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A Response to Concerns about Implants and Non-Hodgkin’s Lymphoma (a guest post by Dr. Stanley Paul Frileck)

Stanley Paul Frileck M.D., F.A.C.S. of Beverly Hills Physicians has been closely following some of the media coverage of this issue in such publications as The New York Times. His thoughts on the matter are below.

I’m a rather experienced plastic surgeon and one of the operations I do is breast augmentation with silicone implants. Like many of my patients, I have read about BIA-ACLC non-Hodgkin’s lymphoma that seems to be associated with textured breast implants in some rare cases. Only a few of my patients have called to ask, but most folks understand we are talking about an extremely low likelihood. 

An FDA Executive Summary notes: “….Based on available information, it is not possible to confirm with statistical certainty that breast implants cause ALCL.”  It also says “….most women with ALCL have made a full recovery after surgery.” The associated implants were bacteria contaminated.

While it would be foolish to dismiss this finding out of hand, my guess is that not too many plastic surgeons will stop using silicone breast implants. Some people thinking about breast augmentation may decide not to go ahead, but if the need, want, desire, was there, I would not advise against the operation with textured silicone gel implants.

Doctors live with those kinds of decisions all the time. We look at the numbers like everyone else. The difference is in the responsibility for the recommendation. Most physicians practice at only one level, presumably the highest. 

As one of those doctors, my recommendations are the same for everyone: mother, lover, sister, stranger. Nor is this about selling breast surgery, which should not happen. It’s rather about informed consent.  The only reason I would mention the risk of ACLC cancer to a new patient, is because it is in the news. No material implanted anywhere in the human body is perfectly safe. Dental implants, for example, can foment squamous cell cancer; joint implants can cause hemopoietic cancer; all are rare.

There is enough to consider when thinking about a breast augmentation: capsule formation, infection, hematoma, and more. These all come at a greater risk than a silicone-related cancer, and even those risks are extremely low. The risk of ACLC is much lower again. (I am purposely tap dancing around the statistics, because while I know the danger of an ACLC is really tiny, I don’t want to get caught up in the numbers.)

Remember, two things occurring in relation to each other, is not the same as one thing causing the other. Women with implants should be aware of the possibility and check with the FDA sites below for further information.

https://www.fda.gov/…/ImplantsandProsthetics/BreastImplants/ucm239995.htm

https://www.fda.gov/medicaldevices/productsandmedicalprocedures/implantsandprosthetics/breastimplants/ucm239996.htm

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