Breast Implants, Textured Breast Implants & Anaplastic Large Cell Lymphoma (ALCL): A Rare form of Non-Hodgkins Lymphoma (NHL).

A Scientific Guide for patients.

Many patients in Australia and across the world have recently become aware of the risks associated with a specific make of Breast Implant, called Poly Implant Prosthese (PIP), Polyurethane Breast Implants (Furry Brazilian) or Textured Implants.

Dr. Bobby Kumar (Cosmetic Surgeon) has never used PIP Breast Implants and does not recommend textured breast Implants. He has chosen only to use breast Implants with a proven and trusted safety record, and breast Implants that are recognised and approved by the major medical authorities around the world, such as FDA (Food and drug authority of the US), TGA and NHMRC of Australia as well as UK’s Medicines and Healthcare products Regulatory Agency (MHRA).

Breast Implants that are recommended at the Bare Aesthetics Cosmetic clinics and by Dr. Bobby Kumar are Eurosilicone (It has one of the lowest rates of all breast Implants for rupture) and Mentor Breast Implants. These Implant companies provide guarantees for their Implants; Eurosilicone Implants are Insured for life to all my patients and the company will exchange for free any on their Implants that develop a spontaneous rupture and or capsular contracture.

Dr. Bobby Kumar (Cosmetic Surgeon) in his opinion has recommended that the PIP Implants be removed especially if they have ruptured; this is contrary to the recent advice provided by the TGA  and their advisors.

1. What are the concerns regarding Breast Implants and the rare ALCL tumour?

Depending on the source of scientific literature and information there are a slightly varying number of ALCL cases in women having undergone breast Implantation.

After a careful review of literature published from January 1997 through May 2010, the FDA identified 34(one study identified only 27) unique cases of ALCL in women with breast implants worldwide. In addition, the FDA has received information from other international regulatory agencies, scientific experts and breast implant manufacturers. Altogether, the agency is aware of approximately 60 cases of ALCL in women with breast implants. Most of these women are mainly in Europe and some in the USA.

However, based on all the evidence available to us at this time, the FDA believes that women with certain types of breast implants may have a very low but increased risk of developing ALCL.

Since initially publishing this article it has been recognised and established that there is a link between Textured Breast Implants, the formation of capsular contracture and ALCL by Australian researchers (Click on the following link for details: http://www.mq.edu.au/newsroom/2014/11/11/link-found-between-textured-breast-implants-and-rare-cancer/ )

2. What is Anaplastic Large Cell Lymphoma (ALCL)?

ALCL is not breast cancer. According to the National Cancer Institute (USA), ALCL is a rare malignant tumor (non-Hodgkin lymphoma) that may appear in several parts of the body including the lymph nodes, skin, bones, soft tissue, lungs or liver.

Also according to the National Cancer Institute, an estimated 1 in 500,000 women per year in the U.S. are diagnosed with ALCL. ALCL in the breast is even rarer. Approximately 3 in 100 million women per year in the U.S. are diagnosed with ALCL in the breast (with or without breast Implants).

Even though ALCL has been found in the breasts of some women with breast implants, it is not breast cancer. ALCL is a type of lymphoma, a cancer of the cells of the immune system.

In fact the type of ALCL that forms in association with some breast Implants, that is, ALCL Kinase negative, is an even rarer form of all the subtypes of ALCL.

ALCL comprises only 2% of all newly diagnosed NHL worldwide. Lymphomas occurring in the breast are even rarer, comprising only 0.04 to 0.5% of all breast cancers and approximately 1-2% of all extranodal (outside of lymph nodes) lymphomas.

The absolute risk of developing ALCL following breast augmentation is extremely small. It is estimated by de Jong et al. to have an incidence of 0.1 to 0.3 per 100,000 women with breast Implants per year.

