Breast Implants, since their initial development in 1961 by Cronin and Gerow with the help of Dow Corning, have made a great impact on the lives of many women both through breast augmentation for volume increase<\/a> and reconstruction for rehabilitation of women after mastectomy for cancer<\/a>.<\/p>\r\n
Generation 1<\/strong><\/p>\r\n
Generation 2<\/strong><\/p>\r\n
In the 1970s, a number of improvements were made.<\/p>\r\n
Generation 3 and 4<\/strong><\/p>\r\n
Generation 5<\/strong><\/p>\r\n
The outer shells have become stronger and the silicone gel used for the filling has become more cohesive.\u00a0
The implants are available in round and anatomical shapes, with the former being available in round or textured surfaces while the latter is available only with textured surfaces to overcome the risk of implant rotation.
There is also a greater availability of shapes and projections, to customize the choice of implant to suit the patient best.<\/p>\r\n
The majority of patients have good outcomes with the use of breast implants<\/a>.<\/p>\r\n
Grade 1 \u2013 the breast looks and feels normal<\/p>\r\n
Grade 2 \u2013 the breast looks normal but feels slightly firm<\/p>\r\n
Grade 3 \u2013 the breast looks abnormal and feels firm<\/p>\r\n
While capsular contractures and gel leak, bleed and implant rupture are well recognized complications, there is increasing evidence, mainly anecdotal, that a proportion of patients with breast implants exhibit troublesome medical symptoms which are difficult to explain but have gained significant relief with the removal of these implants.<\/p>\r\n
For a long time, these symptoms, while present in a proportion of patients with implants, have not been recognized by many in the industry and profession. There has been a change recently and in May 2019, the FDA released a statement it was taking steps to better characterize \u201cBreast Implant Illness (BIA)\u201d<\/strong> <\/a>\u00a0and its risk factors, and for implant recipients to have all of this information available to them.<\/p>\r\n
While information was being gathered on BII, a new problem appeared when it was noted that some women were presenting with swollen, tender and enlarged breasts on one side, presence of a lump in the breast or armpit, usually about 5 \u2013 7 years after breast augmentation.\u00a0 Further investigation showed the presence of a fluid collection around the implant.\u00a0<\/p>\r\n
Examination of the lump in the breast or armpit or of the fluid collection in a small proportion of patients showed the presence of Anaplastic Large Cell Lymphoma, which has now been named Breast Implant Associated \u2013 Anaplastic Large Cell Lymphoma (BIA-ALCL).<\/strong><\/p>\r\n
First seen in 1997, over the last 5 \u2013 7 years, there have been about 900 patients who have been diagnosed with BIA-ALCL.\u00a0 A feature common to all patients is that they received textured implants.\u00a0 Treatment will involve PET\/CT scans to check if there is spread elsewhere in the body.<\/p>\r\n
After evaluation by an Oncologist for staging of the disease and treatment planning, the implant along with the capsule is removed.<\/p>\r\n
Patients with advanced disease may require treatment with chemotherapy or in rare cases radiation therapy.<\/p>\r\n
There has been a worldwide recall \/ cessation of sale of textured breast implants.<\/p>\r\n
Many surgeons, including myself, now restrict ourselves to the use of round, smooth implants.<\/p>\r\n
More work is being done to develop tests to check potential allergy and reaction to silicone amongst patients needing breast implants.<\/p>\r\n
In addition, greater investigation needs to be done to see if there are allergic or autoimmune patterns in a patient\u2019s history.<\/p>\r\n
In addition, patients need to be fully updated on the above problems noted with the use of breast implants<\/a>, to help them make informed decisions about going down this path.<\/p>\r\n
References<\/em><\/u><\/strong><\/p>\r\n
1 \u2013 Special Report:\u00a0 Breast Implant Illness and BIA-ALCL.\u00a0 www.breastcancer.org<\/a> (16.9.2020)<\/p>\r\n
2 \u2013 What is BIA-ALCL?\u00a0 www.breastcancer.org<\/a> (16.09.2020)<\/p>\r\n
3 \u2013 What is Breast Implant Illness?\u00a0 www.breastcancer.org<\/a> \u00a0(16.09.2020)<\/p>\r\n
4 \u2013 Frequently Asked Questions About Breast Implant Illness and BIA-ALCL \u00a0www.breastcancer.org<\/a> (16.09.2020)<\/p>\r\n