Silicone Valley

Dr. Starr Mautner

Plastic surgery is ingrained in our South Florida culture. There is rarely a day that goes by that I do not see a patient who has undergone a breast augmentation. In addition, many of my patients who were treated for breast cancer with mastectomy have undergone implant-based breast reconstructions.  For this reason, I often get asked about the safety of breast implants.

The good news is that women with breast implants are not at increased risk of developing breast cancer compared to women without breast implants, and are screened for cancer similarly with mammography. However, in women with breast implants, the radiologist will obtain extra pictures and displace or move the implants out of the way in order to visualize all of the breast tissue. Patients may also be advised to undergo a supplemental breast ultrasound or MRI to increase the sensitivity of screening.

Currently, both saline and silicone breast implants are regulated and approved for sale in the United States by the Food & Drug Administration (FDA).  Both types of implants have an outer silicone shell, which can either have a smooth or textured surface.  Textured implants were created as a way to keep implants in place so they do not move.  The textured shell of the implant is also believed to decrease the amount of contracture or scarring that can occur around an implant.

While extensive studies of silicone implants in the late 1990s failed to show a link between breast implants and autoimmune diseases, rheumatologic and neurologic conditions, and systemic diseases, recent concerns over their safety have put breast implants in the news again.  In 2011, the FDA began investigating a possible association between breast implants with a textured outer shell and a very rare type of lymphoma, called breast-implant associated anaplastic large cell lymphoma (BIA-ALCL). This is not a breast cancer, but a type of cancer of the immune system.  With only 457 cases of BIA-ALCL reported in the United States, more research is being done to better understand why a small percentage of patients with textured implants develop BIA-ALCL. The incidence of developing this extremely rare type of lymphoma is approximately 1 in 30,000 women with textured implants.  When caught early, BIA-ALCL is usually very curable, with surgery to remove the implant and its surrounding capsule. 

Symptoms of BIA-ALCL include late onset of breast pain and swelling in a woman with breast implants that were placed at least 1 year prior and fluid seen around the capsule of the implant. This is usually evident on physical exam and confirmed on a breast ultrasound or MRI.  It can be diagnosed by sending a sample of the fluid to a lab to specifically rule out BIA-ALCL. Since the disease is so rare and most patients with textured implants do not develop BIA-ALCL, prophylactic breast implant removal in patients without symptoms is not recommended.

If you currently have breast implants, there is no need to change your routine medical care and follow up.  If you notice any new changes in the way your breasts look or feel, including swelling or pain around the implant, be sure to talk to your health care provider about the possibility of BIA-ALCL.  If you are thinking about getting breast implants, make sure to discuss the risks and benefits of both textured and smooth-surfaced implants with your plastic surgeon. Additionally, prior to getting breast implants, it is recommended to have a mammogram first in the event that you have any concerning imaging findings that would need to be worked up thoroughly before undergoing cosmetic surgery. 

If there is a topic you would like to hear more about pertaining to women’s health or more specifically breast health, you can message me on Facebook @drstarrmautner.

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