Breast Augmentation in McAllen and Brownsville
Breast augmentation remains one of the most popular cosmetic surgical procedures. U.S. data from the American Society for Aesthetic Plastic Surgery show that in 2014, over 286,000 women underwent breast augmentation (up from only 101,000 in 1997). Since the female breast is one of the most defining representations of beauty, vitality, and sexuality in the human form, it is understandable that many women desire fuller, larger, and shapelier breasts. It is important to understand that “Breast Augmentation” (or a “Boob Job”) can encompass a simple breast augmentation with an implant or a more complex breast augmentation with a breast lift (an augmentation / mastopexy procedure). Women with prior breast augmentation procedures sometimes desire redo breast augmentation surgery to either change the size of their implants (they want to be bigger), or to correct more serious complications from a poorly performed procedure, which requires a more complex revision breast augmentation.
In a Breast Augmentation (or Augmentation Mammaplasty), an implant (silicone gel or saline) is placed either behind the breast or the chest muscle in order to enhance the size, shape and fullness of the breast. The proportions of the body are also improved. The implants can be placed through one of four incisional approaches (see below for more detail): an inframammary incision (the most common); a periareolar incision (at the border of the areola and the skin, which can often result in an almost invisible scar); the trans-axillary approach (through the arm pit); or the trans-umbilical approach (TUBA) through the belly button (Belly Button Boob Job).
Breast Augmentation has been performed for over 30 years in over 3 million women. Throughout this time, the surgical techniques and breast implants themselves have been continuously refined to increase the safety and reliability of the procedure. The primary factors that contribute to a successful Breast Augmentation are thorough attention to detail during the pre-operative planning stage, meticulous attention to surgical technique and implant placement, and careful patient compliance during the recovery process. It is critical that your procedure by performed by a highly trained and expert surgeon.
Am I A Candidate?
You are a good candidate for cosmetic Breast Augmentation if you are otherwise healthy and have at least one the following conditions or characteristics:
- You have always considered your breasts to be too small or under-developed (mammary hypoplasia)
- You feel that your figure is out of proportion because your small breasts make your hips appear wider
- You feel that your small breasts limit your choices of flattering clothing or swim wear
- Your breasts have lost volume, especially upper breast fullness, after pregnancy, weight loss, or with age
- The upper part of the breast appears “empty”
- Your breasts have a different size or shape from one another (asymmetrical mammary hypoplasia)
- You have previously had breast implants and are experiencing problems with them (revision breast augmentation)
- One or both breasts failed to develop normally, or have an unnatural, elongated shape
Only you can decide if Breast Augmentation is a good option for you, and each patient has her own preferences regarding what is “normal” and “beautiful” for her breasts. I will discuss your individual goals regarding the change you seek in the shape and size of your breasts, together we will define a realistic treatment plan, and I will individualize my surgical approach to incorporate your desires with my surgical expertise. I will assess the quality and quantity of your existing breast tissue in order to determine the proper choice of breast implant and technique.
During your consultation, I will thoroughly evaluate your general health status and any pre-existing health conditions or risk factors, which could compromise your surgical outcome or jeopardize your health. A detailed breast analysis with measurements of multiple physical parameters of your breasts and chest wall will be obtained in order to define all pre-existing, natural asymmetry. It is important for patients to understand that natural asymmetry exists between both breasts in all women, some more than others. Most importantly, patients must be aware that breast augmentation surgery does not result in identical breasts, although every effort is made to optimize the symmetry between the left and right breasts. If significant breast size asymmetry exists, we may need to use two different sized breast implants. If the breasts are too droopy (Grade 2 or 3 ptosis), then we may need to add a breast lift to correct the ptosis and avoid a Snoopy Nose deformity (residual breast ptosis). If the nipples are too long, patients may desire a nipple reduction. Inverted nipples can also be corrected.
