Public Perceptions on Breast Implant–associated Anaplastic Large Cell Lymphoma

Abstract

BACKGROUND: Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) has entered the spotlight as high-profile media outlets, and the Food and Drug Administration has begun to relay the evolving science to the public. This study aimed to gauge the baseline knowledge and concern regarding BIA-ALCL among adult laywomen within the United States. Additionally, we sought to understand the influence of variables including previous exposure to breast implants for both cosmetic and reconstructive purposes and the source of information on these outcomes. METHODS: Amazon.com’s Mechanical Turk and Qualtrics were used to survey 500 American women about the risk of BIA-ALCL. Respondents self-reported demographics and any prior experience with breast implants. Eleven questions were asked regarding respondents’ concerns of BIA-ALCL and the source of their knowledge. Responses were reviewed for quality control before participants were paid for involvement. Responses were analyzed using descriptive statistics and chi-square tests. RESULTS: The average age in our cohort (n = 500) was 37.8 ± 11.7 years. The majority of respondents were white (71.4%) and had completed at least a 2-year college degree (69.4%). Of respondents, 12% had previously received breast implants, 73% knew at least one person with breast implants, and nearly 50% would consider receiving a breast implant. After providing information about the risk of BIA-ALCL, respondents showed a clear preference to smooth implants and 58.4% were still willing to receive a reconstructive implant and 45.8% a cosmetic implant. One-third reported that they would be less likely to receive implants. Most respondents with implants or those who knew someone with implants were still willing to receive an implant (P ≤ 0.001). Of respondents with breast implants, 66.7% reported some degree of concern regarding BIA-ALCL and 35.0% are strongly considering removing their implants. When presented with information on autologous reconstruction, 17.0% of all respondents preferred implants and 42.4% would consider both options. Fourteen percent had previously heard about BIA-ALCL, the majority from multiple sources—predominantly health professionals or media/healthcare blogs. The source of a respondent’s information regarding BIA-ALCL was not associated with their degree of concern or desire to remove the implant. Respondents who had previously heard of BIA-ALCL or who had implants were more likely to understand the association between implants and BIA-ALCL (P < 0.001). Of respondents, 89.8% believe that plastic surgeons should discuss BIA-ALCL with all patients considering prosthetic implants. CONCLUSIONS: Patients undergoing breast reconstruction using implants for both cosmetic and reconstructive purposes receive their information primarily from healthcare professionals or media/healthcare blogs; however, only a minority have heard of BIA-ALCL and understand the strength of the association between BIA-ALCL and implants. When provided with the most up-to-date information, patients understand the rarity of the complication and the majority are unchanged in their decision to receive breast implants. As plastic surgeons, we can promote awareness among prospective patients and reassure the anxieties of those who have previously received breast implants. Our findings suggest that professional healthcare blogs and media outlets may be the most effective way to spread knowledge to those who are not in direct contact with healthcare professionals.