Allergan Breast Implants

Background

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It has been reported that there are approximately 300,000 breast augmentation and 150,000 breast reconstruction procedures performed annually in the United States.  Of these, approximately 5% involved textured breast implants. 

 

FDA reported 33 deaths worldwide

 

Deaths in U.S. were 36%

Allergan accounted for 36% of deaths

Unknown MFGs accounted for 61% of deaths

Allergan accounted for 92.3% (12/13) of deaths from known MFGs

 

FDA reported 320 cases of BIA-ALCL in U.S. through 7/6/19

 

Allergan (et al) accounted for 90.6% (481/531) of implants from known MFGs

Projected Allergan from unknown MFGs (90.6% of 42) = 38

Projected Allergan from 573 incidence = 519 (481+38)

Allergan (et al) – projected – accounts for 90.6% (519/531) of implants

 

Based upon projected Allergan implants and number of cases of BIA-ALCL in U.S. (320 cases), Allergan is projected to account for 290 cases of BIA-ALCL in U.S.

 

Macro-Textured implants like BIOCELL (Allergan) represent less than 5% of breast implants sold in U.S.

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Textured implants account for only 10% of all breast implants sold in U.S.  Textured implants in France, Canada and France represent as much as 80% of their market share of total breast implants

 

Reported increased risk of acquiring ALCL is 6x greater with Allergan textured implants than with textured implants made by other MFGs

 

Study shows increased risk of acquiring ALCL is 14.11x greater with Biocell (Allergan) textured implants compared with Siltex textured implants.  Same study shows Silimed textured implants showed an increased risk of 10.84x greater than Siltex textured implants.

 

The lifetime risk of developing BIA-ALCL, from epidemiological studies and implant sales data from the U.S., Canada, Netherlands and Australia, ranges from 1:1,000 to 1:30,000 with textured implants.  The current lifetime risk of BIA-ALCL is estimated to be 1:2,207 - 1:86,029 for women with textured implants based upon current confirmed cases and textured implant sales data over the past two decades.

 

In January 2018, a Dutch study estimated the risk of ALCL in women with breast implants to be: 

• 1 in 35,000 for women at age 50

• 1 in 12,000 at age 70

• 1 in 7,000 at age 75

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In the United States, approximately 300,000 breast augmentations and 150,000 breast reconstructions are performed annually.

 

Number of breast implants in the U.S. each year (American Society of Plastic Surgeons)

 

2011      307,000

2012      286,000

2013      290,000

2014      286,000

2015      279,000

2016      290,000

2017      300,000

2018      290,000*

 

Total      2,328,000

 

Incidence of BIA-ALCL (FDA)         1 in 3,817 to 1 in 30,000**

 

*Average since 2011

**Based upon medical device reports (MDRs)

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If we assume that there are 300,000 breast augmentations and 150,000 breast reconstructions performed per year in the U.S. (450,000)

 

450,000 x 8 (2011-2018) = 3,600,000***

180,000 (5% of 3.6 million) involve textured breast implants

Assuming 100% of textured breast implants are Allergan, and the risk is 6x greater with Allergan, the incidence range would be 1 in 636 to 1 in 5,000****

Projected number of BIA-ALCL among Allergan textured implant recipients is 36 to 283 from 2011-2018 in the U.S.

 

If one assumes that MDAs are underreported (10%), projected number of BIA-ALCL among Allergan textured implant recipients is 360 to 2,830 from 2011-2018 in the U.S.

 

However, one must also consider that the lag time between current implant insertion to diagnosis of BIA-ALCL has been from 0.8-27 years, with a mean of 9.75 years, which would likely mean that the number of actual diagnosed cases is much lower.

 

***There are likely duplicates within this number – women with multiple surgeries

****There is a recent study in May 2019 that reported incident rate of 1/434 women with textured breast implants…slightly higher rate.

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These are the following Allergan (or Allergan related) products and styles that are associated with the increased risk of BIA-ALCL and have been recalled:

 

Allergan Natrelle Saline-Filled Breast Implants (formerly McGhan RTV Saline-Filled Mammary Implant) approved under P990074.

 

The following are the textured styles associated with P990074:

 

  Style 163 – BIOCELL Textured Shaped Full Height, Full Projection Saline

  Breast Implants

  Style 168 – BIOCELL Textured Round Moderate Profile Saline Breast

  Implants, also referred to as 168MP (168 Moderate Profile)

  Style 363 – BIOCELL Textured Shaped Moderate Height, Full Projection

  Saline Breast Implants, Allergan catalog includes 363LF, or 363 Low

  Height Full Projection

  Style 468 – BIOCELL Textured Shaped Full Height Moderate Projection

  Saline Breast Implants

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Allergan Natrelle Silicone-Filled Textured Breast Implants (formerly Inamed Silicone-Filled Breast Implants) approved under P020056.