If any surgeon promises you a “perfect” result – you should question their integrity and run! Surgical training and technical mastery are essential components, as no two bodies or surgeries are exactly the same. Because the human body’s natural wound healing is unique to each person, physicians can NEVER make promises of perfection in medicine and surgery. What I strive for is safety, consistency and excellence in my surgical outcomes, and dedication to service in abundance for my patients’ care needs. This is what we mean by “Individuality Perfected!”
After your consultation, photographs will be taken before and after surgery. Also, as a baseline precaution, most women older than 35 will be required to have had a normal mammogram within 6 months prior to the procedure. If one has not been done, we will arrange for a screening mammogram to be obtained prior to surgery.
We perform our Breast Augmentation procedures only in certified outpatient surgery centers or hospitals under general anesthesia combined with local and tumescent anesthesia. The local anesthesia we use during your surgery helps our patients recover with minimal pain. In fact, we encourage our patients to go out for dinner the same night of their surgery, our patients’ benefit from our 24-hour Recovery Protocol. We do not believe in “awake” or “Twilight” breast augmentation surgery, as this often results in discomfort for the patient and disappointing results, and can also be dangerous.
Most primary breast augmentation procedures (without additional breast lift or revisions) last about one hour. If a breast lift or a revision is needed, the procedure is much more complex and obviously lasts longer. If Dr. Rodriguez recommends a breast lift for your breast augmentation procedure, this is very important to avoid a Snoopy Nose deformity.
There are many factors to be weighed when considering incision types, such as the degree of enlargement desired, your existing breast anatomy, and the type of breast implant desired. I always strive to minimize scarring, and will work with you to determine which incision approach is right for you. Some procedures even leave no breast scars! The three most common incision options are inframammary, periareolar, and transaxillary. The transumbilical approach (TUBA, i.e. Belly Button Boob Job) is also available for select patients. Patients sometimes worry that the peri-areolar approach may place them at increased risk for nipple sensation loss or difficulties with breast-feeding. This has not been the case with my patients. Breast implants, especially when placed in the subpectoral positions (see below) do not affect a woman’s ability to breast-feed. In addition, the risk of permanent nipple sensation loss is extremely low for all approaches (less than 1% in my hands) – even the periareolar approach.
- The inframammary approach is the most common approach for breast augmentation. A small incision is hidden under the breast fold, along the underside of the breast where it meets the chest wall. This incision allows for the most direct access to the inferior breast anatomy for optimal implant placement and adjustment. Both saline and silicone gel implants can be placed using this approach, although silicone implants require a slightly larger scar because they are pre-filled and cannot be rolled tightly for insertion. Use of the Keller Funnel has allowed me to further decrease the size of my inframammary scars for silicone implants. (Click here to see an example of an inframammary breast augmentation).
- The periareolar incision can result in an almost invisible scar at the junction of the areola (which is the dark pigmented skin surrounding the nipple) and the breast skin. The incision is usually placed at the bottom edge, but can also be placed on the top edge if a small Crescent Lift is needed to even the areolas on the breast. A crescent lift allows me to raise the nipple-areolar complex 1cm to enhance the symmetry between the breasts. The periareolar incision allows very direct access to the chest wall, and leaves little noticeable scarring. Both saline and silicone implants gel can be placed using this approach, and use of the Keller Funnel has allowed me to place large silicone implants via the peri-areolar approach with small scars. The peri-areolar approach is also ideal for patients who may need a Breast Lift, but who choose to stage their Breast Lift for a later dated after their Breast Augmentation. When they return for their breast lift, there is no additional scarring from an unnecessary inframmary or transaxillary approach. (Click here to see an example of a periareolar breast augmentation with a Crescent Lift on the left breast, and also a periareolar breast augmentation without a crescent lift).
- The transaxillary approach offers the advantage of no scars on the breast and utilizes a small incision hidden within a natural skin crease in the armpit. Both saline and silicone gel implants can be placed using this approach, although silicone implants require a slightly larger scar because they are pre-filled and cannot be rolled tightly for insertion. Use of the Keller Funnel has allowed me to further decrease the size of my transaxillary scars for silicone implants. Patients who select the transaxillary or transumbilical approaches to avoid visible scarring on their breasts must accept that it will take longer for the implants to fully settle and must be very compliant with their post-op instructions for ideal results. (Click here to see an example of a transaxillary breast augmentation).
