in fact, lead to a diagnosis of possible ALCL.

In the cases linking breast implants and lymphoma, the cancer grows in the breast, typically in the capsule of scar tissue the forms around the implant. Symptoms of lymphoma include painful swelling and accumulation of fluid around the implant. Removing the implant and the tissue around it cures the cancer; however, some women may require additional treatment with radiotherapy and chemotherapy.

If you already have breast implants, it is important that you undergo routine screenings such as mammograms or MRIs to monitor the implants for any harmful changes. If you have silicone gel-filled breast implants, consider undergoing regular MRI screenings in order to detect any ruptures. If you do not experience any problems, there is no reason why you should have to remove your implants or change your check-up routine. However, if you begin to notice or experience any symptoms such as persistent pain or swelling surrounding the implant, contact your doctor immediately. Doctors say that 80% of women with breast implant-associated ALCL will likely experience accumulation of fluid around the implant, while 40% will likely experience swelling of the breast or feel a lump.

If you are considering getting breast implants, educate yourself on the benefits and risks associated with implants. Talk with your doctor about the differences between textured and smooth implants. Whatever you decide, it is important that you are fully aware of the potential risk associated with textured implants.

If you have been diagnosed with breast implant-associated ALCL, your doctor will examine you, run a few tests, and ask you questions relating to your health, daily lifestyle, and medical history. There are several diagnostic tests available to find out if you have breast implant-associated ALCL and if your lymph nodes have been affected. Such diagnostic tests include the following:

• Ultrasound
• Positron emission tomography scan – PET CT scan
• Computed axial tomography scan – CAT scan
• Magnetic resonance imaging scan – MRI scan
• Bone scan
• Mammography
• Needle biopsy
• Blood test

For a large number of women with breast implant-associated ALCL, treatment involves undergoing surgery to remove the implants. If the cancer has spread to the lymph nodes, radiation and chemotherapy may be required. The type of treatment that you will receive generally depends on several factors such as:

• Type of ALCL
• The progression of the cancer – or stage
• The location of the cancer
• Your age
• Your overall well-being

Moreover, available treatment options include the following:

• Implant removal with total capsulectomy (IRTC) – complete removal of the tissue capsule that surrounds the breast implant.
• Lymph node dissection (LND) – removal of lymph nodes that appear to have ALCL cells
• Radiotherapy – elimination of cancer cells with high-targeted radiation, such as x-rays, gamma rays, and charged particles
• Chemotherapy – elimination of cancer cells with one or more anti-cancer drugs, also known as chemotherapeutic agents
• CD30 - the main diagnostic test used to determine lymphocyte activation in advanced BIA-ALCL. It is typically recommended as part of a clinical trial to show malignant cells in Hodgkin’s lymphoma.

Of the above treatments, the treatment that you will receive for breast implant-associated ALCL will be customized to meet your individual needs. On a positive note, ALCL is typically treatable by removing the implant and surrounding scar tissue. In cases where cancer has spread to the lymph nodes or affected other organs, undergoing rounds of radiotherapy and chemotherapy may be recommended by your doctor. In general, most patients are put into remission and have a good prognosis when they receive the most appropriate treatment suitable to their needs.

Anaplastic large-cell lymphoma (ALCL) has been diagnosed in 1 of every 500,000 women – making it a very rare type of cancer. Furthermore, the symptoms associated with ALCL are often the same as those of the more common types of breast cancer. For this reason, ALCL is hard to diagnose. Still, it is important to be aware of the potential risks associated with breast implants and lymphoma.

If you experience any symptoms whatsoever, such as breast swelling, pain, or accumulation of fluid surrounding the implant, make an appointment to see your doctor. Together, discuss and decide what is right for you.