Breast implants : an overview

By 11/28/2018 News

Implants and breast cancers. What are the risk?

Various articles in the press or reports on television have recently suggested that breast implants may present a possible cancer risk.
Patients are sometimes faced with a huge amount of false information, so it’s important to filter everything and keep them properly informed.

Breast cancer

  • Breast cancer is the most common cancer among women. In France, around 60,000 cases of breast cancer are diagnosed each year, and men can also be affected (500 each year in France). Breast cancers are ductal or lobular carcinomas, and may be either In Situ or invasive. In Situ carcinomas do not metastasize, whereas invasive carcinomas can metastasize via the lymph system and reach the lymph nodes, lungs, liver, bones or brain.
  • The risk of breast cancer is not higher in cases of breast augmentation using implants.
  • Factors increasing the chances of breast cancer are a family history of breast cancer and certain genetic mutations. In fact, in 5 to 10% of cases of breast cancer, there is a genetic predisposition linked to a mutation in the BRCA1 or BRCA2 genes.

Other factors that increase the risk of breast cancer are now widely understood: secondary risk factors include early puberty or late menopause, lack of pregnancy or early pregnancy.

  • Treatment for breast cancer is first to surgically remove the tumor and any lymph nodes in the armpit area that may be affected. Depending on the case, treatment may also include chemotherapy or radiotherapy. Hormone therapy may also be considered if the cancer is sensitive to hormones.
  • Screening for breast cancer is essential and begins with palpation. An annual consultation that includes a clinical breast examination is required for every woman starting from puberty.  From the age of 40, a mammography and ultrasound screening is also recommended. If these exams show anything suspicious, a biopsy will be performed to analyze the tissues and make an accurate diagnosis

Breast implants, wherever they are positioned (retro or prepectoral, that is, behind or in front of the pectoral muscle) do not prevent breast cancer from being detected.

Anaplastic large cell lymphoma (ALCL)

  • Anaplastic large cell lymphoma (ALCL) is an extremely rare tumor that has recently been discovered, and no cases have been diagnosed in patients who have had never had breast implants. In France, 53 cases of ALCL have been reported, out of more than 500,000 women with implants.
  • The origin of this non-Hodgkin’s lymphoma remains to be confirmed, but it would appear that the texturizing of implants may have a role to play in the onset of ALCL. A textured implant is one with a rough outer surface, which is designed to help the implant adhere to the tissue. Various studies suggest that, as with breast cancer, a specific genetic make-up may be a contributing factor. Additional studies are still required.
  • The treatment of ALCL involves removing the implant and a performing a radical capsulectomy (the complete removal of the implant envelope), and sending the capsule for specific testing. The evolution of ALCL when treated promptly is very encouraging, and the lymphoma can be cured completely.
  • To prevent ALCL, the French Society of Plastic Reconstructive and Cosmetic Surgery recommends stopping the use of textured implants.

It is strictly not recommended to perform preventive removal of textured implants in a woman who presents no abnormal clinical signs.

  • On the other hand, as for all women, an annual check-up with a doctor is recommended. The main signs of anaplastic large cell lymphoma may be inflammation around the breast, an increase in breast size, or breast pain. Any woman with abnormal signs should be given a mammography and ultrasound examination, as well as an MRI of the breast if there is any doubt.

The HAS (Haute Authorité de Santé – French national health authority) and Mrs. Buzyn, Minister for Health, have underlined that there is absolutely no need to panic, and that the benefit of reconstructive or aesthetic surgery to women is currently much higher than the risk presented by anaplastic large cell lymphoma.

 

Sources: ww w.fmr.org – www.has-sante.fr