- The transumbilical (TUBA) approach (i.e. Belly Button Boob Job) offers the advantage of NO breast scars or armpit scars. Instead, a very small incision is hidden inside the belly button and special instruments are used to properly place saline implants in the subpectoral position (under the muscle). This is an advanced breast augmentation technique that is only performed by a few surgeons across the country. Transumbilical Breast Augmentation (TUBA) requires careful patient selection. The ideal patient for TUBA has minimal chest wall asymmetries and does not require a formal breast lift. As with the transaxillary approach, patients who select the transumbilical approach to avoid visible scarring on their breasts must accept that it will take longer for the implants to fully settle and must be very compliant with their post-op instructions for ideal results. Only saline implants can be placed via the transumbilical approach. (Click here to see an example of a transumbilical breast augmentation).
After deciding on the incision site, we will select the appropriate implant placement. Breast implants can be placed either submuscular (beneath the chest muscle) or subglandular (over the chest muscle.) The choice of where to place the implant depends on a variety of factors, including the degree of augmentation desired, the type of implant selected, and your particular anatomy.
- Submuscular placement is the preferred and most commonly used placement for breast implants due to its numerous important advantages. Both saline and silicone gel implants are regularly placed in the submuscular position. Because the lower attachements of the pectoralis chest muscle are released during the procedure to properly position the implant, the submuscular position is effectively a dual-plan pocket. The advantages of submuscular placement include: enhanced soft tissue coverage of the implant, which tends to produce a more natural appearance for most body types; decreased risk of visible rippling; decreased risk of capsular contracture; and decreased interference with mammography, because the implant is under the muscle. Due to the stretching of the muscle by the implant, submuscular placement can result in mild-to-moderate muscle soreness and muscle spasm in the early post-operative period (similar to a strenuous workout). Please refer to my 24-Hour Recovery after Breast Augmentation protocol, which minimizes recovery time and discomfort. After surgery, I recommend that patients minimize targeted pectoralis lifting exercises to avoid bulking up the muscle, which can cause lateral displacement of the implant over time.
- The subglandular method places the implant behind the breast tissue, but above the chest muscle. Subglandular implant placement may result in a more comfortable recovery (since the muscle is not stretched), but it may be more likely to interfere with mammograms. In addition, less tissue over the implant means that the implants will be more visible and may look less natural. Rippling of the implant tends to be more evident in the subglandular position, and the rate of capsular contracture is increased. In particular, women with thin skin or very small breasts are not good candidates for this option. Useful for specific indications.
- Subfacial Implant Placement (between the muscle and its fascia) can be a useful option for complex re-augmentation procedures, although I prefer preserving the subpectoral space using Seri® Surgical Scaffold.
In addition to deciding on incision location and implant placement, patients need to select the type, style, and size of implants that best suit their goals.
The final result of your breast augmentation depends on three factors: 1) the amount of existing native breast tissue; 2) the quality of the breast skin envelope (i.e. is the skin too loose and droopy or too tight and restricted); and 3) the size and shape of the implant you choose.
Breast Implants are available as either Round or Shaped implants. Shaped implants are more highly cohesive silicone gel implants that are shaped to resemble the natural teardrop shape of a youthful breast. Although initially popularized as the “gummy bear implants”, the fact is that all modern FDA approved silicone gel breast implants, whether shaped or smooth, can be considered “gummy bear implants”, because the cohesive silicone gel prevents any leaking. Disadvantages of the shaped silicone gel implants are that they are not intended to create upper breast fullness, they require larger incisions to place, and there is a risk that the implant can rotate after placement, creating a distorted appearance.
More commonly, patients seek breast augmentation with implants to enhance or restore their upper breast fullness. For this, round implants from either Mentor or Allergan can be used. Modern breast augmentation is not just about larger breasts, but enhanced breast shape. I ask patients to consider what breast size they desire in relation to their body proportions. Round implants come in Moderate Profile, Moderate Plus Profile, High Profile, and Ultra High Profile shapes.