It has been propsed that the link is associated with a bacterial infection in contact with the textured surface of the breast Implant. The infection creates a chronic inflammatory state and activates the patients Immune system and lymphocytes causing a transformation into what is now referred to as BIA-ALCL (Breast Implant Associated ALCL)

3. Symptoms associated with development of ALCL and women with Breast Implants

The main symptoms of ALCL in women with breast implants were persistent swelling or pain in the vicinity of the breast implant. These symptoms were noted to occur well after the surgical incision had healed, often years after implant placement (published articles estimate 6 months to several years after breast augmentation).

Upon evaluation, evidence of fluid collection around the breast implant (seroma) was observed. Some patient reports indicated that a palpable mass or capsular contracture (thick and noticeable scar capsule around the implant) were present.

4. Where in the breast has ALCL been found in women with breast implants?

In the case studies reported in the literature, the ALCL was found near the textured breast implant, and contained within the fibrous scar capsule. However, it was not in the breast tissue itself. The illustration below shows the location of the ALCL in these reports. In most cases, the ALCL cells were found in the effusion fluid (seroma) surrounding the implant or contained within the fibrous scar capsule.

Breast Implants and ALCL tumours

5. Prognosis

ALCL disease occurring in women with breast Implants is a clinically indolent disease with a favourable prognosis, as distinct from the systemic ALCL disease type.

Management consists of removal of the involved breast Implant and capsule, which likely on current evidence will prevent local reoccurrence (evaluation for other disease sites needs to be performed).

With capsule confined disease, adjuvant chemotherapy and radiotherapy is not necessarily required; however this decision is made by a medical oncology team.

6. Conclusion

Whilst ALCL of the breast and in particular in women with breast Implants is rare, it is recognosed now that there is a positive association between BIA-ALCL and textured breast Implants. There is a causal link  between textured breast Implants , bacterial infection and developing BIA-ALCL.

Textured Implant range include PIP Implants, Micro textured breast Implants & Poly Urethane breast Implants (Commonly referred to as ‘PURE’ or ‘Furry Brazilian’).

The scientists have suggested that smooth breast Implant surfaces potentially have a lower or no risk of developing ALCL. 

The expert panel also believes that there is evidence of an increased risk of developing ALCL in women that have breast augmentation in the Subglandular plane (under the breast) compared to those women with Subpectoral breast augmentation (under the pectoral muscle).

The treatment is removal of the textured breast Implant and fibrous capsule. It is not clear whether there is still a long term risk of developing ALCL despite removal of the affected breast Implant and capsule.

7. So what are the issues with the PIP breast Implants?

The media and the PIP manufacturing company have released a statement suggesting that PIP Implants have a higher than expected spontaneous rupture rate, at least approximately 4x greater than other types of breast Implants. There is a greater risk of Capsular Contracture and now a suggestion that this particular breast Implant is implicated in the formation of a rare form of NHL tumour (BIA-ALCL) of the scar tissue(Capsule) surrounding the Implant.

Of particular concern are textured PIP breast Implants as well as textured titanium coated breast Implants.

8. Consequently Poly Implant Prosthese(PIP) has advised that patients should consider removal of their PIP breast Implants.

This has caused significant concern amongst patients with PIP Implants or in fact with any breast Implant, as evidenced by the number of calls received at Bare Aesthetics Cosmetic Surgery Clinics. In Australia PIP breast Implants were used largely by Surgeons in South Australia (State where the parent Importing Company of PIP breast Implants resided) and Queensland.

PIP breast Implants were banned for use in Breast Augmentation in the USA by the FDA in the year 2000 when it became evident that there were significant spontaneous rupture rates and capsular contractures. It was also recognised that PIP manufacturing company were using Industrial strength Silicone, not authorised or appropriate for use in medical breast augmentation.

Despite the FDA findings the Australian TGA only banned PIP breast Implants in approximately 2010, when similar concerns were raised by Australian patients reporting adverse outcomes.

