Some women choose to receive breast implants, for cosmetic reasons or breast reconstruction, following a mastectomy. But does this result in a heightened chance of developing cancer?
Fact: Women with breast implants have an increased, but still extremely low, risk of developing anaplastic large-cell lymphoma (ALCL), a type of non-Hodgkin lymphoma that is often curable if detected early. The heightened risk is associated almost entirely with implants that have a textured, rather than a smooth, surface.
“The disease is entirely unrelated to breast cancer, and it does not seem to matter whether the implant contains silicone or a saline solution,” says Mehra Golshan, MD, FACS, distinguished chair in Surgical Oncology at the Susan F. Smith Center for Women’s Cancers at Dana-Farber. Research suggests that ALCL occurs in about one in 50,000 women receiving an implant.
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When the disease does arise, it tends to crop up more than a year – often, several years – after an implant is put in.
When patients develop a chronic swelling and fluid buildup around the implant a year or more after the implantation procedure, doctors drain the fluid and test it for a marker called CD30, which indicates lymphoma, according to Yoon Chun, MD, director of Reconstructive and Aesthetic Breast Surgery at Brigham and Women’s Faulkner Hospital, a Dana-Farber partner in adult patient care. Removing the implant and the entire capsule of scar tissue around it usually eliminates the lymphoma, but if the cancer has spread, patients may require chemotherapy and radiation therapy.
Traditionally, most women choose smooth, round implants, Chun remarks. One of the downsides of such implants is that they sometimes ride upwards in the chest after radiation therapy, creating a less natural appearance. In other cases, they can produce more visible rippling in the overlying skin. But only 4 to 7 percent of the documented cases of implant-associated ALCL may have occurred in women who received smooth implants, rather than textured implants. Textured, anatomically shaped implants have been used for both reconstructive and cosmetic purposes where a more natural upper contour is desired. The rough surface is thought to hold the implant in place more firmly and minimize the risk that it will rotate.
Researchers don’t know, definitively, why ALCL is associated with textured implants. Some theorize that the rough surface of a textured implant may trigger an immune system response that spurs the disease. Others point to infections around the implant as possible culprits, But Chun emphasizes that ALCL is still very rare under these circumstances.
“When we discuss treatment and reconstruction options with a patient, we go over the risks associated with any implant, which can include bleeding and infection,” Golshan remarks. “We explain that ALCL is very uncommon and that if it does develop, it can be treated.”