Surgeons unite over breast implant safety and associated cancer links

 Three leading surgical organisations have issued a joint statement outlining their views on the safety of breast implants and concerns about associated cancer risks. 

The Association of Breast Surgery (ABS), the British Association of Aesthetic Plastic Surgeons (BAAPS) and the British Association of Plastic Reconstructive Surgeons (BAPRAS) said there are two main areas of concern for patients with, or considering having, breast implants for either cosmetic or reconstructive reasons – Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) and. Breast Implant Illness (BII), or Autoimmune Syndrome Induced by Adjuvants (ASIA). 

Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) 

The World Health Organisation (WHO) defined BIA-ALCL as a disease in 2016 and  data suggests it occurs with one in 24,000 implants inserted in the UK. 

By comparison, breast cancer, which is not related to having breast implants, occurs in one in eight women in the Western World. 

In July 2018, the MHRA advised that the risk of ALCL should be discussed with all patients considering having breast implants for either cosmetic or reconstructive reasons, however, there are significant variations in incidence rates being cited between countries who have reported cases of BIA-ALCL and the full clinical details are only known in approximately one third of BIA-ALCL patients worldwide.The statement, which was signed by BAPRAS president-elect Mr Mark Henley, ABS president Ms Julie Doughty and BAAPS president-elect Ms Mary O’Brien, said, “BIA-ALCL is usually treatable and curable with surgery. BIA-ALCL continues to be a rare disease in the UK [but] we are monitoring both UK and international events closely with the MHRA. 

“It is therefore essential to obtain as much information as possible about each case to help understand this disease. The national Breast and Cosmetic Implant Registry (BCIR) is in regular contact with other international Registries, and it is important that UK government funding should continue to support this.

“The UK plastic and breast surgery associations are closely involved in a growing international collaboration by the healthcare community to collect the information needed to find out more about breast implants and inform our patients. Patient safety is of paramount importance and our guidance will be updated in the light of new evidence.”Current advice from MHRA and all regulators world-wide is that those patients who have breast implants do not need to have them removed as the risks associated with surgery to remove implants and capsules outweigh the risks of potential disease. However, should patients develop any breast symptoms such as swelling, lumps or pain they should seek immediate advice from their family doctor and or operating surgeon and should be referred for assessment.

Advice for clinicians and patients in the UK on BIA-ALCL has been published by MHRA. 

Breast Implant Illness (BII), or Autoimmune Syndrome Induced by Adjuvants (ASIA)

Another concern is whether implants can make some people ill. Breast Implant Illness (BII), or Autoimmune Syndrome Induced by Adjuvants (ASIA), is a collection of multiple symptoms, most of which are common in the general population who do not have breast implants. BII/ASIA is not a WHO recognised disease, but there is much ongoing work and an enormous amount of data being collected and analysed internationally to establish if BII is a classifiable disease or not.

On this subject, the statement said, “Our three surgical associations are represented on the Plastic, Reconstructive and Aesthetic Surgery, Expert Advisory Group (PRASEAG), which advises the MHRA. The group also has a representative on the International Global Network Forum and ICOPLAST (International Confederation of Plastic Surgery)“The MHRA is also looking at the published literature on both BIA-ALCL and BII. The PRASEAG expert advisory group will review the literature to build on the knowledge already gained as part of the Independent Review Group’s (IRG’s) report, which was commissioned by the Chief Medical Officer in the 1990s. This detailed review looked at the safety of breast implants from a number of different perspectives and considered evidence from a number of sources. The IRG published its report in 1998 (link to IRG report) finding there was no evidence of a link between silicone breast implants and the symptoms reported at that time.“The MHRA is collecting data from surgeons and the public via their own Yellow Card system. This is an important resource to help them understand the numbers of patients and types of conditions involved.”

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