Breast Implant Associated Cancer - Symptoms, Risk, and Treatment

Introduction:

Breast cancer is the most common cancer in women after skin cancer. Breast implant-associated cancer is a rare type of lymphoma seen in people who underwent augmentation surgery with breast implants or reconstruction surgery after breast removal because of cancer. This type of cancer occurs around scar tissue and fluid around the breast implants.

What Are Breast Implants?

People who desire larger breasts undergo surgery to place implants that enhance their size. The procedure is called breast augmentation or augmentation mammoplasty. This is done by placing breast implants under the chest muscle or breast tissue. They are also used in people with breast cancer after surgical removal of breasts or in case of any injury, which is called reconstruction.

What Are the Types of Breast Implants?

There are mainly two types of breast implants: Saline and silicone breast implants.

• Saline Breast Implants: They have an outer shell of silicone and are filled with sterile salt water. If the implant shell leaks, the saline implants collapse. The body absorbs the saline, and it gets eliminated. Saline implants are firm and uniform. These implants are indicated in people above the age of 18 years.

• Silicone Breast Implants: They also have an outer shell of silicone and a silicone gel-filled interior. The breast feels more natural due to the silicone gel. In case of the implant shell leaks, the silicone gel may remain in the implant shell or the breast implant pocket and, therefore, will not collapse. These silicone breast implants are indicated in women above 22 years of age.

The other modifications of breast implants are:

• Structured Saline Breast Implants - Like saline breast implants, they are made of sterile saline water. It contains an inner structure to make it feel more natural.

• Gummy Bear Breast Implants - They are form-stable, firm implants. Even if the implant shell is broken, it maintains its shape. The silicone gel consistency of this implant is higher than normal silicone breast implants. A large incision is needed for placing gummy bear breast implants.

• Round Breast Implants - The breast appears full than the gummy bear implants due to its round shape and is less likely to get out of place.

• Smooth Breast Implants - They are soft and movable with natural movement.

• Textured Breast Implants - This implant develops scar tissues, which helps it stick to the implant, and there will be less chance of it moving inside the breast. So repositioning will not be visible.

What Are the Risk Factors of Breast Implant?

• The shape of the breast implant changes due to scar tissue formation. This is called capsular contracture.

• Pain in the breast.

• Infections can be associated with augmentation surgery.

• Loss of sensation in the nipples and breast area, usually temporary.

• Sometimes, there will be a need for another surgery when the implant changes position or if there is a need to remove the implant.

• There can be breast implant illnesses like fatigue and joint pain. Removing the breast implant will stop these symptoms.

What Is Breast Implant-Associated Cancer?

In a study, the food and drug administration (FDA) proved a link between breast implants and ALCL (anaplastic large cell lymphoma). It is a rare cancer of the immune system. This cancer is called breast implant-associated anaplastic large cell lymphoma or BIA-ALCL. It has been identified that people who have breast implants with textured surfaces have a greater risk of getting breast implant-associated anaplastic large cell lymphoma.

What Is Breast Implant-Associated Anaplastic Large Cell Lymphoma?

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a lymphoma developing in the area around breast implants with textured surfaces and in the scar tissue. Anaplastic large-cell lymphoma is seen mostly on the skin and lymph nodes. Breast implant-associated anaplastic large-cell lymphoma is a subdivision of anaplastic large-cell lymphoma. It is not breast cancer but cancer of the immune system (a type of non-Hodgkin’s lymphoma). It can be seen with saline and silicone breast implants and reconstruction after breast cancer but is not associated with smooth breast implants. It is a rare but very serious cancer and can be fatal if not treated promptly.

Textured surface tissue expanders can increase the risk of breast implant-associated anaplastic large-cell lymphoma. Tissue expanders are temporary implants placed under the breast skin or muscles to stretch skin and tissues. Later these are replaced with breast implants. Tissue expanders should be used only for six months. They stretch the skin and other tissues before breast reconstruction after mastectomy for tissue defects and to correct underdeveloped breasts.

What Are the Symptoms of Breast Implant-Associated Anaplastic Large Cell Lymphoma?

The symptoms include:

• Persistent breast swelling and breast enlargement.

• Presence of lumps in the armpit or breast, mass, and hardening of the breast.

• Pain in the region where the implant is placed.

• Change in the shape of the breast, asymmetry.

• Skin rash.

• Fluid accumulation around the breast implant.

What Are the Diagnostic Methods of Breast Implant-Associated Anaplastic Large?

• MRI (magnetic resonance imaging) uses strong magnetic fields and radio waves to produce a detailed view of the breast. It will find out fluid or any masses around the breast implant and in the region of the lymph nodes.

• Ultrasound of the symptomatic breast.

• CT (computed tomography) uses x-rays and computer technology to produce cross-sectional slices of the breasts.

• PET (positron emission tomography) uses radioactive drugs to differentiate between normal and abnormal metabolic activities.

• Lymph node testing with the help of needle biopsy with drainage of the fluid accumulated.

• Sometimes, bone marrow biopsy and blood tests are also performed.

What Are Treatments of Breast Implant-Associated Anaplastic Large Cell Lymphoma?

• Early stages of breast implant-associated cancer are completely curable.

• The treatment includes the surgical removal of the breast implant and associated cancer.

• Chemotherapy (drug therapy using one or more anti-cancer drugs, including powerful chemicals, to kill the tumor cell in the body).

• Radiation therapy (radiotherapy uses a high beam of radiation to kill the cancerous cells in the body).

• Stem cell transplant (or bone marrow transplant: in which damaged stem cells are replaced with healthy stem cells).

Conclusion:

The augmentation surgery takes only one to two hours and is done under general anesthesia. Breast implants do not prevent breast sagging. It only changes the shape and size of the breasts. Breast implant-associated cancer can be prevented through continuous monitoring and follow-up with the doctor. So discussing all the merits and risks associated with breast implants with the surgeon before the surgery will help the patient gain the correct perspective and help take the optimal recourse.