Ce site n’est pas un site médical mais un site dédié aux échanges et informations entre malades des implants mammaires.
FDA Update Shows 457 Cases of ALCL Linked to Breast Implants
En mars 2017, la FDA a finalement émis un avertissement confirmant que les implants mammaires causent le cancer BIA-ALCL (LAGC en FRANCE) mais l’histoire des implants mammaires provoquant un cancer du lymphome associé aux implants mammaires remonte à bien plus loin. Le premier cas de lymphome dû à des implants mammaires a été rapporté en 1997, et depuis de nombreuses années, de nombreux cas de BIA-ALCL sont survenus et ont été rapportés, mais il semble y avoir eu un rejet de BIA-ALCL et d’autres cancers par les régulateurs. implants mammaires et associations de chirurgiens plasticiens et chirurgiens plasticiens. Malgré tous ces cas de BIA-ALCL et d’autres cancers survenus et étant signalés, les fabricants soumis à la FDA et la FDA ont approuvé plus d’implants texturés pour la vente aussi tard que le 23 septembre 2016 sachant que les implants texturés sont particulièrement liés et responsables de BIA-ALCL. En fait, le taux d’incidence de BIA-ALCL pour les implants texturés Allergan (anciens et nouveaux) est d’environ 1 sur 4 000 provenant d’études américaines et australiennes, mais d’autres types d’implants causent également BIA-ALCL. Les femmes ont du mal à faire reconnaître par le chirurgien plasticien l’importance de BIA-ALCL et la nécessité de le tester. Si vous avez texturé des implants et des symptômes de BIA-ALCL, vous devez pousser pour les tests au moment de votre expiant.
LE LYMPHOME ASSOCIÉ AUX IMPLANTS DU SEIN BIA-ALCL est un type de lymphome non hodgkinien, un cancer des cellules du système immunitaire (et non du sein) qui peut être causé par les implants mammaires. Les principaux symptômes de BIA-ALCL sont un gonflement persistant ou une douleur au voisinage de l’implant mammaire, un sérome, une masse mammaire, une contracture capsulaire, des ganglions lymphatiques enflés et sont généralement associés à des implants texturés mais pas toujours. Ces symptômes peuvent apparaître après la cicatrisation de l’incision chirurgicale de l’implant et peuvent souvent apparaître plusieurs années après la pose de l’implant. Si vous avez un gonflement, une douleur, un sérome, une masse mammaire, une contracture capsulaire ou des ganglions lymphatiques enflés et surtout si vous avez des implants texturés, veuillez pousser fort pour les tests BIA-ALCL. Les chirurgiens doivent envisager la possibilité d’une ALCL lorsqu’ils ont un patient présentant un début tardif et un liquide persistant autour de l’implant (sérome péri-implantaire) avant et / ou pendant l’explant ou présentent les symptômes après l’explant. Lors de l’analyse de l’ALCL au moment de l’explant, les chirurgiens doivent recueillir du sérum liquide frais et des portions représentatives de la capsule et envoyer des tests de pathologie. Le test s’appelle l’immunochimie CD-30 et CD-20 et peu de chirurgiens plasticiens connaissent bien le BIA-ALCL à ce stade, ce sera à vous d’éduquer votre chirurgien plasticien et de persister à obtenir le test si vous avez des symptômes et / ou des implants textures.
Lymphome anaplasique à grandes cellules associé aux implants mammaires : une origine infectieuse ?
31 JAN 2017
Question évaluée : Le nombre de cas rapportés de lymphomes anaplasiques à grandes cellules chez les femmes porteuses d’implants mammaires (LAGC-AIM) a augmenté ces dernières années. Le lien entre implants mammaires et survenue du LAGC-AIM est aujourd’hui clairement établi. La présente étude a pour but la recherche d’un biofilm à la surface des implants mammaires incriminés. Les espèces bactériennes le constituant sont ensuite caractérisées afin de les comparer avec la flore retrouvée sur les implants mammaires incriminés dans les cas de contractures capsulaires (CC).
