What is ALCL?
A rarely reported complication with breast prostheses is BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma). This is not breast cancer, but a type of Non-Hodgkin lymphoma (lymph cancer) that can develop in the capsule and the fluid around the prostheses. ALCL is completely curable when the diagnosis is made early and treated accordingly. In 2018, ALCL was researched in women with breast prostheses in the Netherlands. It was found that women with breast prostheses have a higher risk of developing ALCL than women without breast prostheses. By the time women with prostheses reach the age of 50, the chances of developing ALCL is 1 in 35000. By the age of 75, that could be 1 in 7000.
As in other international studies, it appears that ALCL occurs more often with prostheses with rough texturing i.e. macro textured prostheses. It is important to note however, that it appears that ALCL can develop in the presence of smooth and less rough textured implants too. The healthcare regulator of the Netherlands has indicated that breast prostheses comply with the rules and regulations and that breast implants do not need to be removed.
A similar statement has been issued by the FDA. As a result of this publication, it is expected that follow up studies in Europe will be issued to substantiate the present recommendations.
For whom will a breast augmentation be most suitable?
This procedure can improve your appearance and self-image but does not necessarily comply with your ideal image nor will it make other people approach you differently. Before you consider undergoing a breast augmentation you should consider your expectations and discuss these with your plastic surgeon. The most eligible patients for a breast augmentation are women who wish to obtain an improvement in their appearance and not necessarily perfection. Perfection is an illusion. When you are in good health and have realistic expectations, this procedure is for you.
Which breasts ar most suitable for a breast augmentation?
The result that is to be expected is dependent on the original shape and position of the breasts, and the thickness and quality of the skin. Someone with significantly hanging breasts cannot expect that they are corrected simply by placing prosthesis. A breast lift is then necessary which will result in additional scarring of the breasts. Prostheses must be placed centrally under the nipples.
When the nipples are located laterally on the breasts, the prostheses also need to be placed further apart from each other leaving a wider cleavage. The distance between the prostheses is therefore dependent on the distance between the nipples.
Is there an association between breast prostheses and breast cancer or auto-immune diseases?
There are no indications that breast prostheses have any influence on the development of breast cancer. Millions of breast augmentations have been performed worldwide and never has a connection been made between breast cancer and prostheses. Auto-immune disease develops when the immune system regards the body’s own cells as foreign. Antibodies are then produced against the body’s own tissues. The media has suggested that prostheses can cause auto-immune disease or diseases of connective tissue. This connection has never been proven to exist and women with and without prostheses can develop these diseases.
How long do prostheses last?
It should be taken into account that at some point in the future your prostheses will need to be replaced. Silicone prostheses and saline prostheses will always leak somewhat. Newer generation prostheses will leak less due to improvement in the quality of the casing. Most prostheses can last ten years, but there is always the possibility that they might need to be replaced earlier. There is no guarantee that your prostheses will last 10 years.
What are the risks of a breast augmentation?
A breast augmentation is a relatively simple routine procedure, but as with any operation there are specific risks to this procedure:
Infections can occur in all procedures, but in breast augmentation this is relatively uncommon. It is important that the surgeon adheres to the surgical protocol for the placement of a breast prosthesis. Infections present themselves mainly in the first one to two months after the operation. It presents itself with redness and sensitive swollen breasts. Antibiotics can control the infection at an early stage. Should antibiotics not prove to be successful, the prostheses will need to be removed until the infection has completely subsided. Thereafter, a new prosthesis may be placed three to six months later. In some cases, a salvage procedure can be done by replacing the infected prosthesis immediately under adequate antibiotic cover.
As with any surgery, bleeding can occur after the procedure, presenting itself with painful swelling of the breast. The blood around the prosthesis will need to be removed and the bleeding controlled. Fortunately, bleeding doesn’t occur often, but if it does the chances of excessive capsule formation will increase.
c. Excessive capsule formation
Foreign bodies that are placed in the body, such as breast prostheses, will be surrounded by scar tissue: a capsule. Sometimes the body continues to thicken this capsule producing a thick hard layer that will contract. In the beginning the prostheses will feel a little stiff, but this is not normally a problem. If the capsule contracts further, the shape of the prosthesis will become more like a ball. This is referred to as a capsule contracture. Eventually, when the contracture continues, it will become painful. A capsule contracture will present itself most often within the first three months to a year. The cause of a contracture is not completely clear, but bleeding, infection, and leakage of the prostheses can be associated with it. The management of a capsule contracture involves either breaking up the capsule, removing it, or creating a new pocket for the new prostheses above or below the capsule. Textured prostheses have a smaller chance of excessive capsule formation when placed above the muscle compared to smooth prostheses above the muscle.
When is a prosthesis placed under or above the muscle?
When the skin is thin, it is advisable to place the prostheses under the skin which will make it less visible. Placing it under the skin slightly reduces the chance of contracture, but the prostheses may show slight movement when flexing the muscle. Prostheses above the muscle directly below the breast, will result in a slight projection of the breast and lift of the nipple. Neither placement above or below the muscle will influence fertility, pregnancy or the possibility of breast feeding.
Can a breast be filled with one’s own fat?
The result that is to be expected is dependent on the original shape and position of the breasts, and the thickness and quality of the skin. Someone with significantly hanging breasts cannot expect that they are corrected simply by placing prosthesis. A breast lift is then necessary which will result in additional scarring of the breasts. Prostheses must be placed centrally under the nipples. When the nipples are located laterally on the breasts, the prostheses also need to be placed further apart from each other leaving a wider cleavage. The distance between the prostheses is therefore dependent on the distance between the nipples.
What are saline prostheses?
Saline filled breast implants have been used for many years. Saline is water and salt, in the same concentration as that which we have in our bodies. Saline is easily absorbed by the surrounding tissue should the prostheses start leaking.
The casing of saline prostheses is also made of silicone. Water has very little elasticity and saline prostheses feel firmer compared to silicone prostheses. As with silicone prostheses, the casing of the saline prostheses can be smooth or textured. Textured implants have a slightly lower capsule rate when placed above the muscle.
What are silicone prostheses?
Silicone prostheses are made of a stiff silicone casing filled with softer “cohesive” silicone. Silicone has been used by doctors since the 60’s in implants and for injection needles. The human body normally already contains silicone that has entered the body, for example: babies sucking on a silicone dummy. Firm silicone prostheses maintain their shape better and should a tear occur there will be less leakage.
The casing of the prostheses can be smooth or textured. Textured implants have a slightly lower capsule rate when placed above the muscle.
What guarantees are there after a breast augmentation?
The result of plastic surgery cannot be guaranteed. The competence of the surgeon is of course of great importance, but it is not an exact science and the results can be influenced by many factors. It is important that the patient is well informed about the limitations of the procedure. Satisfaction afterwards is closely related to the expectations beforehand.