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Peter Beitsch, MD/

Breast Implants and Anaplastic Large Cell Carcinoma

I'm not sure why the New York Times is so into this issue but they wrote about it in March of this year https://www.nytimes.com/2017/03/21/health/breast-implants-cancer-deaths.html?action=click&contentCollection=Health&module=RelatedCoverage&region=Marginalia&pgtype=article

and now they are back at it.

https://www.nytimes.com/2017/05/14/health/breast-implants-cancer.html?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health&region=rank&module=package&version=highlights&contentPlacement=1&pgtype=sectionfront

But let's put this in some perspective, there are ~300,000 women every year getting implants for cosmetic reasons and ~100,000 women getting implants for reconstruction (that is ~800,000 implants placed each year in the US).  There have been 359 reported cases of Anaplastic Large Cell Lymphoma (ALCL) most of which have been associated with textured surface implants (only 231 have information about the shell - 203 were textured and 28 were smooth).  The implant contents did not seem to matter (only 312 cases have information about contents - 186 were silicone gel and 126 saline). There has been 9 reported deaths.  Here's some perspective, let's just use 10 years of implants 800,000 x 10 = 8,000,000 implants placed and let's double the number of cases (assuming not all cases are reported).  The chance of getting ALCL is 718/8,000,000 = 0.00009 or if you get 2 implants 0.018% (2 in 10,000) and if you get ALCL your chance of surviving it is 97.5%.

So it is extremely rare, but if you have a patient with previously normal implants and develops fluid around their implant, firm mass, breast enlargement, tenderness, redness and capsular contracture - you should think about ALCL.  Patients with the ALCL confined within the capsule often have an indolent course and good prognosis, responding well to capsulectomy and removal of the implant.  In contrast, patients who present with a distinct mass may have a more aggressive progression and poor prognosis, requiring chemotherapy and/or radiation therapy

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