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Posted Tue 12 June 2018

I was invited to another meeting on 4 June 2018 organised by Mentor, a subdivision of Johnson & Johnson, who are a major provider of breast implants. The meeting was moderated by Mr Paul Harris, Consultant Plastic Surgeon, and the main speaker was Roger Wixstrom, PhD. Effectively this was an overview of what we currently know about ALCL and its possible causes. We still believe that there is a genetic component and also a linkage between a subclinical bacterial infection around the implant and the development of ALCL.

Current incidences for the different types of implants are as follows:

  • Polyurethane implants have an incidence of 1:2832
  • Allergan implants have an incidence of 1:3345
  • Mentor implants have an incidence of 1:86 000

The discussion was then around what one can do to try to prevent infection at the time of implantation although there is no clear evidence that it is happening from skin bacteria, it might also be translocated bacteria from the intestine. It is clear that most cases of ALCL now with better molecular tagging of bacteria are gram-negative rather than many of the gram-positive bacteria that reside on the skin.

It was further reiterated that the incidence of ALCL is thought to be related to the surface area of the texture and that this relates to the biofilm that then can develop, and this relates to an increase in the incidence of ALCL. A lot of work is being done on looking at the immunology around breast implant ALCL. Other theories that might be causing or contributing to it were discussed including Dr Dennis Hammond MD’s proposal of a particle theory causing ALCL. There also might be a causal relationship with those with other autoimmune conditions and developmental conditions.

It is quite clear though from the current data that we do not have a complete picture of why this is happening yet and what causes it. This condition obviously is going to affect women who have had cosmetic augmentation and who have had breast reconstruction following breast cancer treatment. In terms of going forward, surveillance now is essential and all patients need to be monitored yearly or if they develop symptoms of swelling, the presence of a mass or pain. At the moment the use of ultrasound and MRI has not been clearly defined.

David R Gateley, Consultant Plastic, Aesthetic and Reconstructive Surgeon