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Breast Implants & Anaplastic Large Cell Lymphoma

If you’re heard the controversy about breast implants and anaplastic large cell lymphoma, you know how scary it sounds. It’s important to keep in mind that most of the issues have been associated with textured breast implants, most often used in reconstructive surgery after breast cancer. However, not all cases are limited to only textured implants.


In December 2018, Allergan, one of the world’s largest manufacturer of breast implants, suspended sales of its textured implants in Europe after the implants were denied renewed safety certificates in France because of concerns about BIA-ALCL (breast implants associated with anaplastic large cell lymphoma). The French regulatory agency and a British association of plastic surgeons have recommended the use of smooth-surface implants in place of textured-surface products. Both European regulators and the U.S. FDA will hold meetings in 2019 to review further the safety of all breast implants but for now, textured implants remain approved for use in the U.S.


“ALCL is a extremely rare cancer of the immune system, and questions have been raised about whether the incidence is higher in women undergoing breast reconstruction with breast implants,” says Dr. Constance M Chen, New York City board-certified plastic surgeon and breast reconstruction specialist. The incidence of ALCL in the breast is 3 cases of ALCL in 100 million women (0.000003%). Dr. Chen adds that “BIA-ALCL has been associated in women who have breast implants for both cosmetic and reconstructive reasons. Women who have breast implants for breast reconstruction due to mastectomy or for cosmetic breast augmentation are at equal risk for developing BIA-ALCL. The simple fact of having a breast implant – of any type, for any reason – in her body places a woman at higher risk of developing BIA-ALCL.” Dr. Chen adds that the current literature estimates that BIA-ALCL may develop in 1 in 3,817 to 30,000 women with textured breast implants.


“While attention has been focused on textured breast implants, BIA-ALCL has actually been found in all types of breast implants: textured, smooth, silicone, saline,” says Dr. Chen. As of 30 September 2017, the FDA had received 414 medical device reports of BIA-ALCL, including the death of 9 patients. Only 272 of the 414 reports included information on the implant surface. Of these cases, BIA-ALCL was found associated with 242 implants with textured surfaces and 30 implants with smooth surfaces. With regard to implant filling, BIA-ALCL was found associated with 234 implants filled with silicone gel and 179 implants filled with saline. About half of the reported cases were diagnosed within 7-8 years of breast implantation.


The Backstory
In 2011, the U.S. Food and Drug Administration (FDA) first noted that the incidence of ALCL seemed slightly higher in patients with breast implants, but it was still very rare even in this population with 60 cases of ALCL worldwide in 5-10 million women (0.0006-0.0012%). Dr. Chen adds, “that at the time, many healthcare professionals believed that e incidence of ALCL in women with breast implants might have even been overestimated because some of the data collected may have been duplicate cases.” However, in 2016 data collection improved due to an increased attention to ALCL and breast implants, and the World Health Organization (WHO) designated breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) as a T-cell lymphoma that can develop following breast implants.


Several recent journal articles explore risk factors for developing BIA-ALCL, including the role of biofilm. Dr. Chen notes that “textured implants have significantly more surface area than smooth implants, which may explain why there is a higher incidence of BIA-ALCL in textured implants than smooth implants.”


Tips for Patients
When ALCL occurs with breast implants, it is identified most frequently in patients undergoing implant revisions for late onset, persistent seroma (a fluid collection that develops around the implant), or other symptoms such as pain, lumps, swelling, or breast asymmetry. Dr. Chen advises that “any women experiencing these symptoms should see a plastic surgeon to be evaluated for BIA-ALCL.”


The FDA already recommends that women with silicone breast implants undergo breast MRI every 2-3 years to evaluate for silent rupture of her silicone breast implants. Dr. Chen advises that if a patient with breast implants feels a change in her breasts, breast imaging can be obtained to evaluate for seroma. If a seroma is found, an interventional radiologist or a skilled breast radiologist can aspirate the seroma fluid to test for CD30 markers and lymphoma. If the cytology is positive, the patient will need to be treated.


