In the first reported case of its kind, gluteal implants (also known as "buttock" or "butt" implants) have been linked to a rare form of cancer that ultimately led to a woman’s death.
The type of cancer the 49-year-old patient was diagnosed with, anaplastic large cell lymphoma (ALCL), has previously been linked to breast implants. In the last eight years, the Food and Drug Administration has identified more than 450 cases of this cancer linked to breast implants, most of them textured implants.
The woman's case “helps to demonstrate that many textured implants could potentially be [a] risk [factor] for ALCL and that in general, the discussion should move from 'breast implant-associated cancer' to 'implant-associated [cancer],' to better encompass the full spectrum of disease," the authors wrote in the report, published February 15 in Aesthetic Surgery Journal.
“We may see more of this. It makes sense, from a mechanism point of view,” said Leslie Popplewell, M.D., associate clinical professor in the Department of Hematology & Hematopoietic Cell Transplantation at City of Hope, who has previously warned of the risk of ALCL associated with textured breast implants. In 2010, she published a study on nine breast implant-associated ALCL cases at City of Hope in the Journal of Leukemia and Lymphoma.
More than 36,000 buttock implant procedures were performed worldwide in 2017, according to the International Society of Aesthetic Plastic Surgery. The operation is quickly growing in popularity, with an 18 percent increase in the number of procedures done over the year before.
As described in the new report, the woman received gluteal textured implants about a year before doctors in Los Angeles observed an ulceration on the skin around the implants, and imaging tests that revealed fluid around the implants. Further testing confirmed the ALCL diagnosis. Unfortunately the cancer had already spread to other parts of her body, including her lungs, and despite aggressive chemotherapy, the patient died several months later.
The report authors note that the case shows only an association between the woman’s implants and her cancer, and that they can’t confirm that the implants were the cause. They also say that her cancer was particularly aggressive, and that implant-related cancers usually develop around 10 years post-implant. The risk of developing implant-related ALCL is considered very low.
Still, they stressed that “It is imperative that all physicians recognize that patients with textured silicone implants other than breast implants may also be at risk of ALCL.” Patients considering such surgery should be informed of the possible risks and how to spot signs of complications, they wrote.
Textured implants, which have a rougher surface to help them stay in place, can irritate surrounding tissue, creating chronic inflammation that initiates an immune response, Popplewell explained. That immune response involves lymphocytes, which can become malignant over time. “If you get chronic inflammation in an area long enough, there’s more opportunity for genetic mistakes in the cells to be made,” she explained, leading to ALCL.
The Food and Drug Administration first alerted women about the risks from textured breast implants in 2011. The agency is currently evaluating their safety. Textured breast implants were taken off the market in Europe in December.
It is essential that women with textured implants, whether in the breasts or buttocks, have the fluid around their implants tested for malignant cells if they are experiencing symptoms of pain or swelling, Popplewell said. “Just removing the fluid isn’t therapeutic. It has to be tested, specifically looking for lymphoma cells.”
“The risks are low, but the thing to remember is that apart from reconstructive surgery after mastectomy for breast cancer, all of these are cosmetic surgeries — so it’s not about weighing the medical benefits vs the medical risks — there really aren’t any medical benefits to cosmetic breast augmentation or ‘gluteal’ enhancement,” Popplewell said. “In addition, since this has been reported mainly in patients receiving textured implants, the discussion around risk of surgery should probably include consideration of smooth implants rather than the textured variety.”