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Lymphoma And Breast Implants

Author : Mai Brooks

Submitted : 2011-04-20 19:49:27    Word Count : 483    Popularity:   41

Tags:   Breast, lymphoma, implant, saline, silicone, seroma, capsule, contracture, scar, plastic, cosmetic, reconstruction, surgery

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In January 2011, articles were published in major US newspapers about the association of lymphoma and breast implants. This is called anaplastic large cell lymphoma (ALCL), an extremely rare type of malignancy. Approximately 1 in 500,000 women is diagnosed with ALCL (anywhere in the body) in the United States each year. Only 3 in 100 million women per year in the US are diagnosed with ALCL in the breast. Breast ALCL has been most often identified in patients undergoing implant revision operations. There are now about 60 case reports of ALCL in women with breast implants worldwide. The total number of implants worldwide is estimated to be between 5-10 million. Based on these numbers, for women with breast implants, the estimation is that one out of 125,000 would develop breast ALCL. To put things in perspective, in the same women, the rate of breast cancer is one out of seven.
According to the FDA (Food and Drug Administration), women with breast implants may have a very small but increased risk of developing this disease in the scar capsule adjacent to the implant. Fortunately, it does not appear that this lymphoma occurs in the breast tissue itself. So far, it is not possible to identify a type of implant (silicone versus saline) or a reason for implant (breast cancer reconstruction versus aesthetic augmentation) associated with a smaller or greater risk. Currently (February 2011), the recommendations are as follows:
1) In women without any abnormal signs or symptoms, breast implants should not be removed due to fear of lymphoma.
2) No screening for lymphoma in breast implant patients who do not have symptoms. This is because reported cases of breast ALCL had manifestations of chronic fluid pocket (seroma), pain, lumps, swelling, or asymmetry. Chronic seroma is persistent and recurring, and should be distinguished from post-surgical seromas that commonly happen immediately after breast surgery. Furthermore, there is no yet identified reliable method to screen for breast ALCL in a non-invasive fashion.
3) If there is suspicion of breast ALCL, the plastic surgeon should collect fresh seroma fluid and representative portions of the capsule (scar around the implant) at the time of surgery and send for pathology tests. Diagnostic evaluation should include cytological evaluation of seroma fluid with Wright Giemsa stained smears and cell block immunohistochemistry testing for cluster of differentiation (CD) and Anaplastic Lymphoma Kinase (ALK) markers.
4) If breast ALCL is confirmed, the implant and the capsule around it should be removed. The patient should be referred to a multi-disciplinary care team with surgical, radiation and medical oncology expertise. Because this type of malignancy is so rare, there is no defined consensus treatment regimen for the population at large. Therapy should be individualized, and may include further surgery, radiation and chemotherapy.

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Dr. Mai Brooks is a surgical oncologist/general surgeon, with expertise in early detection and prevention of cancer. More at http://www.drbrooksmd.com, http://thecancerexperience.wordpress.com and http://progressreportoncancer.wordpress.com.

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