The ideal breast implant shape depends on your chest wall anatomy, how wide your chest is, and how much projection you desire. Moderate and Moderate Plus profile implants have a wider base width diameter, with a more natural projection. High Profile and Ultra High profile implants are designed for women with a narrower chest width diameter who desire fuller and more prominent breast projection. Obviously there is a lot to consider. During your consultation, you will have the opportunity to try on multiple sizes and styles of implants to help you decide which implant style is right for you. This is a personal choice, not unlike deciding between 3”, 6” or 9” heels. I will then ensure that your choice is ultimately appropriate for your body, stated goals, and surgical needs. The choice depends on the look you want to achieve, and not all patients are suitable candidates for certain types of implants. Additionally, it is possible that several different types of implants and surgical approaches can be appropriate, and therefore patients must retain a healthy degree of skepticism if a surgeon offers only one implant type or one approach. I will carefully examine your breasts and obtain detailed measurements of your breast and chest wall. Based on these parameters and my extensive experience with the many available implant options, I will help you to determine the best style and size of implant to achieve the results you desire.
Choosing the Right Breast Implants
Breast Augmentation can be an exciting process, and along the way to your new look you will face numerous decisions. Perhaps the most important decision is what type of implant to use in order to achieve the results you are looking for.
Both Saline and Silicone Gel implants have pros and cons. Saline implants were used predominantly until 2006, when the FDA approved the newer silicone gel implants for use in the United States. Since then, silicone implants have regained popularity. Each different type of implant has a unique set of characteristics and considerations, and my extensive experience with both saline and silicone implants will help me guide you in choosing the implant that will best achieve your breast augmentation goals. Choosing a breast implant is a very personal decision, and you can rest assured that I will take the necessary time to go over all of your options during your consultation.
Silicone Gel Filled Implants
Silicone implants are a safe and effective option for women considering breast augmentation in McAllen and Brownsville. Despite their proven safety, some women remain concerned regarding the safety of silicone implants based on misinformation from the older silicone implants from the past. Silicone implants have never been linked to cancer or connective tissue disease. The problem with the older implants was that the shell was too thin and they were filled with liquid silicone. This resulted in leakage of the liquid silicone through the thin shell or with rupture. The new cohesive silicone gel implants correct these issues with a thicker and stronger shell combined with a silicone gel that does not spill or leak. These implants have undergone more than a decade of testing and clinical studies, and were found by the FDA to pose no significant health risks. In 2006, the FDA lifted its voluntary moratorium on the use of silicone implants, granting marketing approval for breast augmentation with the new silicone gel implants.
The new silicone implants are vastly improved over the earlier generations of silicone, and are filled with a cohesive silicone gel which is much less likely to leak or migrate if punctured, torn, or cut. To ensure ongoing safety, the FDA continues to monitor silicone implants as part of a post-approval study. The findings of some of these studies are summarized in an informational pamphlet from Mentor.
Silicone gel-filled implants are the most popular choice for breast augmentation worldwide. This is because women find that silicone implants can produce more natural looking and feeling results. Silicone implants are less prone to visible or palpable rippling, and they do not slosh like saline implants sometimes initially can as the air inside the implant is absorbed. Silicone implants are associated with a decreased risk of capsular contracture compared with saline implants, and both Mentor and Allergan offer unique implant warranties for capsular contracture for their silicone implants. Use of the Keller Funnel to place the implants further decreases the risk of capsular contracture and also helps me keep my incisions smaller. Both Allergan and Mentor manufacture excellent, FDA approved silicone gel implants in moderate, moderate plus, high profile, and ultra high profiles; and the Allergan INSPIRA implant offers patients an over-filled silicone implant option for even more increased upper breast fullness. Hence, patients truly have more options today than ever before, and I will help you select the best implant option for your desired look! An advantage of silicone gel implants is that they do not deflate. Hence, patients never sense the urgency to return to the OR to replace a deflated implant, like they can with saline implants.