To reiterate Bare Aesthetics Cosmetic Surgery Clinics and Dr. Bobby Kumar have received many enquiries regarding what to do from patients having had PIP breast Implants by another surgeon. Dr. Bobby Kumar (Cosmetic Surgeon) in his opinion has recommended that the PIP Implants be removed especially if they have ruptured; this is contrary to the recent TGA advice.

Patients with PIP breast Implants are naturally distressed and anxious about developing ALCL and removal of the affected breast Implants which then entails increased risk or morbidity of having further surgery and anaesthesia, especially as it will take longer than a standard breast augmentation. Also there is consideration of cost; it is unclear who will finance further surgery for the removal of the affected PIP Implants.

At this stage patients are expected to finance further surgery, although international authorities are suggesting the government finance patients in cases where breast augmentation with PIP Implants followed corrective surgery for breast cancer; or it be financed by the private clinics and or Surgeons that performed the breast augmentation with PIP breast Implants.

Dr. Bobby Kumar is a Cosmetic Surgeon, experienced and qualified to perform Breast Augmentation or Breast Enlargement surgery. For advice regarding Breast Implants and PIP Implant related issues, please contact us at www.bareaesthetics.com.au or call 1300 676 003 or 0430 491 009.


Written by Dr. Bobby Arun Kumar on Monday the 7th of September, 2015. Currently No Comments »

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How does Dr. Bobby Kumar, Cosmetic Surgeon, decide which Breast Implants are best suited to you?

Breast Augmentation surgery is the most common Cosmetic Surgery sought by women in Australia today. Planning for breast augmentation surgery requires choices about breast implants, including,

saline vs silicone

size/volume of breast implant

shape of breast implant (round vs anatomical)

projection of  implant (eg high vs very high)

the outer layer of the implant (textured vs smooth)

placement of the implant (Subglandular or Subpectoral)

So how do you know which type of  implant is best for you and will achieve the results you desire?

When planning Breast Augmentation surgery, Dr. Bobby Kumar does not take a “one type suits all” approach when recommending breast implants. There are several factors that he considers when evaluating which breast implants to recommend to any given patient, including:

Existing features:

Volume of existing breast tissue (ie the amount of breast tissue/size of breasts)

Skin thickness, quality, quantity and elasticity – these features affect the placement of the breast implants of above or below the muscle (Subglandular or Subpectoral) and potentially the size of breast implant. For example, a woman with thin skin seeking a natural result may be best suited to breast implant placement below the muscle to allow for coverage of the implant and to avoid the edges of the implant showing through the skin. The quantity of skin is also taken into consideration as the desired outcome is to fill the skin adequately with the breast implant. An implant that is too small to adequately fill the skin results in an unnatural appearance.

Chest diameter – the width of the chest and breast diameter affect the width of breast implants that can be accommodated. For example, a large breast implant may not be able to be accommodated by a small diameter breast, or conversely a smaller breast implant in a breast with a large diameter may result in poor breast augmentation.

Shape/position of existing breasts – for some women, their breasts have developed a degree of droop with age, changes in weight, and/or pregnancy and breastfeeding. A mild degree of droop can be addressed with certain types of breast implants. Most women seek upper pole fullness and the ability to create cleavage. This, for example, cannot be achieved with anatomical breast implants that are teardrop shaped.

Desired result/outcome:

                The result that each woman wants to achieve with breast augmentation surgery can differ. For example, some women seek an implanted look whilst others want a natural fullness. Some women seek to be a couple of “sizes” bigger, whilst others want to be significantly larger. Trends have changed when it comes to what is considered desirable – currently the most popular look amongst women seeking breast augmentation surgery is full, natural breasts with upper pole fullness and cleavage. Typically women who seek breast augmentation surgery after having children are aiming to restore their breasts to their pre children appearance, seeking to restore volume, shape and proportion to their body shape. 

Other factors:

      Size and development of pectoral muscles

      Height

      Weight

      Pregnancies/breast feeding, weight gain/loss – these factors results in changes over time in the size and shape of the breasts and the stretch of the skin, for example.

