ARTICLE

Guidance for women requiring breast implant removal.

Removal of breast implants has become a very common surgical procedure. For some women, removal of their breast implants is absolutely necessary as they have developed a condition known as Anaplastic Large Cell Lymphoma. This is a malignant condition that develops in the capsule a round breast implants. In these situations not only must the breast implant be removed but a complete and total capsulectomy is performed surrounded by a rim of healthy margin (En Bloc capsulectomy). This is a major surgical procedure and, in some women, can result in considerable breast deformity and damage to the chest wall. 

Other reasons for removing breast implants include prophylactic removal of textured silicone implants. Many of these implants have been recalled and it is not unreasonable for women to request prophylactic removal of these implants because of the risk of Anaplastic Large Cell Lymphoma developing in later years. In these cases, should the patient take on the added risk of En Bloc capsulectomy?

In these patients, a recent article in a prominent plastic surgical journal in the US emphasised that “deciding on an En Bloc resection for a patient diagnosed with Anaplastic large Cell Lymphoma, is very different than deciding on the prophylactic procedure to address cancer risk in a healthy patient who has a textured breast implant”. 

“Currently there is no evidence whether a partial or total capsulectomy has any effect on disease mitigation in patients who have textured implants, but no disease”. 

“Without available data, each surgeon will need to counsel patients that a prophylactic capsulectomy may not reduce the risk for future Anaplastic Large Cell Lymphoma. In addition, the surgeon should inform the patient that this complex and costly operation comes with an increase risk for death along with the potential for aesthetic harm”.

“In asymptomatic patients, this explanation alone or switching to a smooth implant may be appropriate and comes with less cost and risk”. 

This is very sobering advice and states what all surgeons who perform breast implant removal with or without total capsulectomy know.  It is clear that, in some situations when the implant is located in front of the muscle and the capsule is old and thickened, a total capsulectomy can be performed with only minimal aesthetic damage to the breast. If, however, the implant is located behind the muscle then the capsule if often very adherent to the muscle and the rib cage and the risks of surgery may out way any potential benefit.

Breast Implant Illness.

We see many women with the condition known as Breast Implant Illness. This is almost always associated with textured breast implants.  We have noticed that removal of the implants with or without a total capsulectomy, results in improvement of the symptoms within 2 weeks of surgery. It is becoming clear that the real cause of the many symptoms associated with breast implants (Breast Implant Associated Illness) is not leaking silicone or heavy metals but the chronic inflammation that results from textured implants constantly rubbing like sandpaper on the surrounding tissues (the capsule). The coarser the texture, the worse the inflammation and the symptoms. (And the risk of ALCL). Once the source of the inflammation is removed (the textured implants) the inflammation subsides and the symptoms settle.

The authors of this article specifically state, with regard to Breast Implant Illness, that “there is no indication for an En Bloc capsulectomy, and the use of this term and this type of treatment should be discouraged and reserved only for confirmed malignancy”.

So it is clear that, despite the advice given on internet forums, the official recommendation is clear:-

“Particularly important, is the discouragement of En Bloc capsulectomy outside of confirmed malignancy”.

This is very good news for women who have Breast Implant Illness as it confirms that major surgery is definitely not recommended or required.

Click here to see some examples of different types of capsules.

Written by Dr. Allan Kalus

Reference

Plastic and Reconstructive Surgery: April 2021 – Volume 147 – Issue 4 – p 808-818

doi: 10.1097/PRS.000000000000778

Not All Breast Explants Are Equal: Contemporary Strategies in Breast Explantation Surgery

Tanna, Neil M.D., M.B.A.; Calobrace, M. Bradley M.D.; Clemens, Mark W. M.D.; Hammond, Dennis C. M.D.; Nahabedian, Maurice Y. M.D.; Rohrich, Rod J. M.D.; Zhang, Ben H. B.A.; Bregman, Dana M.D.; Perry, Adam D. M.D.

https://journals.lww.com/plasreconsurg/Fulltext/2021/04000/Not_All_Breast_Explants_Are_Equal__Contemporary.7.aspx