The potential association between breast implants and a rare form of cancer was recently brought to light in a New York Times article. Understandably, this has led to a lot of concern from women who already have or who may get breast implants about the safety of their implants. Although the article reports that the breast implants placed in the women featured in the article directly caused their diagnosis of a low-grade lymphoma, there are still many unanswered questions about the causation and the actual risk following breast implant placement.

Here’s what we know about BI-ALCL:

  1. The risk of getting lymphoma following breast implant placement for cosmetic or reconstructive reasons is very low.  Reported lifetime risk in the U.S. ranges from 1 in 30,000 to 1 in 50,000. Hundreds of thousands of breast implants are placed every year, but to-date only 359 cases have been reported from around the world.
  1. BI-ALCL can be treated and cured when discovered early. The typical signs of BI-ALCL are swelling in the breast around the implant after all of the post-surgical swelling has healed (2 or more years after surgery) or a mass in the breast near the implant. If these kinds of symptoms occur, women should be evaluated by their plastic surgeon as soon as possible. Depending on the findings, patients may require imaging of their breast and a possible biopsy or drainage procedure.  Once BI-ALCL has been diagnosed, women will need to undergo surgery to remove the implant and the surrounding capsule as well as any breast masses. Surgery alone is very effective for treating the lymphoma in most patients, though some patients will need chemotherapy or radiation therapy if the disease is more advanced.
  1. Plastic surgery organizations and the FDA are working together to collect more information to better understand BI-ALCL and learn how to prevent it in the future. The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery in conjunction with the FDA have been actively tracking all cases of BI-ALCL and collecting as much clinical information as possible to try to determine the specific risk factors for BI-ALCL. Research is also being done to investigate genetic and other patient factors that may make patients more susceptible to developing BI-ALCL if they do have breast implants.

Although we do have good information on how to diagnose and treat BI-ALCL, there are still many issues currently being studied about why women get BI-ALCL.  Here’s what we still don’t know about the disease:

  1. What type of implant and what qualities about the implant increase the chance of BI-ALCL. Complete data is not yet available for all of the implants associated with the reported cases of BI-ALCL, so it’s still difficult to make definitive statements about which implants may be more concerning. However, many of the cases have involved implants with texturing on their surface, which is a manufacturing technique that helps implants adhere to the surrounding tissue and is particularly important for shaped (“teardrop”) implants to prevent the implants from rotating the wrong direction when used for breast augmentation or reconstruction. It is not yet clear if implants from certain implant companies are more likely to have associated BI-ALCL or why the texturing might increase the risk, although there are several theories about the potential cause. BI-ALCL has been seen in women with both silicone and saline implants.
  1. Why do certain women develop BI-ALCL while the vast majority of women with breast implants do not develop it. There may be genetic factors that make women more susceptible to BI-ALCL that have not yet been discovered, or women who develop the disease may have higher levels of chronic inflammation around their implants. Further reporting of cases and analysis of the current cases worldwide is needed to better understand the cause of the disease.
  1. How can women who already have implants in place prevent the chance of getting BI-ALCL. As the cause of BI-ALCL is not yet known, there is no specific prevention strategy that women can do, although women should be vigilant about any new concerning symptoms and keep their plastic surgeons informed. Screening for BI-ALCL or removal of implants is not currently recommended or supported by available data.

Additional information can be found on the American Society of Plastic Surgeons’ site on BI-ALCL, which will be updated with newer information as it becomes available.

PPT

As breast reconstruction techniques have evolved through the years, patients have benefitted from the advanced technology. One of the latest techniques offering several advantages to patients is breast reconstruction surgery done with what is called pre-pectoral reconstruction.

Pre-pectoral reconstruction places the implant above the chest muscles, which can lead to quicker recovery time, less post-operative pain, and improved mobility. It also prevents hyper-animation deformity, where the pectoral muscles look prominent and can cause a rippling in the implant when they are activated, which can occur when the implant is placed beneath the muscle.

Pre-pectoral reconstruction can be done with either one-stage or two-stage implant reconstruction, which is determined based on patient goals and certain specific details of the treatment plan.

Dr. Anne Peled is a board-certified plastic surgeon specializing in mastectomy and breast reconstruction. For a consultation or for more information, call 415-923-3011 or visit www.annepeledmd.com for more information.

Luncheon

Dr. Anne Peled spoke at the Advances In Breast Cancer Care Luncheon, held October 14th, 2016 at the Yountville Community Center in support of Breast Reconstruction Awareness Day, October 19th, 2016.  The event was sponsored by the St. Helena Martin-O’Neil Cancer Center and also included Dr. Anne Katz, a therapist specializing in breast cancer-related concerns.  The audience included breast cancer care providers, patients and other community members.