The manufacturer and supplier of the breast implants:

               Dr. Bobby Kumar actively stays informed regarding the breast implants available on the market and ongoing research into continued product development in order to maximise the safety and wellbeing of every woman who is seeking breast augmentation surgery. For example, Dr. Bobby Kumar chose not to ever use the now very well publicised PIP implants due to his knowledge of the history and concerns regarding the implants and the manufacturers themselves.

These are all factors that Dr. Bobby Kumar, Cosmetic Surgeon, considers comprehensively in a consultation when discussing the types of breast implants available and which breast implants would be best suited to any given woman seeking breast augmentation surgery.

Make an apointment today for a consultation by calling 1300 676 003 or contacting Wendy on 0430 491 009. Alternatively visit our website at www.bareaesthetics.com.au

 


Written by Dr. Bobby Arun Kumar on Monday the 22nd of April, 2013. Currently No Comments »

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       Women Considering a Mummy Makeover:

“I just want my body back…I’ve had my kids and now I want something just for me, to get my body back to something like the way it was…I maybe considering Breast Implants or a Tummy Tuck ?”

This is the most common phrase I hear from women seeking breast augmentation surgery, abdominoplasty (tummy tuck sydney) surgery, or both together.  Typically these women have had children and see the lasting effects on their bodies every day; loss of volume and shape in their breasts and residual excess skin and tissue on their tummy that doesn’t respond to diet or exercise.  So what are their Cosmetic Surgery options?

Breast Augmentation Surgery:

Breast Augmentation surgery involves the insertion of breast implants into the breasts to increase and/or restore their size. Many women seek breast augmentation surgery to enhance their overall body shape, contours and proportions.  For women who have breast fed their children or lost weight, sometimes a breast lift will be combined with breast augmentation in order to address sagginess or droop of the breasts.

Usually women seeking breast augmentation seek to achieve larger breasts, but retain a natural appearance. Most women don’t want to look “implanted”. A natural look can be easily achieved with the right advice from your Cosmetic Surgeon as to what size, style, shape, projection and volume suits your shape and body type and will achieve the look you are seeking.

Abdominoplasty Surgery (Tummy tuck):

Many women who have had children are unhappy with the residual excess skin and tissue at the base of their tummy that is unresponsive to diet and exercise. (This is also common in both men and women who have achieved significant weight loss). Tummy tuck surgery involves the excision of the excess skin and tissue on the tummy, often with tightening of the underlying tummy muscles, to achieve a smooth and defined tummy. This should in no way be considered a means of weight loss; your Cosmetic Surgeon will advise you to be within your optimal weight range prior to surgery to achieve the best and most lasting result. Tummy tuck surgery is often combined with Liposuction or Liposculpture, where fat is removed through incisions will a metal tube and suction device, in order to achieve a smoother, contoured and natural appearance.

Performing Breast Augmentation and Abdominoplasty surgery (Tummy Tuck Sydney) at the same time is appropriate for some women. The priority of the Cosmetic Surgeon is your safety and minimising your surgical risks; this may mean that the surgeries should be performed on separate occasions if by performing them together your operating time is at a length of operating time that poses increased risk to your safety. This is obviously something that you should discuss in consultation with your Cosmetic Surgeon.

Cosmetic Surgery offers options to women who have reached a point in their life where they want to do something for themselves, take steps to restore and rejuvenate their body’s appearance and re-gain a sense of self confidence. For an appointment for Breast Implants and/or Tummy Tuck Sydney today, contact an accredited and experienced  Cosmetic Surgeon Dr. Bobby Kumar on 1300 676 003 or 0430 491 006.


