Discuss with your surgeon beforehand to take pictures of the implants and capsules, what you would like to be sent to pathology, and what tests to have done. Pathology is typically concerned with the diagnosis of disease and only checks for atypical cells leading to cancer cells when examining capsule tissue. They may not check for infections from bacteria or fungus, nor do detailed descriptions unless directly requested to do so by the surgeon. Pathology reports tend to be very general unless you insist for them to be more detailed.
1. List of potential pathological materials:
- Swabs of Chest & Capsules
- Rarely: potential lymph node (if deemed oversize) and seroma/effusion aspirate for CD30 (if there is fluid collection).
If you have implants and develop unilateral swelling, seroma, enlarged lymph nodes, breast mass, or even capsular contracture, you should push for CD30 ALCL testing. This is especially important with textured implants.
Capsules & Swabs:
During surgery you can have the surgeon take swabs of your chest and capsule, and also have them take pictures of the implants and capsules. We recommend to have capsules and swabs sent to pathology and tested for bacteria, fungus, atypical cells, ALCL (CD30), white blood cells, and foreign materials (gel bleed: silicone, silica, talc, polyurethane). If you have silicone implants you can request for pathology to check for the foreign materials of silicone, silicon, and silica. If you have the earlier versions of the implants before 1991, you can request for them to check for talc, silicone, silicon, and silica in your capsules. If you have polyurethane implants, you can request for them to check for polyurethane, talc, silicone, silicon, and silica. For more info see Stanford pathology. These tests are additional costs to the surgery, please inquire beforehand.
If you have textured implants (silicone or saline) or the symptoms mentioned above, the CD30 test on the capsules for ALCL cancer is recommended to have done. There is a Facebook ALCL support group and currently there are 60+ women with the diagnosis.
Update: As of July 2017, Dr. Mark Clemens states the FDA has received 464 adverse event reports in relation to BIA-ALCL and 12 deaths. See here for his report.
From August 25, 2010 through September 10, 2015, the FDA received 258 medical device reports (MDRs) of anaplastic large cell lymphoma (ALCL) in women with breast implants. – FDA
As of September 2015, of the reports received by the FDA, 50 percent of BIA-ALCL cases are with textured implants, four percent are with smooth implants, one percent have a history of both and 45 percent do not specify whether they were textured or smooth implants. – FDA
As an option for capsule testing, DNA Connexions has a Full View Test that identifies: “bacteria, viruses, fungi and parasites in removed teeth, blood, tissue, implants, bone grafts or other biological samples. It tests for 88 different pathogens, including tetanus, botulism, diphtheria, HPV 16 and HPV 18, Candida albicans and more. Using PCR, one of the most advanced tools in molecular biology today, specificity of this test is one in a trillion or greater and the sensitivity of the test is the ability to detect the DNA of between 1 and 10 microbes.”
If you have saline implants, Mycometrics and Real Time can test saline fluid for mold and microorganisms. Your implants may be destroyed in this testing, you may wish to inquire.
Swabs of the implant surfaces may be taken as well if you want to check for biofilm (bacteria) or fungus. Biofilm is commonly found with medical devices. Although if you do the swabs of the inner layer of the capsule that may be enough.
Generally implants are sent to pathology more for the purpose of having their appearance and labeling recorded with any identifying marks, characters or numbers. This may be useful for those interested in legal proceedings. Plastic surgeons may be able to do this too. If you do send your implants to pathology, ensure that they are not destroyed and will be returned back to you.
You can also request for your breast implants to be weighed.
Removing lymph nodes is a controversial topic.
All foreign substances in the breast may migrate to local and occasionally distant draining nodes. Silicone from ruptured or intact implants can be found in lymph nodes. Textured implants tend to have shell fragments flake off and those may also be found in the lymph nodes and be associated with ALCL.
Removal of a lymph node is called a biopsy. Normally lymph nodes are no larger than 0.5 in (1.3 cm) in diameter and are difficult to feel. They can enlarge to greater than 2.5 in (6 cm). It is not recommended for lymph nodes less than 0.5cm to be removed. Lymph nodes are an important part of your immune system and they help your body to recognize and fight off infections. Conservative removal is advised. Silicone and shell fragments are very difficult to break down and therefore removal of large silicone-filled lymph nodes may be just in some cases. See here for more information on lymph node pathology.
If fluid collection is found, request for it to be sent to pathology and do the CD30 test for ALCL. Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is a cancer of the immune system. One of the presenting signs of lymphoma is seroma and it is highly recommended for it to be analyzed for the possibility of ALCL. There is a Facebook ALCL support group and currently there are 60+ women with the diagnosis. It is more commonly found in textured implants. Don’t assume the doctor will test for fluid collection or send capsules off for testing, these can easily be discarded unless requested by the patient.
2. You can request for a very detailed pathology report, noting the following:
Pathological lesions, if there is any foreign material (such as silicone), lymphocyte infiltration, chronic inflammation, and histologic features.
Note: Nearly every patient receives “synovial metalplasia” in their capsule pathology reports.
Please note that pathology will apply a fixative of formalin or formaldehyde to the capsules and will generally make slides of some of the capsule tissue. Fixatives permanently tamper the capsules and prevent any future form of testing on them. The lab may then hold the capsules for a certain amount of time or destroy them after analysis unless you would like them returned to you, which would need to be arranged. The capsules tell the story of your body’s reaction to the implant. There is an expert, Dr. Blais, who examines breast implants and capsules but he is currently back logged. You may wish to have the capsule returned to you or ensure it is kept by the lab so that Dr. Blais may one day analyze it.