Breast implants and breast cancers

Breast cancer is the most common type of cancer in women. The statistics speak for themselves when it comes to incidence and detection (Cancer Australia). While the incidence appears to be increasing over the years, the survival has also been increasing, due to advanced research, improvements in detection, and improved and focused treatment protocols.

Some patients I see when requesting a breast augmentation, have specific questions regarding implants and breast cancer. The most common questions are:

Do breast implants cause cancer?
Will my implant cause problems with a mammogram?
If I get breast implants, will they prevent my radiologist from detecting any new breast cancers?

The first question is a controversial question and issue. And unfortunately the answer is complex.

Not all breast implants are the same. They are manufactured in different ways, come in many, many shapes and sizes, and have various textures and coatings. Generally speaking, implants come as either round or anatomical, with smooth or a texturing on the surface. Various types of texturing methods have been created, depending on the manufacturing process. Some of these texturing methods have been implicated in the findings of ALCL (anaplastic large cell lymphoma) FDA ALCL, BAPRAS ALCL.

Most implant manufacturers appear to have various incidences of ALCL. Originally it was thought that the ALCL was caused by the method of implant texturing (the salt reduction, or ‘lost salt’ technique vs mechanical texturing). However, new research suggests that certain bacteria around the implant that cause capsular contracture, may also contribute to the formation of ALCL. In a paper that has just been released (Plastic & Reconstructive Surgery, Volume 137(6), pg. 1659-1669).

At present, the jury is still out as to whether the implant texturing is the problem, or whether the bacteria causing the capsular contracture is the problem.

ALCL in these cases is treated by removing both the implant and the capsule (total capsulectomy). By doing so, that is usually the definitive treatment. But in some cases, further chemotherapy has been required to eliminate residual ALCL.

Another area of issue in the past has been the use of polyurethane coating around implants. Polyurethane implants have been around since the 70’s. Originally introduced in the US to counteract capsular contracture, it was discovered that 2,4-toluenediamine (TDA), a carcinogenic by-product of the chemical breakdown of the polyurethane foam coating of the breast implant, was discovered in the urine of women with these implants. This was later proven to not be a significant contributor to new breast cancer cases, but the implants were removed from the market, and never reintroduced in the US. However, polyurethane is attributed to neural tube birth defects in children (neural tube defects).

The last 2 questions deal with implants causing problems with mammograms. I’ve discussed this with a few different radiologists who regularly perform mammograms, and the answer is, yes implants do get in the way of a normal mammogram. However, there is a way around this problem.

A normal mammogram consists of an x-ray, and an ultrasound scan(USS) of the breast to screen for suspicious changes that may suggest cancer. Anything that gets in the way of the x-ray or the USS, will prevent the radiologist from seeing all the breast. If implants are above the muscle, more breast tissue is obstructed and is not seen by the radiologist. They estimate approximately 40-50% of the breast tissue can be obstructed by implants! Less breast tissue is obstructed if the implants are below the muscle.

If this is the case, discuss your concerns with your radiologist. For high risk patients with a family history of breast cancer, an MRI can be performed to look for suspicious areas. Most radiology companies will bulk bill high risk cases.

Further Reading Related to Breast Implants