January 28th, 2011 by Elaine Schattner, M.D. in News, Opinion
1 Comment »
The FDA [has] issued an alert about a possible link between breast implants — saline or silicone — and a rare form of lymphoma called anaplastic large cell lymphoma (ALCL). These lymphoma cases are exceedingly rare, but the association appears to be significant.
The FDA identified a total of approximately 60 ALCL cases in association with implants, worldwide. Of these, 34 were identified by review of published medical literature from 1997 to May, 2010; the others were reported by implant manufacturers and other sources. The agency estimates the number of women worldwide with breast implants is between five and 10 million. These numbers translate to between six and 12 ALCL cases in the breast, per million women with breast implants, assessed over 13 years or so.
In women who don’t have implants, ALCL is an infrequent tumor, affecting approximately one in 500,000 women is the U.S. per year. This form of lymphoma — a malignancy of lymphocytes, a kind of white blood cell — can arise almost anywhere in the body. But ALCL cases arising in the breast are unusual. The FDA reports that roughly three in 100,000,000 women are diagnosed with ALCL in the breast per year in the U.S.
These are very small numbers. Still, the finding of ALCL tumors by the implant capsules is highly suggestive. Almost all of the implant-associated ALCL cases were T-cell type, whereas most breast lymphomas are of B-cell type. The lymphomas arose in women with both silicone and saline-type implants, and in women with implants placed for purposes or augmentation and for reconstruction after mastectomy. Read more »
*This blog post was originally published at Medical Lessons*
January 27th, 2011 by John Di Saia, M.D. in News, Opinion
1 Comment »
From the Food and Drug Administration (FDA) safety alert yesterday:
ISSUE: The FDA announced a possible association between saline and silicone gel-filled breast implants and anaplastic large cell lymphoma (ALCL), a very rare type of cancer. Data reviewed by the FDA suggest that patients with breast implants may have a very small but significant risk of ALCL in the scar capsule adjacent to the implant.
BACKGROUND: In total, the agency is aware of about 60 cases of ALCL in women with breast implants worldwide. This number is difficult to verify because not all cases were published in the scientific literature and some may be duplicate reports. An estimated 5 million to 10 million women worldwide have breast implants. According to the National Cancer Institute, ALCL appears in different parts of the body including the lymph nodes and skin. Each year ALCL is diagnosed in about 1 out of 500,000 women in the United States. ALCL located in breast tissue is found in only about 3 out of every 100 million women nationwide without breast implants.
While the FDA’s new report is interesting, as it stands it’s of little consequence. A mere 60 cases of a unusual breast cancer worldwide is a tiny number compared to the huge number who develop the much more common ductal breast cancers (about one in seven women in the U.S.) Breast implants have not been found to affect this more common cancer incidence. I do expect this statistic to be misquoted by the anti-breast implant factions online.
As an aside, I do remember a case in a fellow plastic surgeon’s mother of a lymphoma near a breast implant capsule when I was a resident. This is the only breast cancer of this type I have ever seen, however, in 14 years of practice. While I don’t doubt the association, I do focus on the significance of this report to the average breast implant patient, which is very little at this point.
– John Di Saia, M.D.
*This blog post was originally published at Truth in Cosmetic Surgery*
January 4th, 2011 by RamonaBatesMD in Better Health Network, News, Research
No Comments »
This article (full reference below, free access) came to my attention via MDLinx. It was interesting to read. The conclusion verified my expectations rather than surprised me.
The authors conducted a retrospective review of patient demographics and implant information from three university settings: Kelowna (British Columbia, Canada), Loma Linda (California, USA), and Temple (Texas, USA). Each cohort included 100 consecutive breast augmentation cases. Characteristics analyzed included age, height, weight, BME, parity, and average implant volume.
When considering the 300 as one cohort, the average age was 34 years with a height of 163 cm (5’4”), weight of 58.1 (127.8 lb) and parity of 1.7 . The average implant size was 370 ml. Read more »
*This blog post was originally published at Suture for a Living*
December 10th, 2010 by John Di Saia, M.D. in Better Health Network, Health Tips, Opinion
No Comments »
Reader question:
A surgeon I’m thinking about seeing said on his website that breast implants were able to be done under local + intravenous anesthetic (like twilight). Can this really be done? I always thought it was too invasive for just twilight, especially if it is under the muscle. Is there an advantage to using twilight? After looking it up, there are lots of differing opinions out there, but I think that this may just be a way for the surgeon to cut costs. What is the cosmetic surgery truth here, Dr. D?
I am not a fan of local anesthesia or twilight sleep for breast implant surgery except in rare cases (simple redos and such). The reasons are patient comfort and practicality. I place most of my breast implants under the pectoral muscles, and these muscles need to be relaxed for this to work out. That relaxation is suboptimal under less than a general anesthetic. Read more »
*This blog post was originally published at Truth in Cosmetic Surgery*
April 3rd, 2010 by RamonaBatesMD in Better Health Network, Humor, True Stories
No Comments »
Crying, she says: “Dr. Bates, my right implant has deflated. Help!”
“Don’t panic. It’ll be okay.”
We review the options and risks. Fortunately, her 9-year-old implants are covered by the 10-year plan.
“Dr. Bates, can I go bigger this time?”
“Yes, that’s an option.”
Smiling, “Then let’s do it.”
*This blog post was originally published at Suture for a Living*
