What You Need to Know if You Have Breast Implants by Denise Grady

The New York Times

May 14, 2017

Nearly all the cases of lymphoma have been linked to textured implants like the one shown here.CreditSouthern Illinois University/Science Source

Nearly every case of the rare cancer that has been linked to breast implants — anaplastic large-cell lymphoma — involves those with a textured surface, not a smooth one, and most implants in the United States are smooth.

The Food and Drug Administration says women with implants who are not experiencing any problems with them should stick to routine care, and do not need to have the implants removed. But symptoms like breast pain, swelling, fluid buildup or lumps should not be ignored.

Not all doctors know how to treat problems from breast implants, according to Dr. Steven Teitelbaum, a plastic surgeon in Santa Monica, Calif. “If the doctor doesn’t show a real fluency in this, see somebody else,” he said. “You don’t want someone who acts like it’s nothing or seems confused.”

To check for lymphoma, doctors use ultrasound (not a mammogram) to look for fluid, and then they drain the fluid and test it for a substance called CD30, which is a sign of the disease.

If the CD30 test is positive, M.R.I. scans and other tests are usually needed to determine the stage of the cancer.

The first step in treatment should be to take out the implants — both, even if only one appears to be causing trouble — and to fully remove the capsules of scar tissue that form around them. If the capsules are not excised, the cancer may linger or recur, and the prognosis worsens.

Even if the implants were used for cosmetic reasons, some insurers cover the surgery to remove them if lymphoma develops, but the surgeon has to make the reason clear and choose the right diagnostic codes.

Doctors report that in about 85 percent of cases, the disease has not spread beyond the tissue around the implant, and surgery alone seems to cure it. Once the disease is cleared, some women even opt for new implants.

But if the lymphoma has spread, chemotherapy will be needed, and possibly radiation. A few women have had such aggressive cancer that they required high-dose chemotherapy and stem-cell transplants. Worldwide, about a dozen women have died.

For women with implants and no problems, regular care should include routine mammograms, performed by a technician trained to deal with implants, according to the F.D.A. For women who have implants filled with silicone, routine care should also include M.R.I. scans to check for implant rupture, with the first scan three years after the surgery and follow-up imaging every two years. But insurers may not cover the cost of these scans for women who got implants for breast augmentation, because such expenses are considered related to cosmetic surgery.

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