The first gluteal implant case has raised concern for risk of anaplastic large cell lymphoma in more than just textured breast implants.
Textured breast implant-associated cancer cases have appeared in the spotlight following a Food and Drug Administration (FDA) hearing in March and the agency’s request to have one of the manufacturers of textured implants voluntarily recall their product in late July.
However, textured implants have also been associated with the same cancer in a different type of implant — gluteal, or buttock.
The first case of gluteal implant-associated anaplastic large cell lymphoma (ALCL) was reported earlier this year in a 49-year-old woman who later died. The FDA identified more than 450 cases of ALCL linked to breast implants, most of them textured implants. ALCL is a rare type of non-Hodgkin lymphoma, and one of the subtypes of T cell lymphoma. It comprises about 16% of all T cell lymphomas, according to the Lymphoma Research Foundation.
In 2017, more than 1,300 buttock implants were performed, down from nearly 3,000 the year before, according to a report released by the American Society of Plastic Surgeons.
“I'm not sure that gluteal implants are ever medically necessary,” Dr. Leslie L. Popplewell, a hematologist/oncologist specializing in lymphoma at City of Hope in Duarte, California, said in an interview with CURE®. “Maybe occasionally they are needed for reconstructive purposes after trauma or surgery, but probably the alternative is to not have them placed at all.”
In the only known reported case of gluteal implant-associated cancer, the woman received the implants about a year before doctors in Los Angeles observed an ulceration on the skin around the implants, and imaging tests revealed fluid around the implants, according to a report. The fluid found was similar to the fluid buildup that occurred in the breast implant cases.
She later received an ALCL diagnosis, but the cancer had spread to parts of her body, including her lungs. “In this case, the lymphoma developed less than two years after the implants were placed and was already widespread by the time the patient was diagnosed,” Popplewell said. “It's not the scenario that is usually seen with the breast implants, but it’s hard to ignore the association, and there were fluid collections around the implants themselves.”
Following chemotherapy, she died several months later. “Death from this kind of lymphoma is very rare,” Popplewell said. “Most of the time, removal of the implant and capsule is adequate treatment, and chemotherapy is not always needed. Survival is very good when this is diagnosed and addressed appropriately.”
The signs of ALCL usually being with pain or swelling, and some fluid is present around the implant. “This one case had widespread disease with fluid around the lungs and heart, as well as skin eruptions,” Popplewell said. “But we might speculate that if the same mechanism was involved, gluteal implants might also develop fluid in the peri-implant capsule with pain and swelling.”
Some experts feel the addition of this case calls for the diagnosis to be changed to “implant-associated lymphoma” rather than breast implant-associated.
Since Popplewell sees patients after diagnosis is made, she recommended patients speak with their plastic surgeon about what needs to be discussed before an implant placement.