Disadvantages: Because silicone implants do not deflate if the outer shell develops an opening, the FDA recommended surveillance MRIs to check for possible silent implant rupture every 3-4 years after surgery. This is because unlike with saline implants where a small puncture in the implant shell results in obvious implant deflation, silicone implant rupture can only be detected with MRI. Insurance does not cover these surveillance MRIs. Another slight disadvantage with silicone implants is that they require slightly larger incisions for placement, and they cannot be placed through the belly button because they arrive pre-filled from the manufacturer.
Keller Funnel 2: Since using the 2nd generation Keller Funnel to place all of my silicone gel implants, I have been able to significantly decrease the size of the incisions for placement of the implants, and they are now almost as small as my incisions for saline implants. Also, if a patient is combining a breast augmentation with a tummy tuck for a mommy makeover, then if the patient is a candidate for a TUBA and does not need a breast lift, then I can perform the TUBA and insert the silicone implants through the tummy tuck to avoid and scars on her breast! The Keller Funnel also decreases my patients’ risk for developing capsular contracture.
Saline-filled breast implants are comprised of a silicone outer shell (the same used for silicone gel filled implants) that is filled with sterile saltwater (saline) during the procedure through a one-way valve with removable fill tubes once the implant is in proper position. From 1992 to 2006, saline-filled breast implants were the only option available for the majority of women seeking breast augmentation in the United States. There are no health risks associated with the medical-grade saltwater solution that fills these implants. This saline solution is the same as used for IV fluids. The FDA, however, limits the use of saline implants in women under 18 years old.
Advantages: Since they are filled during the surgery, saline implants can be placed through very small incisions (even through the belly button), and I can “fine tune” the final fill of each implant during your procedure to correct for minor breast size asymmetry. Saline implants can also be overfilled to customize the implant profile according to your preference. In the case of leakage or rupture, the saline is harmlessly absorbed by the body and eliminated. Saline implants may also cost less than silicone gel filled implants due to lower manufacturing costs.
Disadvantages: Some women report that saline-filled implants can look and feel less natural than silicone gel implants. For instance, saline implants may exhibit a wrinkled or rippled appearance, particularly in women with little existing breast tissue and when the implants are placed above the chest muscle. Saline implants are associated with increased palpable rippling along the inferior breast, and can feel firmer if overfilled. Saline implants are also associated with an increased risk of capsular contracture, and neither Mentor nor Allergan offer implant warranty coverage for capsular contracture for saline implants. Most importantly, saline implants will deflate should a leak occur. Saline implant deflation requires a return to the operating room to replace the deflated implant, which can be complicated by contracture of the implant capsule around the shrinking implant.
Both saline and silicone implants are covered by a manufacturer’s warranty against rupture and deflation.
Augmentation or a Lift?
Patients must have realistic expectations of what a Breast Augmentation procedure can and cannot accomplish. There are limitations to the degree to which a breast implant can produce a natural appearance of the breast. Women often think of breast size in terms of bra cup size. If you are currently a size “A” and wish to be a size “D”, there must be adequate existing breast tissue coverage; otherwise you have a greater risk of palpable or visible implant edges or a double bubble deformity. Additionally, in some cases, if there is too much loose skin or breast droop, a Breast lift may be necessary in addition to a breast implant in order to restore the beauty of your breasts. Placement of an implant alone in such circumstances will not improve the appearance of the breast, and in fact may make the breast less attractive. Some surgeons try to place a very large implant to take up the slack in the skin envelope, producing an excessively heavy, droopier breast, and often the redundant and saggy breast skin will droop over the implant causing a “Snoopy-nose” deformity. Women are sometimes concerned about the associated scarring if they need a breast lift, and the truth is that scarring depends on the primary components: how a patient’s body heals (which cannot be controlled); surgical technique; and the quality of the suture materials. Patients should carefully review a surgeons before and after photos to understand their typical results for breast lift surgery.
