Update from Dr. Brown on Breast Implant Safety and ALCL – August 2019

On July 24, 2019, Allergan announced that they were issuing a voluntary recall on their BIOCELL textured breast implants and tissue expanders. This announcement by Allergan has added to the concern and worry being experienced by many women with breast implants.

In Canada, Health Canada had taken action in advance of this decision by Allergan when they announced the suspension of Allergan’s license for its BIOCELL breast implants on May 28, 2019.

The primary reason for this suspension and recall has been a recognized association between a rare type of lymphoma and textured surface medical devices. We initially wrote about Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) in our blog post of December 12, 2018.

See blog post: Update on Breast Implant Safety and ALCL – Dec 2018

It is important to know that to date, due to the low risk of developing BIA-ALCL, there has been no recommendation from regulatory agencies including Health Canada and the FDA to remove or replace textured breast implants or tissue expanders in women who are asymptomatic and have a normal examination.

I would like to provide some background and share some information regarding these recent events. In Canada, most breast implants and tissue expanders have been made and distributed by two companies (Allergan and Mentor). Both companies make implants and expanders that have one of two surfaces: smooth and textured.

Why might you have a textured surface breast implant?

There are several advantages to a textured surface implant. When using a shaped (teardrop, anatomic) implant or expander, the texturing assists in holding the implant in position so that it does not rotate. In fact, all shaped implants are textured. In the past, texturing has also been felt to decrease the incidence of some of the more common complications associated with breast implants including hardening (capsular contracture) and implants shifting out of position (malposition).

The actual cause of BIA-ALCL remains unclear but one of the most accepted theories is that bacteria may find their way into the crevices or spaces within the textured surface and stimulate an inflammatory response that in a small number of patients may eventually lead to lymphoma.

What do we suggest for our patients?

Late in 2018, our office began a process of trying to contact all of our patients with textured surface breast implants to notify them of this new information, explain what patients should look out for and to suggest that they contact our office to come for a follow-up visit that would include a discussion of patient options. This approach has been helpful in allowing us to speak to and assess many of our previous patients dating back to 2002.

If you are a patient of Dr. Brown and you have not received an email from us, it may be because you have smooth surfaced implants or it may be that we were unable to find updated contact information for you.

We encourage all of our patients to contact the office so that we can confirm for you the type of implant that you have. If you have a textured surface implant we would like to assist you in arranging a follow-up visit or if not possible for you to attend in person, then it will give us an opportunity to provide you with necessary information and to answer your questions. Additionally, all women with breast implants, regardless of the type, benefit from ongoing follow-up of their medical devices and we hope that you will continue to come for complimentary annual or biannual assessments at our office.

Please contact us with any questions or to arrange an appointment.

Dr. Mitchell Brown

Links

Allergan Voluntarily Recalls BIOCELL® Textured Breast Implants and Tissue Expanders
https://www.allergan.com/news/news/thomson-reuters/allergan-voluntarily-recalls-biocell-textured-brea

Health Canada suspends Allergan’s licences for its Biocell breast implants after safety review concludes an increased risk of cancer
https://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2019/70045a-eng.php

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Dr. Brown Talks About Cellulite and Cellfina

In this video, Dr. Mitchell Brown discusses cellulite: how it is formed, whether lifestyle changes can help, and surgical treatment options, including Cellfina.

Cellfina is an FDA and Health Canada-approved treatment for cellulite that has been shown to produce results that last for at least two years. Book a consultation with Dr. Brown to determine if you are a candidate for Cellfina.

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All About BRA Day in Toronto with Dr. Brown

Toronto Plastic Surgery, Breast Reconstruction Toronto

BRA (Breast Reconstruction Awareness) Day is an initiative founded by Toronto Plastic Surgery’s own Dr. Mitchell Brown, that promotes education, awareness and access for women considering post-mastectomy breast reconstruction.

BRA Day events are held in communities across Canada in October. This year’s Toronto event takes place on October 17th, 2018. Dr. Brown and the Canadian Cancer Society are also hosting a free BRA Day event at Toronto Plastic Surgery on October 24th, 2018.

During these events, leading plastic surgeons have the opportunity to provide breast reconstruction education and answer patient questions. Attendees are given the opportunity to hear patient stories and connect with women who have been through it, and in the Show & Tell Lounge, volunteers share the real-life results of their breast reconstruction.

Leading up to this year’s BRA Day event, Dr. Brown has taken the time to answer some common questions about this event and why it is so meaningful to him.

1. First, what is BRA day?

Breast Reconstruction Awareness Day is an initiative that promotes education, awareness and access for women considering post-mastectomy breast reconstruction. Today, hundreds of educational events are held across the world on and around BRA Day, which typically occurs on the third Wednesday of October. These events bring physicians, surgeons, nurses, support staff and, especially, patients together to improve education and awareness around options for breast reconstruction.

2. Why is this event so important to you?

I am so lucky to have many great reconstructive options for breast cancer patients. Unfortunately, there are still far too many women that are never presented with these options. Education and awareness are the first steps to ensure that women with breast cancer can make the best choice about whether or not to undergo reconstruction and what type of reconstruction is best for them.

3. Dr. Brown, tell us a bit about why you founded the event.

Breast Reconstruction Awareness Day was founded in 2011 to address a clear need for better access, education and awareness for options related to breast reconstruction. Over the many years of my career, I had been meeting with women who had previously undergone mastectomy and went years without knowing that breast reconstruction was even an option. To me, this was unthinkable, especially in an advanced country like Canada. The message certainly has grown and since 2011 BRA Day is now celebrated in over 30 countries worldwide.

4. Who can benefit from this event?

Breast cancer patients, their families and support networks, physicians, surgeons and other healthcare workers that look after breast cancer patients can all benefit from BRA Day events. This event will provide an overview of current options for reconstruction both in the immediate (same time as mastectomy surgery) and delayed (months or years later) settings. It will provide an opportunity to ask questions of the surgeons involved as well as from recent patients that have undergone reconstruction or even those that have chosen not to.

5. What effect have you seen the event have on attendees over the years?

Feedback from the BRA Day events has been excellent. Women frequently report having had an opportunity to be educated in an environment that is comfortable and safe. The ability for women to network with their health care professionals as well as other women who have undergone the reconstruction process is unique and incredibly beneficial. Attendance has continually increased over the years and this has stimulated educational events that are now held throughout the year.

6. What can people expect at this year’s event?

This year, in an intimate, informal setting, we will review current options for breast reconstruction, provide a list of questions for patients to consider while deciding on options for breast reconstruction and spend as much time as possible answering questions from patients and families. We have a number of excellent patients attending who will be able to share their story and answer questions first hand.

7. If someone cannot attend this year’s BRA Day event, but is interested in learning more about breast reconstruction options, what do you suggest?

Fortunately, through the efforts of BRA Day around the world, more and more resources have become available. First, there is likely another event near you that you may be able to attend. Most events are listed here. You can find excellent comprehensive information on the Toronto Plastic Surgery website, or from organizations such as the Canadian Cancer Society, and the Canadian Collaboration on Breast Reconstruction. Finally, don’t be afraid to ask your healthcare provider to organize a consultation with a plastic surgeon that performs reconstructive breast surgery.

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