Our monthly academic journal, Plastic and Reconstructive Surgery, highlighted a “special topic” section which addressed lymphoma arising in the breasts of women with implants. There were 6 articles which reported facts as well as opinions.
Less than o.5% of all breast cancers are lymphomas. The first report in a patient with breast implants was in 1997 and there have been isolated case reports in the pathology and the cancer literature. Since 2010, a number of plastic surgeons started to report T cell lymphomas arising in the scar tissue around a breast implant. Dr. Brody’s research article in Plastic and Reconstructive Surgery recovered 173 cases in the world literature. This can occur in any breast implant patient whether the implants were placed for augmentation or reconstruction. To put this into perspective, the incidence of T cell lymphoma in a breast implant patient approaches 1 in 3 million.
The data suggests an inflammatory cause. The body’s reaction to a foreign material (in this case a breast implant) is to create a barrier between the implant and the body. The body’s immune system responds to the breast implant by surrounding it with white blood cells and T cells. T cells are part of the immune system’s response to inflammation. This foreign body inflames the area and the body therefore develops a barrier; i.e. scar tissue. The demographics suggest the T cell lymphoma in the scar around the breast implant may be the result of a low grade infection or chronic irritation from a textured implant surface. Over the last 15 years, I have preferred the smooth round implants for both augmentation and reconstruction.
You should be concerned if there is a sudden and dramatic swelling of the breast after the initial healing period after breast implant surgery. If this occurs, go visit your plastic surgeon. The cancers were documented 4 months to 25 years after the implant was placed (median 9.3 years) so it really can present at any time after the implants have been placed. Such a presentation should elicit further evaluation by ultrasound (US) or magnetic resonance imaging (MRI) of the affected as well as the opposite breast. An open surgical exploration is typically required with removal of the fluid, capsule, and the implant. Make sure the surgeon sends the fluid to examine for T cell cancer cells. Often the lymphoma will be found within the scar capsule and not within the breast itself. Therefore the capsule needs to be completely removed and further evaluated by a pathologist. The implant type and manufacturer needed to be recorded and submitted to the implant data bank.
T cell lymphoma arising in the breast implant capsule is generally not an aggressive tumor. In fact, if the tumor is confined to the scar capsule, complete removal of the capsule and vigilance is the recommended treatment for tumor control. Although surgical extrication is the treatment of choice, some patients have undergone radiation and chemotherapy similar to other body lymphomas (e.g., Hodgkin’s and non-Hodgkin’s Lymphoma). About 5% of diagnosed patients showed an advanced tumor requiring aggressive oncology treatment.
Again it is important to seek help if you have a sudden and dramatic swelling of the breast after having augmentation or reconstruction using breast implants. Make sure your plastic surgeon knows how to care for lymphomas arising in the breast after implant placement. I routinely use smooth walled implants and prescribe antibiotics for 5 days after surgery to decrease the risk in my patients.
Thomas J. Francel, M.D.