Dr. Peled spoke on advances and new directions in breast cancer care.  She addressed some of the latest innovations in breast cancer surgery and oncology to help diagnose and treat breast cancer. Her talk also discussed new and successful techniques in breast reconstruction in order to educate patients about all of their surgical and reconstructive options.  Dr. Peled discussed how to help patients talk with their providers about their surgical plan and if breast reconstruction is right for them.

The Mission of Breast Reconstruction Awareness Day

Breast Reconstruction Awareness Day is a collaboration between the American Society of Plastic Surgeons, The Plastic Surgery Foundation, breast centers, nurse navigators, corporate partners and breast cancer support groups. Breast Reconstruction Awareness Day was founded to educate patients and providers about breast reconstruction options. Informing women of their reconstruction options before or at the time of diagnosis is critically important to improving life after breast cancer.

The American Society of Plastic Surgeons (ASPS) is the largest plastic surgery specialty organization in the world.  Founded in 1931, the society is composed of board-certified plastic surgeons that perform cosmetic and reconstructive surgery.  The mission of ASPS is to advance quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. The Society advocates for patient safety, such as requiring its members to operate in accredited surgical facilities that have passed rigorous external review of equipment and staffing.

ASPS works in concert with The Plastic Surgery Foundation (The PSF), founded in 1948, which supports research, international volunteer programs and visiting professor programs. The foundation’s mission is to improve the quality of life of patients through research and development. The PSF accomplishes its mission by providing invaluable support to the research of plastic surgery sciences through a variety of grant programs.

Oncoplastic Surgery

What is “oncoplastic” breast surgery?

Although many patients are aware of breast reconstruction following mastectomy, many do not know about the option of breast reconstruction done at the time of lumpectomy. Oncoplastic surgery is the term used to describe rearranging the breast tissue at the time of lumpectomy to help improve the appearance of the breast after surgery.


What types of procedures can be done for oncoplastic reconstruction?

Reconstruction following lumpectomy can include rearrangement of tissue alone, breast lift, or breast reduction. Breast lift or reduction is also often recommended to be done on the opposite breast as well to improve symmetry after surgery. Learn more about the different oncoplastic reconstruction options HERE.


Are these procedures covered my insurance or are they considered “cosmetic”?

Although every situation needs to be confirmed individually, the State of California (and many others) mandates insurance coverage for any breast reconstruction for cancer, which includes oncoplastic surgery.


What questions should I ask to see if I’m a good candidate for oncoplastic surgery?   

When you meet with your breast cancer surgeon, you should ask if he/she performs oncoplastic surgery or works with a reconstructive surgeon who does.  Studies have shown that the best time to perform oncoplastic reconstruction is at the time of lumpectomy, not at a later surgery, so ask if you can have your reconstruction in the same stage.


Contact our office

For more information about oncoplastic breast surgery or to schedule a consultation with Dr. Peled, please contact our office at 415-923-3008 or complete the online form here.

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Is Direct-to-Implant Breast Reconstruction Right for Me?

Common options for breast reconstruction after mastectomy include implant-based reconstruction and autologous reconstruction using a woman’s own tissue.  Traditionally, implant-based reconstruction is done in two-stages, with a temporary implant called a tissue expander placed at the time of mastectomy followed by a second surgery several months later to exchange the expander for a permanent implant.

However, many plastic surgeons are now realizing that selected patients may be able to have one-stage surgery with an implant placed at the time of mastectomy, which is known as direct-to-implant reconstruction or a “One and Done” approach  http://www.cbsnews.com/news/one-and-done-breast-cancer-reconstructive-surgery/.  The benefits of this approach are that women can avoid the need for a second surgery for the exchange and get to their final reconstructive outcome more quickly.

Who are the ideal candidates for direct-to-implant reconstruction?

The best candidates for direct-to-implant reconstruction are women with small-to-medium sized breasts who either want to stay the same breast size or be only slightly larger following reconstruction. Direct-to-implant reconstruction can be done with either nipple-sparing or non-nipple-sparing mastectomies. This approach is ideal in women undergoing prophylactic mastectomies for a genetic mutation or strong family history of breast cancer, though can also be done in women who have breast cancer, depending on their type of cancer and other cancer treatment.

What happens during the surgery and what is the recovery like?

Once the mastectomy and lymph node dissection (if needed) is complete, the permanent implant size is determined and the implant is placed underneath the pectoralis major muscle. A surgical drain is placed in each breast to make sure that fluid doesn’t build up after the surgery. Patients stay overnight in the hospital and typically go home the following day.  Post-op visits usually occur at 1 week and 2 weeks after surgery, with drains coming out at the 2-week visit.  While walking is encouraged immediately after surgery, no heavy lifting or strenuous activity is recommended for at least 4 weeks, with most patients returning to their usual activities and exercise regimens by 6 weeks after surgery.

Contact our office

For more information about breast reconstruction or to schedule a consultation with Dr. Peled, please contact our office at 415-923-3008 or complete the online form here.