Yale Medicine doctors give perspective on headline news from the Food and Drug Administration.
What’s the relationship between breast implants and cancer risk? Even though research has shown that implants don’t increase a woman’s risk of breast cancer, the Food and Drug Administration just released a report that cites nine deaths from a rare lymphoma (not breast cancer) possibly associated with breast implants in some women.
Called anaplastic large cell lymphoma (ALCL), a rare T-cell type of non-Hodgkin's lymphoma, the news has many women who have had breast reconstruction after a mastectomy or cosmetic breast augmentation concerned about their breast health.
“The study the FDA references linking implants to lymphoma is several years old now, and while scary, is talking about a situation that is incredibly rare,” says Anees Chagpar, MD, MBA, MPH, a Yale Medicine breast surgeon and director of the Breast Center at Smilow Cancer Hospital at Yale New Haven Hospital.
“The FDA knows of only 359 cases (likely since the study was first reported in 2011), but each year, about 400,000 women get implants,” says Dr. Chagpar, who is also an associate professor of surgery at Yale School of Medicine. “While it’s hard to discern the rate at which lymphoma occurs in these patients, it is a small number,” says Dr. Chagpar. This is important to keep in mind if you or a loved one have breast implants, she adds.
The FDA’s announcement is based on data collected from the Plastic Surgery Foundation. Yale Medicine’s John Persing, MD, chief of Plastic & Reconstructive Surgery, served as the foundation’s president and was part of an effort to develop this registry to track cases of this lymphoma associated with breast implant recipients.
“The FDA’s recent announcement should not change anything for the overwhelming majority of patients,” says Henry Hsia, MD, a Yale Medicine plastic surgeon. However, he advises that “anyone with pain or discomfort or other concerning changes in her breasts should get in touch with her plastic surgeon.” Changes include swelling, lumps or pain.
In fact, says Dr. Hsia, Yale Medicine has been educating patients about this risk since the study was first published. “For years now, all of our breast reconstruction patients at Yale Medicine have been counseled extensively when they come for their initial preoperative consultation visit about the ALCL risks (along with the general risks of implants such as infection), and this week's announcement should hopefully only reinforce the counsel and advice that they originally received from their providers,” Dr. Hsia says.
Women with breast implants may wonder if there is any change to advice they’ve been given about getting mammograms. According to Dr. Chagpar, women who’ve had mastectomies and have implants for reconstruction do not need routine mammograms, as there should be minimal (if any) breast tissue remaining. “If they have implants for cosmetic reasons, they should follow the same breast cancer screening guidelines (including mammography) as anyone else,” she says.
Yale Medicine oncologists who practice at Smilow recommend that women ages 40 and older receive annual mammograms. If you are at increased risk for breast cancer due to family history or have had chest radiation for other conditions during your lifetime, talk to your health care provider about having a breast cancer screening test before age 40.
Here are some tips to keep in mind if you have implants or are considering them:
Know thy implants. The implant-associated lymphoma cases reported to the FDA occurred more often in women who have textured versus smooth implants. “Before getting breast implants, make sure to talk to your health care provider about the benefits and risks of textured-surface versus smooth-surfaced implants,” advises the FDA in its announcement.
Keep your serial number. It’s a smart health move to keep the manufacturer serial number information provided by your plastic surgeon at the time of reconstruction or augmentation. That way if there’s ever a recall or health concern surrounding the type of implant you have, you can make an appointment with your doctor to discuss your options, if necessary.
Follow recommendations. Some doctors recommend periodic MRIs to check for issues such as silent ruptures or leakage. Follow through on that. “Patients are informed that implant manufacturers recommend periodic surveillance of breast implants with MRIs every two to three years. However, insurance coverage for these surveillance studies varies,” says Dr. Hsia.
Pay attention to symptoms. Generally speaking, don’t ignore unusual health symptoms of any kind. Make a doctor’s appointment, and discuss how you’re feeling with your health care provider. Regarding this type of lymphoma specifically, the symptoms most women report include persistent swelling or pain near the breast implant, according to the FDA. Some women detect lumps, masses, excess fluid or capsular contracture (thick scar tissue around the implant). See your doctor if you have discomfort after implantation, which should be evaluated and possibly biopsied to rule out rare incidences of implant-associated lymphoma.
If you have questions about breast implants, contact our plastic surgeons at (203) 785-2571.