Treatment of BIA-ALCL includes removal of the implant and capsule surrounding the implant and sometimes chemotherapy and radiation. If ALCL is diagnosed through imaging and testing of the fluid around the breast, treatment is generally the surgical removal of the implant and the entire capsule that surrounds it. In its early stages, all traces of cancer are generally removed by surgery. Further treatment is necessary only if all the cancer could not be removed or if the disease has spread to the lymph nodes or other parts of the body.


Dr. Chen clarifies that the FDA does not currently recommend prophylactic breast implant removal in patients without symptoms or other abnormalities. At present, breast implants are still approved in the USA when used as labeled for breast augmentation or breast reconstruction, as the risk of ALCL is still considered to be small and inconclusive. All of this may soon change, however, as new and better data is collected on BIA-ALCL.

Now You Can Try On Boob Jobs With Virtual Reality

Virtual reality isn’t just for gaming – now, plastic surgeons are beginning to use 3D plastic surgery simulators so you can “try on” a breast augmentation!

The software can help you see what a round implants would look like as opposed to a tear drop one, what the implant would look like under the muscle versus above, and what different sizes would look like on your frame.

Read more about it in the New York Post story here.

Can I Breast Feed After Breast Augmentation?

For women who are getting a breast augmentation and want children down the road, the ability to breastfeed is often a concern. Board-certified San Antonio plastic surgeon Elizabeth Harris, MD sheds professional light on this issue for us below. Thanks, Dr. Harris!


Women who undergo breast augmentation often share a common concern about breastfeeding: they fear that they will not be able to breastfeed future children due to scarring and other complications resulting from surgery on their breasts. There is some justification for this fear, but there is no reason to assume that breast augmentation rules out future breastfeeding.


The truth is that many women manage to breastfeed their children after breast augmentation without a great deal of trouble. This is especially true of women whose cosmetic surgeon uses one of two approaches to breast surgery. Axillary incisions and crease incisions underneath the breast cause few, if any, complications with regard to breastfeeding.

Axillary incisions are popular for several reasons. These incisions are made through the armpit. Due to their location in the armpit, they do create noticeable scar tissue but the patient’s breasts retain their whole appearance and do not lose any function in the area of breastfeeding.

Inframammary incisions are made under the fold or crease of the breast. They can be noticeable, depending on the resulting contour and shape of the breast. However, they also have very little impact on a woman’s ability to breastfeed.


There are certain approaches to breast augmentation, however, that do create complications for women hoping to be able to breastfeed children in the future. For example, the periareolar incision is very popular because it uses the border of the nipple to disguise the incision. One key result of this approach, though, is damage to the tissue that is most critical to breastfeeding. The breast becomes engorged with milk as expected, but the exits are obstructed. This can be a painful experience for mothers.

Women who wish to have and breastfeed children in the future shouldn’t feel like they have to choose between breast augmentation and breastfeeding. The important thing is to educate yourself about the possible approaches and the likely results of those methods with a board-certified surgeon who can best guide you. It is possible to have the best of both worlds!”

Dr. Elizabeth Harris, MD, San Antonio, Texas, USA

What Is Fat Transfer Breast Augmentation?

For Women’s Health, I explore the basics of what you need to know about fat transfer for the breasts, face and butt. Since you’re using your own fat, people also call this natural plastic surgery. But did you know that you can’t really gain more than one cup size in your boobs if you go this route? Check out the story to learn more.

5 Things You Need To Know About Natural Plastic Surgery – Grace Gold for Women’s Health

(Photo above is courtesy of Dr. Parham Ganchi; it shows a butt augmentation fat transfer from the stomach)

Breast Enhancement Pills

(Partner Post)

Are you unsatisfied by your natural breasts, but reluctant to undergo the time and expense of enlargement surgery? Know more about breast enhancement creams and natural pills that enhance your look, get noticed by others and boost your confidence. Find out the top 2 breast growth supplements at with detailed reviews compiled from different consumers.

There are surgical and non-surgical methods of increasing the size of your breasts. While this site focuses on breast augmentation, many women prefer a non-surgical approach to getting the look of larger breasts.

Alternatives to Surgery

If you’re not quite sure that surgery is right for you, there are lots of other options, too. You can increase breast size naturally in a variety of ways, including exercises that build the chest muscles, using breast enlargement pumps, and pills and creams that encourage the look of larger breasts. Always research and look for user reviews before deciding to purchase a product.

