Breast implant-lymphoma connection debated

Although breast implants are without a doubt the most extensively studied medical devices on the market and are widely regarded as safe, a new report is raising questions about a possible connection between implants and a rare form of non-Hodgkin's Lymphoma called ALCL. Dr. Garry Brody, a Professor Emeritus of plastic surgery at USC, has been collecting a database about these rare cases, now totaling 25. Importantly, the tumor occurs in the scar capsule around the implants, not in the breast, and appears to be associated with a specific type of textured implant surface. A more important distinction is that these tumors behave in a very benign fashion and are highly curable by surgical removal of the capsule. This suggests that they are actually something other than ALCL despite the fact that they have all of the features of it under microscopic examination.
Although any report of cancer and breast implants is likely to be sensationalized, a cautious approach would be prudent in interpreting this story. In addition to the unanswered question of whether or not this is really a cancer, the incidence among women with implants appears to be in the range of one in a million, which could only be characterized as extremely rare. There will likely be other reports coming forth as the story is publicized, but given the number of women worldwide with implants, it is likely to remain a rarity. So in the good news column, place the fact that it is highly curable, and if it does have a causative link, it is to a type of implant that is less frequently used now (I have been using exclusively smooth-surface implants for augmentation for 15 years.) To keep this in perspective, it is the drive to the plastic surgeon's office that is the most dangerous part of breast implant surgery, not the implants.

Behind the scenes in a plastic surgery practice

While we hope that we make it look easy, there’s a lot that goes on behind the scenes to make a plastic surgery practice tick. It does simplify matters that I don’t do as much reconstructive surgery as I used to, so my day doesn’t typically start with hospital rounds anymore (I use the time to get to the gym instead.) We do surgery most days here in our accredited facility, which is a great convenience but also a lot of work to keep up to speed and comply with safety standards. Practices that do surgery in an offsite facility often have surgery days and clinic days, so some patients have to wait until the afternoon to start, all the while hungry and thirsty because no oral intake is allowed for anesthesia reasons. But maintaining all of the standards of accreditation for a surgery facility is time consuming work, including such things as regular inspection of all equipment, Advanced Cardiac Life Support certification by all clinical staff, quality assurance reviews, drills for emergency situations, and the like. And every case begins with a “time out” checklist, similar to what an airline pilot does before takeoff. I also serve as an inspector for AAAASF, the accrediting agency for our surgery facility ( http://www.aaaasf.org/consumers.php ), though our own inspections are of course done by an independent examiner.


There’s another aspect to my practice that isn’t typical, in that I use the same nursing staff in surgery as for patient consults, pre-op visits, and post-op care. The advantage of this is that the patient sees the same people before, during, and after surgery, which is a comfort and helps assure consistency. When the surgery is done at a facility separate from the practice, the surgeon has less control over the patient’s experience. The challenge is that my nurses have to possess the technical skills to assist in surgery as well as the people skills to work on the clinic side, and that is a special combination.

Of course before you ever get to the operating room, or the consultation room for that matter, you will have met the front office staff. Their challenge is finding time for all of the administrative chores involved in medical recordkeeping while still devoting 100% of their attention to you.

When it all works as planned, I find time for interesting clinical research projects, blogging, teaching, and learning. There’s not a lot of “down time” around here, and we (or at least I) wouldn’t have it any other way.