Nature des bactéries :
Prédominance de Ralstonia spp. sur les implants associés aux LAGC (p<0,05) Prédominance de Staphylococcus spp. sur les implants associés aux CC (p<0,001) MEB : visualisation d’un biofilm et de cellules lymphomateuses sur les implants associés aux LAGC et d’un biofilm sur les implants associés aux CC. Points forts : Cette étude est la première à rechercher un biofilm sur les implants mammaires associés aux LAGC et à caractériser les espèces bactériennes le constituant. Pour la première fois, l’hypothèse d’une étiologie infectieuse est avancée pour expliquer la survenue de cette forme rare de lymphome. Points faibles : Ralstonia spp. non retrouvée en surface de la moitié des implants associés au LAGC (9/19). Ce point n’est pas discuté par les auteurs. Biofilm étudié sur un nombre réduit d’implants associés aux CC (12/62) sans justification des auteurs, avec dans certains cas la présence de Ralstonia spp. Les périodes et lieux de recueil des prothèses ne sont pas détaillés de même que la flore locale, notamment Ralstonia spp., des lieux d’interventions. Le prétraitement des échantillons biologiques collectés (matériel tumoral non frais ; recherche du biofilm appliquée à une portion limitée de tissu). Conclusion: Cette étude démontre la présence quasi systématique de colonisation bactérienne sur les prothèses mammaires. Ce biofilm a un rôle avéré dans la survenue de contractures capsulaires ou de lymphomes anaplasiques à grandes cellules. Bien quel ne soit ni nécessaire ni suffisante, la mise en évidence de Ralstonia spp. implique, selon les auteurs, le besoin de développer et diffuser une stratégie de prévention concernant la colonisation bactérienne de tels implants. Plus globalement, la raison expliquant le développement du biofilm et le type de bactérie impliqué doit être explorée. Rédigé par Jean-Baptiste Pain & Lionel Tortolano D’après Hu et al.: Bacterial Biofilm Infection Detected in Breast Implant-Associated Anaplastic Large-Cell Lymphoma. Plast Reconstr Surg, 2016 Jun;137(6):1659-69
Position de l’ANSM sur le LAGC .
En mars 2015, le groupe d’experts réunis par l’Institut National du Cancer (Inca) a conclu qu’il existe un lien clairement établi entre la survenue de lymphome anaplasique à grandes cellules et le port d’un implant mammaire.
L’ANSM a alors créé un comité scientifique spécialisé temporaire composé d’experts en hématologie, chirurgie plastique, immunologie, biocompatibilité, toxicologie et tribologie afin de comprendre les causes d’apparition de cette pathologie. Les investigations engagées ont abouti à la mise en œuvre d’études visant notamment à comprendre les mécanismes immunologiques intervenant lors du contact de la surface de l’implant mammaire avec les tissus. Ces études sont actuellement en cours sur les différents types de surface des implants.
En parallèle, une revue approfondie des données de matériovigilance a été réalisée, tant sur la base des cas de LAGC-AIM déclarés en France, que sur la base des données recueillies lors des inspections des fabricants ou transmises directement par ces fabricants.
Cette revue confirme le risque d’apparition d’un LAGC-AIM associé à un ou plusieurs implants de marques parfois différentes.
Cette pathologie reste rare comparée au nombre d’implants mammaires posés chaque année. L’augmentation des LAGC est régulière en France.
Sur les 56 cas diagnostiqués à ce jour en France[1] les implants mammaires texturés de marque Allergan sont actuellement surreprésentés. Cette surreprésentation numérique est également constatée dans les cas de LAGC-AIM rapportés dans le monde.
L’ANSM poursuit ses investigations et continue d’exercer une analyse approfondie de chaque nouveau cas déclaré de LAGC-AIM pour toutes les marques d’implants mammaires.
L’Inca a d’autre part été saisi très récemment par le Ministère des affaires sociales et de la Santé sur ce sujet pour actualiser l’avis rendu par son groupe d’experts en mars 2015. L’information sur le LAGC-AIM sera complétée à partir des conclusions de cette saisine.
Suivi des patientes porteuses d’un implant mammaire
Pour les femmes porteuses d’un implant mammaire et sans signe clinique au niveau des seins, le groupe d’experts de l’Inca préconise, dans son avis du 4 mars 2015 , un suivi identique à celui qui existe actuellement pour toutes les femmes et ne recommande pas de proposer une explantation préventive vis-à-vis du risque de LAGC-AIM aux femmes porteuses d’un implant mammaire quel qu’il soit.
Signes cliniques qui doivent inciter à consulter
En cas d’épanchement abondant, d’augmentation de volume, de douleur, d’inflammation, de masse, d’ulcération (lésion de la peau) au niveau du sein, il faut consulter un médecin. Toute autre anomalie évoquant une complication liée à l’implant nécessite une consultation.
Il est recommandé de pratiquer une échographie. Si cet examen n’est pas suffisant, une IRM est préconisée en deuxième intention.
Quoi qu’il en soit, à titre préventif, il est important que la personne implantée soit suivie régulièrement par un médecin.
Information avant implantation
L’ANSM rappelle aux professionnels leur obligation d’apporter une information complète aux femmes concernées. Le choix de la pose d’un implant mammaire, que ce soit dans un contexte esthétique ou dans le cadre d’une reconstruction mammaire, doit pouvoir être évalué et décidé en connaissant les risques associés.
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