Natural Products

Some women choose to enhance breast size naturally using products for breast enhancement. These products generally come in one of two forms, either pills or creams. Some natural breast enhancement products include a pill and a cream, which are meant to be used together. Quality natural products typically contain herbs, plant extracts and other organic elements.

Visual Tricks to Give the Illusion of Bigger Breasts

There are a few tricks you can use to create the appearance of large and firmer breasts. Look for push up bras with silicone or gel inserts for the most authentic looking boost to your bust. Underwire styles can help lift sagging breasts. And some women use bronzer to contour the appearance of cleavage so that breasts look larger. Take a look on YouTube to see some tutorials on how to do this if you’re interested, and remember to use matte (not shimmery) bronzer for the most natural-looking results!



5 Facts About Boob Jobs Debunked

(Partner Post, by Claire McPhillimy)

Whether we’re wearing the wrong size bra or showing too much cleavage, when it comes to boobs we’re regularly getting it all wrong – or so we’re told.

But misunderstandings and mistakes aren’t our fault, not when you consider that from the moment puberty hits the only information we get about our breasts is usually gleaned from playground whispers. After all, the relationship we have with our barely developed boobs is kicked off listening to classroom debates about who is or isn’t stuffing their bra and fearful gossip about the dangers of wearing one to bed! Often, we end up carrying these childhood insecurities and mistaken ideas all the way to adulthood.

The Mystery of Boob Jobs

Nowhere is this clearer than the world of boob jobs.

Although 9,652 breast augmentations were performed in the UK last year, for many women going under the knife to boost their bust remains a dream.

One of the biggest reasons is that, like those playground rumors, we’re inundated with false stories and misinformation about what the process entails.

When you’ve been toying with the idea of getting a boob job for a while, separating fact from fiction with the information available is tricky.

And it’s left many of us with unfounded anxieties.

Separating fact from fiction

Don’t get us wrong, you’re right (and sensible!) to ask questions before a surgery.

But lots of your concerns are probably based on “facts” which may be fabrications or fear-mongering exaggerations.

To help you make an informed decision, we’ve debunked five of most common myths about boob jobs.

#1: You Can’t Breastfeed Afterward

Women often believe that breastfeeding won’t be possible after a boob job, and delay having one until they’ve finished having kids.

While some surgeries are riskier, like reductions, most women who have implants go on to successfully breastfeed. A respectable surgeon will be willing to talk through all possibilities with you, so don’t be shy about raising any concerns.

#2: The Gym Will Be Off-Limits

Although gym bunnies and sports enthusiasts often worry that implants will ruin their fitness regime, it’s only the recovery process which is majorly effected. You’ll be advised not to exercise at all for the first couple of weeks, and keep it low impact for at least the next couple of weeks.

Yes, it’s a pretty significant break if you’re used to hitting the treadmill five days a week, but after you’re healed up you’ll be able to resume your normal workouts.

#3: Say Goodbye to Underwired Bras

The joy of filling out a new cup size and exploring different lingerie is a big motivation for getting a boob job until someone drops the bombshell that you won’t be able to wear underwired bras afterward.

But it’s only immediately following surgery that you’ll be advised to stick to a non-wired, comfortable bra. Once you’re given the all clear from your surgeon, you’ll be able to wear whatever types of bra you choose.

#4: Everyone Will Know

Post-surgery, some people love their new boobs so much they want to show the results to the world. For others, a natural boost they can keep entirely to themselves is the goal.

The good news is that a subtle look is achievable. A good surgeon will advise you on the correct size, the appropriate placing (above or below the muscles) and the best shape of implant to give you your ideal look.

#5: Visible Scarring Will Be Left Behind

As with all medicine, cosmetic surgery has come a long way. New methods of performing breast enlargements are increasingly effective and scarring isn’t as big an issue as you imagine.

An expert surgeon will assess your individual case first but should be able to hide scars around the areola or in the small crease under your breast. Although you’ll know it’s there, strangers on the street will be none the wiser 🙂

Study Proves: Women Stare At Breasts As Much As Men

1 reports that in an October 2013 study published in the journal Sex Roles, researchers asked 29 female and 36 male students to examine 10 photos of college-aged women. Using a gaze-tracking device known as EyeLink II, the female participants were observed to look at the other women’s breasts and waists just as long as the male participants did. Check out YouBeauty’ story on the study for more details here.