As with any type of surgery, there are potential risks and complications, such as adverse reactions to anesthesia, bleeding, infection, poor healing of the surgical scar, and pain. Post-operative bleeding or formation of a seroma (a collection of the watery fluid around the implant,) may require re-operation and drainage, and may be associated with an increased incidence of infection or capsular contracture.
What is most important is for patients to ask their surgeon what their specific incidence of complications is. In our practice, we have extremely low incidence of infection, capsular contracture, hypertrophic scarring, implant asymmetry, or wrong sized implants – well below the national averages. This is large part to our extensive pre-operative consultation and surgical techniques.
Infection of a breast implant is extremely rare, but may require removal of the implant for up to several months until the infection can be completely cleared and the implant can be re-inserted.
Postoperative formation of a fibrous tissue capsule around the breast implant is a normal bodily response when a foreign object is placed in soft tissue. Capsular contracture, however, is a persistent and aggressive shrinkage of this tissue capsule surrounding the implant, causing the implant and breast to feel unnaturally firm and sometimes painful. Capsular contracture is usually progressive, worsening with time, over the course of several months to years. This may result in asymmetry, making the breasts appear misshapen or out of position. The occurrence or severity of this condition varies with each individual, and there are no reliable data as to why it occurs in some people. Submuscular implant placement has been shown to decreases the incidence of capsular contracture compared with subglandular placement.
Implant Asymmetry, which is different than underlying, natural and pre-existing breast asymmetry, may sometimes occur as a result of unexpected early healing after implant placement.
Deflation of a saline breast implant may occur when the saline solution leaks either through the valve, or through a puncture or defect of the outer shell of the implant. This requires surgical replacement. Rupture of a silicone implant is more difficult to diagnose, since the implant does not deflate. Special MRI studies are required to identify a ruptured silicone implant, and the FDA recommends an MRI study be performed every 3 years for surveillance after silicone implants. Insurance does not typically cover surveillance MRI for silicon implant rupture. Both saline and silicone implants are covered by a manufacturer’s warranty against rupture and deflation.
Sensory changes may occur in the nipples or outer breasts, and scars may be unsightly. Patients with very small breast volume or thin skin pre-operatively may note visible wrinkling or rippling of the implants, especially in the subglandular position, and more commonly when larger size implants are chosen. Delayed wound healing may occur in persons with diabetes, history of radiation, autoimmune disease, or in smokers. It is important to have a thorough medical evaluation beforehand to address these potential risks.
Breast Augmentation may not be a one-time surgery. It is very likely that additional surgeries and doctor visits will be necessary over the course of your lifetime to maintain the appearance of the breasts after Breast Augmentation, either because of problems related to the implants themselves (deflation, capsular contracture, rupture, etc.) or because of changes affecting the appearance of the breasts over time (pregnancies, weight gain, loss of breast tissue as a function of age, etc.)
There is no evidence that breast implants affect fertility, pregnancy, or a woman’s ability to breast-feed. Even without implants, not all women may be able to breast-feed. Although there may be a slightly increased risk for scarring within the breast and a decreased ability to breast feed when the peri-areolar (nipple) incision is used as compared to the inframammary (breast fold), axillary (under-arm), or transumbilical (belly-button) incisions, this has not been scientifically proven.
Health insurance does not cover Breast Augmentation, and may not cover re-operation (additional future surgery) in the event of complications. Your premiums may increase, coverage may be dropped, or future coverage may be denied.
Most risks of Breast Augmentation surgery can be lessened and managed by carefully following the recommendations and instructions you will receive during your consultation. Any of your personal questions or concerns can be addressed at that time as well.
Making the decision to have breast augmentation is the beginning of a journey to a new and improved you. Along the way, you will be faced with numerous choices and I will help you carefully weigh all of your options. My extensive training and experience performing breast augmentation allows me to customize each procedure to your individual needs.
If you would like to find out more about breast augmentation, we encourage you to take the first step toward feeling more attractive and more self-confident. Please contact us to schedule your private consultation with Dr. Filiberto Rodriguez, a double board-certified cosmetic surgeon and breast augmentation specialist.
