Looking pretty awesome after all these years.
This is a question posted by a patient on RealSelf. She’s a lady in her 50’s with 11 year old anatomic Allergan Style 410 implants. She has typical menopausal symptoms and does not think her implants are causing her night sweats, mild brain fog or hot flashes. She’s heard about BIA-ALCL and wants to know if she should have her implants removed. The photos she submitted show an absolutely beautiful long term result and the rest of her looks pretty awesome too. She’s obviously either biologically privileged or she’s a gym rat or maybe both. She’s very lean. She doesn’t have enough fat for a meaningful fat transfer. Her breast volume is mostly implant. She loves her implants but she is scared. What should she do?
So let’s be rational about the advice we give her based on what we know about BIA-ALCL. First of all, she cares about her appearance. Will she look good after explant? IMHO, no. She will be very, very small breasted. If she’s okay with that, fine. But I don’t think she will be okay with it.
What are the odds that she will get BIA-ALCL? The latest numbers coming out of Dr. Mark Clemen’s work at MD Anderson estimate the chance of her developing BIA-ALCL is about 1 in 3000. What about the chances of her DYING from BIA-ALCL? Well, with increased awareness, early diagnosis and proper treatment, those chances are approaching ZERO. I cannot rationally recommend she part ways with her awesome and great looking implants for those odds.
Now let’s look at breast cancer. What are the odds? Well, about 1 in 8 or 9 women will be diagnosed with breast cancer. The cure rate for breast cancer is much lower that the 90% plus cure rate for early diagnosed and properly treated BIA-ALCL. Do we recommend bilateral prophylactic mastectomy for your average patient with average breast cancer odds? Of course we don’t. Women should be freaking out about the fact that they have breasts instead of the fact that they have textured breast implants! And this post is in no way dismissing the suffering and, yes, death of patients with delayed diagnosis and/or treatment of BIA-ALCL. These numbers mean nothing to someone who has died or lost a loved one BIA-ALCL. We now know so much more about the etiology, diagnosis, prevention and treatment of this really weird malignancy.
So this is what I would advise this lady if she were my best friend or sister: Her implants are getting up there in years. I would get them removed and replaced with smooth, round cohesive gel implants. With her anatomy she will look fine with round implants. It’s been demonstrated very well that anatomic implants offer almost zero benefit over round implants in patients with normal anatomy. If her surgeon finds seroma fluid or capsule nodules, he/she should do a capsulectomy and send the fluid and capsules for examination. If the capsule is smooth and thin and unremarkable, he/she can just adjust the implant pocket if necessary to accommodate the new implant and leave the existing capsule in place.
And then she needs yearly exams and regular mammograms based on her breast cancer risk.
Thanks for reading and I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity. Dr. Lisa Lynn Sowder
@lisalynnsowder
