Breast Implant Illness, Capsular Contracture and BIA-ALCL

by Hisham Fansa

Breast implants are a good way to enlarge breasts, compensate for asymmetries or restore breasts after cancer. A long-awaited breast augmentation can improve the quality of life of patients and contribute to their well-being. Well informed, properly planned and performed, most patients are very satisfied afterwards. However, implants are not a "maintenance-free" solution.

The U.S. Food and Drug Administration (FDA) writes on its website that an implant does not last a lifetime and will need to be replaced over the course of a lifetime. Statements about the lifespan of an implant vary widely. Depending on the study and the implant indication, an implant can last anywhere from 2 to 15 years. Here, it is not always the implant that is the problem (e.g. rupture and silicone leakage), but the body's reaction to the implant.

Here we distinguish different problem areas, of which we would like to point out three in particular:

BII - Breast Implant Illness. As early as the mid-1980s and 1990s, it was suspected that implants could trigger systemic physical diseases. Autoimmune diseases and breast cancer were mentioned here. Proof of this was not forthcoming. The U.S. company Dow Corning, then a manufacturer, then settled in court disputes with affected patients in the United States. In recent years, a new term has emerged. Breast Implant Illness. Many women described physical changes after having breast implants. These showed general symptoms that could not be assigned to a specific disease. Among others, fatigue, depression, hair loss, rheumatic complaints and gastrointestinal problems were seen. Currently, no laboratory test exists to confirm such a condition, but many patients report an improvement in symptoms after implant removal. We have listed a little more about this here.

Capsular fibrosis/capsular contracture. The body generally does not like implants. Therefore, it encapsulates the implants. This in itself is a safety process that protects the body, for example in case of silicone leakage. Over time, however, this capsule around the implant begins to shrink (contract). This can deform the breast, causing it to become hard and the implant to dislocate within the breast. Thus, this capsular fibrosis can become an aesthetic problem. Unfortunately, it can also cause pain in the breast at the implant and the capsule, so that it is necessary to perform another operation to remove the implant and the capsule. In the case of radiation therapy for breast cancer, the implant can develop capsular fibrosis more frequently and more quickly. In this case, it is more advisable to use autologous tissue for breast reconstruction.

BIA-ALCL- Breast Implant Associated Anaplastic Large Cell Lymphoma. Some implants can lead to a rare lymphatic disease around the implant due to their roughness. Overall, these lymphomas are very rare in relation to the amount of implants used worldwide, but must be treated in any case. An accumulation was seen with implants that are very rough ("textured"). Some implant types have been withdrawn from the market in this context. Therefore, the tendency today is to use less roughened implants. An ALCL can manifest itself by an accumulation of fluid around the implant (late seroma). In this case a sample should be taken. A BIA-ALCL disease should always be treated surgically by removing the implant, the capsule and the lymphoma.

You are welcome to contact us about breast augmentation and breast reconstruction. We can advise you on breast implants, alternative procedures, and also on complications and problems caused by previous surgeries.