Written by Dr. Bobby Arun Kumar on Wednesday the 27th of February, 2013. Currently No Comments »

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Tummy Tuck otherwise Known as an Abdominoplasty

Tummy Tuck is surgically known as Abdominoplasty surgery. The surgery is performed for Cosmetic and legitimate medical and surgical reasons. In Sydney and Adelaide patients can claim part of the procedure on Medicare and their private health insurance. Women following child birth and if they have had a caesarian section can be left with an overhanging lower abdomen. These patients decide to have Tummy Tuck surgery to address the hanging “Pannus” of redundant skin and soft tissues.This is the case for those patients that have succeeded in losing a significant amount of weight. Consequently these patients are left with a large redundant apron of skin and subcutaneous fat and tissues which in themselves are a problem; causing skin fungal infections, aesthetically undesirable lower torso and the patient is left with having to hide the redundant mound in clothing.

Tummy Tuck Surgery or Abdominoplasty at Bare Aesthetics Clinics

Who makes the best candidate for a Tummy Tuck?

Tummy Tuck or abdominoplasty surgery is becoming a popular form of Cosmetic Surgery for men and women. It is considered by patients for a variety of reasons. The most obvious reasons are that patients have a significant redundancy of skin and tissues of the upper and lower abdomen.

The cosmetic considerations are based on patients who may have had previous surgery and or delivered babies via caesarian section and they are left with a flap or “Pannus” of skin and tissues which typically overhang their clothing. These patients often find it unsightly and difficult to find the right clothing to hide the overhanging skin and tissues. They are also reluctant to go to the beach during summertime for fear of embarrassment when wearing a bathing suit. Read More »


Written by Wendy on Friday the 22nd of July, 2011. Currently No Comments »

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Adelaide Breast Augmentation, Enlargement or Breast Implant Cosmetic Surgeon

Breast Implant surgery is one of the most common Cosmetic Surgery procedures performed in Australia. Many women are choosing breast augmentation to enhance their breast shape and size, body proportions and contours. Some women have always felt uncomfortable with smaller or uneven breasts; other women seek to restore their breast size and shape after pregnancies and breast feeding or significant weight loss. Whatever your motivation, it is important to research the procedure and seek the opinion of a qualified and experienced Cosmetic Surgeon.

Dr. Bobby Kumar produces natural,beautiful and aesthetics Breast Enlargement results

High Profile Breast Implants

Dr. Bobby Kumar, Cosmetic Surgeon, has been performing Breast Enlargement surgery in Sydney for many years and is now offering his considerable skills and experience to patients in Adelaide. Dr. Bobby Kumar performs patient consultations and breast enlargement surgery in Adelaide on a regular basis. He is experienced in a range of Cosmetic Surgery Procedures, including breast augmentation or breast implants cosmetic surgery; tummy tucks or abdominoplasty, face lifts, breast reduction and breast lift surgery.

Breast augmentation involves the use of implants to enhance breast size and shape. There are two main types of breast implants, saline or silicone. Silicone implants have become more popular due to their natural feel. They consist of an outer silicone shell containing silicone gel. The silicone gel stays intact in the rare event that an implant ruptures or breaks. Saline implants also have an outer silicone shell, but are filled with saline, a fluid based on water and salt similar to that naturally occurring in our bodies.

The Size Shape and Style of breast Implant selection is discussed in your Consultation with Dr. Bobby Kumar

Breast Implant Size

Recently in Adelaide there have been well publicised issues with a particular commonly used brand of breast implant that were manufactured in France. There were reported cases and an increased incidence of breast implants rupturing and leaking. Dr. Bobby Kumar has never used this particular type of implant due to his own concerns and research regarding their negative outcomes. The breast implants he chooses to use come from a manufacturer and supplier that is TGA approved and has the lowest incidence of complications.

Breast implants also vary in their size, shape and volume. The most suitable breast implant to achieve the results you desire will be discussed between you and Dr. Bobby Kumar based on your physical examination and measurements. A breast implant that is suitable for one woman may not be appropriate for another, depending on features such as existing breast tissue, shape or droop of the breast, size of the chest, and body proportions. These issues will all be discussed at length with you by Dr. Bobby Kumar so you are in the best position to make an informed decision about what is right for you.  Many women do not want to have an ‘implanted’ look and Dr. Bobby Kumar strives to achieve the most natural looking results.