Are you surprised? I’m not!

Are You Wearing The Right Bra?

Ask any woman who has gotten her bra professionally sized and she’ll tell you: The right fit can make all the difference.

But the right cup and bust aren’t the only important factors when choosing a bra, according to Elisabeth Dale, author of the book “The Bra Zone” and founder of The Breast Life blog. “It’s like picking out shoes for an outfit — sometimes you want flip-flops or ballet slippers or high heels,” she says. Having a variety of bra styles means you can dress your chest for the occasion. Here’s how.

Read more in my story for the TODAY show: Are You Wearing The Right Bra? 

Breast Implants As Holiday Gifts

CNN Money has a feature today on the growing popularity of giving cosmetic surgery – most notably breast augmentation – as a holiday gift.

“Holiday gift giving has become a staple at many cosmetic surgery practices, and the popularity has grown over the last several years, according to Tom Seery, Founder and CEO of, a consumer website for patients considering cosmetic procedures.

Seery said that people are widely more accepting of nips and tucks than they used to be, and the fact that it’s become more mainstream makes people more comfortable admitting they want something done.

According to the American Society of Plastic Surgeons, 15.1 million people had cosmetic procedures in the U.S. in 2013, up 104% from 2000.

“Because of that, cosmetic surgery is much less of an awkward conversation to have around the dinner table,”Seery said.”

Read the entire story here.

Boob Job Ban For Minors Coming To Germany

Get this: about 10 percent of all plastic surgery patients in Germany are teenagers under the age of 20 – according to Jens Spahn, the health spokesman for one of Germany’s leading political parties. (The German Association of Plastic Reconstructive and Aesthetic Surgeons claims that number is rounded up too high to be accurate.)

“I think it is completely unacceptable to give a 15-year old a breast enlargement as a Christmas present,” he told Der Spiegel. And as such, he’s getting ready to work on a ban on plastic surgery for minors starting next year.

While I agree that teenagers shouldn’t be getting breast augmentation, my reason has less to do with “morals” and everything to do with safety. Women’s breasts don’t reach a “final” size until their 20s, and even after that, factors like pregnancy, breastfeeding and weight gain can still dramatically change your size. Getting a breast augmentation when you’re so young could ultimately end up with a size and shape that you don’t want – so it’s best to wait until after about the age of 21, at minimum!

I however don’t agree with a ban on plastic surgery for minors – there could be compelling emotional and psychological reasons one may want a procedure (like ear pinning or rhinoplasty) at that age, and it should be decided by a board-certified plastic surgeon on a case-by-case basis – not by a flat out ban by government intervention.

What do you think?

The Holidays: Popular Plastic Surgery Time

Believe it or not, cosmetic surgery is a popular holiday gift. Experts say it’s in due part to being the best time of year for many to undergo the procedures they’ve been wanting.

“Since things tend to slow down workwise in December, the holidays are the perfect time make a tweak and address something that’s been nagging you about your appearance,” says American Academy of Facial Plastic Surgery and Reconstructive Surgery President Edward H. Farrior, MD, FACS. “Holiday breaks offer the downtime you need to rest and recuperate from any procedures, plus the timing allows you to start the New Year fresh.”

So whose getting gifted? According to the survey, two-thirds of the patients are mothers – and most typically in their 40’s.

Whether you’re treating yourself or sharing the gift of beauty with a friend or family member, follow the Academy’s need-to-know tips before selecting a surgeon:

The best patient is informed.  Do your homework on procedures and treatments before visiting the surgeon so you are armed to have an informed conversation when you get there.


When you select a facial plastic surgeon, you’re putting your trust – or loved one – in that physician’s hands. It is imperative that the surgeon you choose is highly credentialed to ensure the best possible outcome. Always select a board-certified surgeon.


While it may be tempting to get a discount on aesthetic procedures, you should always exercise caution with blindly purchasing them. The problem is that it’s potentially dangerous and unethical to sell cosmetic surgery deals without first evaluating the patient. Remember, you don’t want a surgeon who is about the bottom line – but all about your satisfaction and results!