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Check out our latest article published in the Aesthetic Plastic Surgery Journal. Published March 15th, 2021
Invited Discussion on: Lipo-Bodylift Reconstruction Following Massive Weight Loss—Our Experience with 100 Consecutive Cases
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Plastic Surgeons at the Hurwitz Center for Plastic Surgery respond to Food and Drug Administration (FDA) September 2020 released of updated recommendation regarding breast implants. This guidance affects implant safety labeling, doctor to patient communication and consent, and rupture screening. While the majority of this information is based on already available public information, the FDA suggested that implant manufacturers and physicians provide greater information to patients regarding the use of breast implants and various medical conditions that have been associated with the use of breast implants. Beyond compliance to the FDA mandate, the Hurwitz Center offers a consistent approach to medical complications that includes advanced screening for conditions like breast implant rupture and BIA-ALCL.
BIA-ALCL, or breast implant associated anaplastic large cell lymphoma. This condition is a rare type of lymphoma that develops in the capsule adjacent to primarily textured breast implants. It is not a type of breast cancer, but rather presents years after the implantation of the breast implant, typically as sudden, painless swelling in the breast or armpit. The majority of fluid collections around a breast implant are not BIA-ALCL however, which has a lifetime risk of less than <0.02%. But these fluid collections are recommended to be evaluated with ultrasound and the treatment is usually removal of the implant and breast implant capsule.
BIA-ALCL should be differentiated from Breast Implant Illness or BII which is another reason patients may have implants removed. Dr. Armando Davila of the Hurwitz Center for Plastic Surgery in Pittsburgh, Pennsylvania describes BII as breast implant “allergies”. Regarding the condition he says “There are potentially thousands of women across the United States who have been potentially affected by this [Breast Implant Illness]. These patients have often been ignored or dismissed by plastic surgeons who claim nothing is wrong with them. It is refreshing to see the FDA has acknowledged more openly the condition, and by being more transparent about the possibilities of this implant intolerance, patients can make a more informed decision about their bodies”. While breast implant illness does not appear to be
a life-threatening health condition, and its frequency among implant users is low, some individuals can present with debilitating symptoms of fatigue, muscle aches, or skin conditions. While there is no specific test for BII, plastic surgeons usually take the approach of ruling out other possible causes of symptoms through other specialized medical providers. “Many of these patients can also have diagnosed autoimmune disorders”, says Dr. Davila, “There is no strong evidence that placement of the breast implant causes the autoimmune disorder, but more likely, these patients already have a prevalence towards hyperactive immune systems, which may lead to a type of allergy to implants regardless of what the implant is filled with”. Dr Davila refers to how the majority of breast implants are made of a soft silicone shell and then are filled with either silicone cohesive gel or saline, but ultimately the silicone shell is in contact with the patient. “If patients present with BII, some wish to have a change from one fill type to another, but overall, I do not recommend these patients getting implants again because the shells are similar in both types”.
BII can be mimicked by another much more common condition of capsular contracture, or hardening of the capsule surrounding the implant. Capsular contracture can present with pain and can be related to implant rupture. While rates of rupture can vary, on average Dr. Davila tells patient the risk is about “1% per year the implant is in”. He emphasizes that implants are not lifetime devices and the FDA continues to recommend replacement at 10 years. However with the newest generation of form stable or “gummy bear” implants, detecting rupture can require advanced imaging. Dr. Dennis Hurwitz, founder of the Hurwitz Center for Plastic Surgery has made a commitment to providing patients with easy access to this technology in the form of portable high frequency ultrasound or HFUS. “I wanted patients to be completely comfortable with their breast implants, without having to spend money on expensive and difficult to obtain MRI’s which can be hundreds or thousands of dollars”, says Dr. Hurwitz. At the Hurwitz Center, Dr. Davila and Dr. Hurwitz both use portable high frequency ultrasound to easily diagnose fluid collections, implant ruptures, capsular contracture, and even perform image guided procedures like aspirations which can help diagnose BIA-ALCL. This technology has become even more important, now that the new FDA recommendations have changed their screening suggestions for silicone breast implants. Previously the FDA recommended MRI screening 3 years after the initial surgery and 2 years after that, now transitioning to recommend ultrasound screening 5-6 years after first implantation and then every 2-3 years after. Dr. Davila believes that the previous recommendations were rarely followed due to high out of pocket costs and lack of access to MRI; “Very few patients I have ever seen followed MRI recommendations, this often led to waiting until there was a problem with the implant already, so that insurance would cover the imaging.” Now with the ease of HFUS the Hurwitz Center offers all patients who have had implants placed by either Dr. Davila or Dr. Hurwitz free lifetime screenings, which only take 10-15 minutes.
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