The first step in the breast augmentation process is to have a consultation with Dr. Bobby Kumar in Adelaide to discuss your options and obtain all the information you require about breast surgery. If you want to proceed with surgery, there are a few things to bear in mind. Breast surgery is usually performed as a day procedure under either twilight sedation or general anaesthetic. Most women return to work within 1 – 2 weeks depending on their type of work. Heavy lifting is to be avoided after surgery, in order to allow the chest tissues to heal and the implants to settle into position. Usually women are back into their normal routine, including exercise, at about 6 weeks after surgery.

Women who have had breast augmentation typically report a high level of satisfaction with the results including the enhancement to their overall body shape and proportions and often experience a boost in their self confidence.

Bare Aesthetics and Breast Augmentation,Breast Enlargement in Sydney,Adelaide and Port Macquarie

Natural Breast Augmentation results by Dr Bobby Kumar

Cosmetic Surgeon Dr. Bobby Kumar is an experienced and trusted Breast Augmentation and Breast Enlargement surgeon offering natural and beautiful results for women seeking Breast Implant surgery in Adelaide. For more information visit www.bareaesthetics.com.au or contact for all appointments in Sydney, Port Macquarie and Adelaide today on (02) 9571 4850 or 0430 491 009.

Click on link below to find out more about a Breast Augmentation Consultation in Sydney, Port Macquarie or Adelaide at the Bare Aesthetics Cosmetic Surgery clinics with cosmetic surgeon Dr. Bobby Kumar.

Breast augmentation or Breast enlargement what to expect in your consultation with cosmetic surgeon Dr Bobby Kumar


Written by Dr. Bobby Arun Kumar on Wednesday the 13th of July, 2011. Currently No Comments »

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Women who choose to have breast implants for breast augmentation surgery do so for a number of reasons. They may be unhappy with the size of their breasts and with having a ‘flat’ chest with loss of volume. Or they are women who have had a baby and breastfed, and have found their breasts have lost shape and volume. The majority of women are either seeking to enhance or restore their breast volume and shape.

Breast enlargement surgery should be performed by a certified Cosmetic Surgeon. Initial consultations are critical for discussion with your Cosmetic Surgeon as to your expectations and what surgery can achieve. Consultations should include discussion of your medical history, what you are seeking to achieve, and the Cosmetic Surgeon’s recommendations for your options.

Usually you are able to ‘try’ some breast implants to get an idea of the size and shape achievable if you decide to proceed with a Breast Augmentation. To help this process it is helpful to wear a well fitting bra (the breast implants are placed inside your bra) and a fitted t-shirt. Read More »


Written by Dr. Bobby Arun Kumar on Tuesday the 2nd of February, 2010. Currently No Comments »

Read related subjects to this article from Bare Aesthetics on breast augmentation or breast augmentation adelaide or breast augmentation sydney or Breast Enlargement or Breast implant or Breast Implant Adelaide or Breast Implant Sydney or Breast Implants Sydney or breast lift or Breast Reduction or Cosmetic Plastic Surgeon or Cosmetic Plastic Surgery or Cosmetic Surgery.


Women who choose to have breast implants for breast enlargement surgery do so for a number of reasons. They may be unhappy with the size of their breasts and with having a ‘flat’ chest. Or they are women who have had a baby and breastfed, and have found their breasts have lost shape and volume. The majority of women are either seeking to enhance or restore their breast volume and shape.

Breast augmentation surgery should be performed by a certified Cosmetic Surgeon. Initial consultations are critical for discussion with your Cosmetic Surgeon as to your expectations and what surgery can achieve. Consultations should include discussion of your medical history, what you are seeking to achieve, and the Cosmetic Surgeon’s recommendations for your options. Read More »


Written by Dr. Bobby Arun Kumar on Thursday the 28th of January, 2010. Currently No Comments »

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