A Word About Breast Implants and the Risk of Cancer
There is no evidence that implants either cause or play a role in the development of breast cancer, and there is no statistical difference in the occurrence of breast cancer in women with implants as compared to women without implants. Similarly, if or when breast cancer is detected, there is no statistical difference in the stage of disease when comparing women with implants to those without implants. Women must be knowledgeable about their risk factors, such as family history of breast cancer in first-degree relatives before menopause. Women must be diligent about self-examination of the breast, as well as scheduling regular breast examinations by your gynecologist or plastic surgeon. However, regardless of the type of implant or or whether the implant is placed above or below the muscle, breast implants may make mammography somewhat more difficult and less reliable, especially in cases where capsular contracture develops. Approximately one in eight of all women will develop breast cancer, and breast implants may make cancer more difficult to detect by mammography in women with implants. However, modern mammography centers are equipped with the latest equipment and trained technologists and physicians who are accustomed to imaging the breasts of women with implants.
Additional radiographic views, or in some cases, ultrasound or MRI examinations of the breast, may be required to fully evaluate the breast or any suspicious area of the implant itself. In some cases, mammography may result in rupture or deflation of the implants.
Recent media attention has focused on the increased incidence of Anaplastic large cell lymphoma (ALCL) of the breast in women with breast implants. It is important to note that ALCL of the breast is actually ALCL of the breast implant capsule, and removal of the breast implant capsule (capsulectomy) completely cures the ALCL. ALCL is an extremely rare form of lymphoma, with an incidence of 1/500,000 per year as per the National Cancer Institute.1 Diagnosing ALCL in the breast is even more rare, with a yearly incidence of 3 in 100 million women. In 2011, the FDA reviewed data from a 13-year period, during which 60 cases of ALCL of the breast (34 definitely unique, and some of the 60 could be duplicate cases) occurred in women with breast implants. The number of women with breast implants worldwide is estimated to be between 5 and 10 million. Calculating for the worst-case scenario, assuming that all 60 cases were unique and that only 5 million women have implants worldwide, the expected yearly incidence of ALCL of the breast implant capsule would be 4.6 cases per year for the 5 million women who have breast implants. With these current data, the incidence of ALCL of the breast is less than 1 case per 1 million women with breast implants per year. Although this is less than the expected incidence of ALCL for all body sites (2 per 1 million women per year), it is higher than the expected incidence of ALCL of the breast without implants (3 per 100 million women per year). The incidence of ALCL of the breast with implants (in a 1-year period, for every 1 million women who already have breast implants, 1 woman will be diagnosed with ALCL) can be compared with the risk of being struck by lightning, which is higher (2 other women in this same group, according to current National Oceanic and Atmospheric Administration statistics.) Most women are not afraid of lightning strikes, and should view these new findings about breast implants similarly.
Although ALCL is not breast cancer, patients may rightfully wonder why they would consider an intervention that might increase their risk for any form of cancer. To place this in perspective, it is worth reviewing the association between alcoholic beverages and breast cancer. On the basis of the National Cancer Institute data, approximately 1 in 8 women will be diagnosed with breast cancer in her lifetime. With an average life expectancy of 80.8 years (US Census Bureau data), the average yearly risk for a woman to develop breast cancer is estimated to be 1 in 650 (an incidence of 1539 cases per 1 million women per year). Multiple studies have shown that even moderate consumption of alcohol significantly increases the chance of developing breast cancer. In a meta-analysis of 38 epidemiologic studies, Boyle and Boffetta found a pooled relative risk of 1.1 for the development of breast cancer in women who drank an average of 1 alcoholic drink per day. This means that approximately 154 new cases of breast cancer per 1 million women who drink alcohol are attributable to the lifestyle choice of drinking, much higher than the 1 case of ALCL per 1 million women who choose to have breast implants.
1 This discussion regarding ALCL is adapted from: Bogdan, M. Keep Anaplastic Large Cell Lymphoma Breast Implant Risk in Perspective. Medscape Plastic Surgery & Aesthetic Medicine, 2011-02-24.
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