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BREAST LYMPHOMA

BREAST LYMPHOMA ASSOCIATED WITH BREAST IMPLANTS (BL)

 

Breast Lymphoma
It is now known and established that breast implants are associated with an increased risk of breast lymphoma. Breast lymphoma is a cancer of the lymphocytes (blood cells) that are around the breast implant. As such it is a cancer of the blood cells not a cancer of the breast cells themselves.

Cause/Pathogenesis
Breast lymphoma associated with breast implants is due to a bacterial contamination with Ralstonia. Ralstonia is a very common bacterium in the environment and is believed to get on to breast implants at the time of insertion. The body places lymphocytes in the area around the implants to attempt to deal with the Ralstonia. The lymphocytes become deranged as they can’t deal with the Ralstonia and eventually become cancerous and thus a breast lymphoma is formed in the fluid around the breast implant.

Incidence
The lifetime incidence of true breast cancer (cancer of the breast gland cells and not related to breast implants), for the reason of comparison and context, in the normal population in Australia is approximately 1 in 10 patients.

The risk of breast lymphoma associated with breast implants is:
1) Smooth implants- no increased risk (assuming that the smooth implant has not been put into a previously textured pocket)
2) Macro textured implants e.g Allergan and McGhan- approximately 1 in 5,000
3) Micro textured implants e.g Mentor- approximately 1 in 50,000

Of patients that develop breast lymphoma associated with breast implants, 90% require surgery only in the form of capsulectomy and removal of the breast implants. Only 10% require having chemotherapy or radiotherapy.

Typical Patient with BL
The typical patient that develops breast lymphoma is 7 years post breast augmentation and develops severe recurrent swelling of one or both breasts that is otherwise asymptomatic. This swelling is not just mild but is extreme swelling where the breast increases 50%-100% in size compared to the normal size.

If a patient develops severe swelling they should seek immediate review by their surgeon so that an ultrasound guided aspiration of the fluid can be made to evaluate the cells around the breast.