ALCL & BII

Transcript

Everyone considering breast implants needs to be informed of the potential risks. Many of these risks, such as capsular contracture and implant rupture, have been known for many years and explain why breast implants are never lifelong. In recent times, there have been two conditions that have been spoken about a great deal, particularly on social media. These are BII and ALCL, which are different, and I thought it important to explain this. Breast implant illness, or BII, is a description of many varied body or systemic symptoms that patients put down to their breast implants. These symptoms include things like brain fog, excessive tiredness, hair loss, muscle aches or joint pains. Although theories exist linking silicone, heavy metals in breast implants or bacterial contamination of the implant's surface, so far there is no known scientific link between breast implants and these problems. Hence, BII is not an actual medical diagnosis. That said, in my own and many other plastic surgeons' experience, these symptoms do frequently get better if the breast implants are removed. A lot of research is underway to find out the cause of these problems in patients and to agree the best treatments. Many patients believe that the problem comes from the capsular scar tissue that the body creates around breast implants. For this reason, they request something called an en bloc excision of the implant and the capsule together. This is quite aggressive and damaging surgery, so patients need to be fully informed and then to fully understand the consequences of their request, which can be based on bad information from the internet. It's vitally important that if you feel you have BII, then you should seek the advice of an expert surgeon who deals with such patients regularly but doesn't prey on your worries and rush to very aggressive surgery in all cases. ALCL is a very different condition and should not be confused with BII. Around 2015, it became clear from several scientific articles that a white blood cell malignancy was being recognised around some breast implants. This condition has since been termed Breast Implant Associated Anaplastic Large Cell Lymphoma or BIA-ALCL. We now understand a great deal more about this condition, which is related to some textured breast implants. In the data collected so far, it appears that not all breast implant textured surfaces act in the same way and over 90% of the worldwide cases of ALCL have occurred in the presence of a textured surface called biocell, which is from an implant company called Allergan. These implants have been taken off the market but have not been recalled from patients because it is thought that the surgery to remove them has greater risk than leaving them in. That's because the rate of ALCL is probably around 1 in 3,000 biocell textured implants inserted. Other textured surfaces have a much lower rate such as around 1 in 30 or 50,000 implants inserted. The treatment of ALCL is usually thorough investigation with detailed imaging and assessment within a cancer unit. It usually involves the removal of the implant and capsule tissue together. That is the en bloc excision. There is usually no need for any additional oncology management although new immunotherapy treatments have been developed. What's important for all patients is to keep checking their breasts and if they notice a change to see a plastic surgeon who deals with such issues. It's also important to keep a record of the implants that you have and probably get a regular ultrasound or MRI check every few years. It's essential for me to state here that I have a professional relationship with an implant company called Mentor who are owned by Johnson & Johnson, the biggest healthcare company in the world. I provide some of the educational output for other surgeons around the world and I'm paid to do this on an hourly rate and do not have any other link such as share deals. I also do not get paid to use their implants. Hence I am completely independent as a plastic surgeon and I act in the best interests of my patients and never implant companies.