This is out of the Plastic and Reconstructive Surgery Journal October 2017.
We know the rare ALCL cancer associated with the capsules of breast implants is linked to textured surfaces. The question this group asked was, is there a difference in the textured surfaces? Specifically looking at the surface area of the texturing which varies between breast implant brands.
Was there a difference? The answer is YES.
“Breast Implant Associated Anaplastic Large Cell Lymphoma in Australia and New Zealand: High Surface Area Textured Implants are Associated with Increased Risk.”
Study:
- 55 cases 2007-2016
- Mean age of patient: 47
- Mean exposure to implant: 7.46 years
- 4 deaths
- All were textured implants
- Biocell salt loss texturing (Allergan/McGhan)
- Polyurethane texturing (Silimed)
- Siltex imprinted texture (Mentor)
Findings
- Biocell showed risk of 14.11 x higher than Siltex
- Polyurethane risk 10.84 x higher than Siltex
Their theory as to why:
There are 2 kinds of presentations of ALCL:
The first is the “mass type”, which has a poorer prognosis.
The second is the “seroma type”,” which is a slower growing disease. They think the slower growing serous type is like cutaneous ALCL, which is associated with chronic inflammation and autoimmune or infectious triggers. The thought with the cutaneous is that there is a slow trend, where there is a premalignant phase which progresses into ALCL. This is associated with an overexpression of CD30 and a recruitment of T cells.
ALCL in breast implants is thought to be related to chronic inflammation from biofilm. (Read all my blogs on biofilm. I have been a believer for a while.) We know textured implants have a greater surface area, which promotes higher levels of the bacterial biofilm growth, and this higher bacterial load makes an increase in activation of lymphocytes. Gram negative bacteria in particular are found.
The difference in the rates between brands then becomes an issue simply of the amount of surface area. The more surface area = the more biofilm = the higher risk of ALCL.
What do I think?
ALCL is rare. I do not want you to go charging into the sunset worrying about this cancer if you have implants. The vast majority of breast implants placed are smooth walled round implants. But it is important to figure out why things do happen and to know the good and bad of implants.
Biofilm is a risk for anyone with ANY foreign object placed in the body- from an artificial hip joint to a silicone breast implant. The key when placing these is sterility. I do a multitude of things prior to breast augmentation, from topical skin antibacterials prior to surgery, to irrigation with antibiotics during surgery, to using the Keller funnel and a “no touch” technique when placing the implant.
I love that plastic surgeons see an issue, study the issue, and find advice or solutions. Biofilm was something no one knew about or discussed in great detail until about 5 years ago. Knowing about it has changed how I practice, which benefits the patients with lower rates of complications and issues.