 

The following are the textured styles associated with P020056:

 

  Style 110 – BIOCELL Textured Round Moderate Projection Gel Filled

  Breast Implants

  Style 115 – BIOCELL Textured Round Midrange Projection Gel Filled

  Breast Implants

  Style 120 - BIOCELL Textured Round High Projection Gel Filled Breast

  Implants

  Style TRL - Natrelle Inspira BIOCELL Textured Responsive Silicone-Filled

  Breast Implants

  Style TRLP - Natrelle Inspira BIOCELL Textured Responsive Silicone-Filled

  Breast Implants

  Style TRM - Natrelle Inspira BIOCELL Textured Responsive Silicone-Filled

  Breast Implants

  Style TRF - Natrelle Inspira BIOCELL Textured Responsive Silicone-Filled

  Breast Implants

  Style TRX - Natrelle Inspira BIOCELL Textured Responsive Silicone-Filled

  Breast Implants

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Style TCL – Natrelle Inspira BIOCELL Textured Cohesive Silicone-Filled

  Breast Implants

  Style TCLP – Natrelle Inspira BIOCELL Textured Cohesive Silicone-Filled

  Breast Implants

  Style TCM – Natrelle Inspira BIOCELL Textured Cohesive Silicone-Filled

  Breast Implants

  Style TCF – Natrelle Inspira BIOCELL Textured Cohesive Silicone-Filled

  Breast Implants

  Style TCX – Natrelle Inspira BIOCELL Textured Cohesive Silicone-Filled

  Breast Implants

  Style TSL – Natrelle BIOCELL Textured Soft Touch Silicone-Filled Breast

  Implants

  Style TSLP – Natrelle BIOCELL Textured Soft Touch Silicone-Filled Breast

  Implants

  Style TSM – Natrelle BIOCELL Textured Soft Touch Silicone-Filled Breast

  Implants

  Style TSF – Natrelle BIOCELL Textured Soft Touch Silicone-Filled Breast

  Implant

  Style TSX – Natrelle BIOCELL Textured Soft Touch Silicone-Filled Breast

  Implants

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Natrelle 410 Highly Cohesive Anatomically Shaped Silicone Filled Breast Implants approved under P040046.

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The following are the textured styles associated with P040046:

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  Style 410FM

  Style 410FF

  Style 410MM

  Style 410 MF

  Style 410 FL

  Style 410 ML

  Style 410 LL

  Style 410 LM

  Style 410 LF

  Style 410 FX

  Style 410 MX

  Style 410 LX

 

Treatment / Use

 

Textured implants are used because they develop scar tissue to stick to the implant, making them less likely to move around inside of the breast.

 

Implants are used for augmentation as well as reconstruction following breast cancer treatment.

 

Allergan, which includes McGhan and Inamed branded implants, has been manufacturing breast implants since at least 2000 when their Natrelle brand was given pre-market approval by the FDA.  Since then, they have received approval (PMA) for multiple brands of silicone and saline breast implants, including textured and smooth products.  In addition, used for reconstruction, Allergan received 510(k) approval for tissue expanders.

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Injuries / Complications / Concerns

 

On July 24, 2019, the FDA made a request to Allergan, the manufacturer of a specific type of textured implant, to recall specific models of its textured breast implants from the U.S. market due to the risk of BIA-ALCL.

 

 

BIA-ALCL is not breast cancer - it is a type of non-Hodgkin's lymphoma (cancer of the immune system). In most cases, BIA-ALCL is found in the scar tissue and fluid near the implant, but in some cases, it can spread throughout the body. At this time, the overall incidence of developing BIA-ALCL is considered to be low; however, a BIA-ALCL diagnosis is serious and can lead to death, especially if not diagnosed early or promptly treated. In most patients, BIA-ALCL is treated successfully with surgery to remove the implant and the scar tissue surrounding the implant; however, some patients may require treatment with chemotherapy and/or radiation therapy.

 

 

The FDA requested that Allergan recall all BIOCELL textured breast implants and tissue expanders marketed in the U.S. based on newly submitted Medical Device Reports (MDRs) reporting worldwide cases of BIA-ALCL and BIA-ALCL-related deaths associated with these devices. Allergan has notified the FDA that it will recall its BIOCELL textured breast implants and tissue expanders from the global market.

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These products have the same BIOCELL textured surface (shell), which is a unique surface used only by Allergan. A list of Allergan's BIOCELL textured devices marketed in the U.S. that will be voluntarily recalled can be found at the end of this communication.

 

 

The FDA's analysis was attributed to a new worldwide reported total of 573 unique BIA-ALCL cases including 33 patient deaths. Of the 573 cases of BIA-ALCL, 481 are reported to have Allergan breast implants at the time of diagnosis. In addition, 12 of 13 deaths occurring in patients with BIA-ALCL where the manufacturer was known occurred in patients implanted with an Allergan breast implant at the time of their BIA-ALCL diagnosis. The manufacturer and/or texture is unknown for the remaining 20 reported deaths from BIA-ALCL.

 

 

Based on the currently available information, including the newly submitted data, our analysis demonstrates that the risk of BIA-ALCL with Allergan BIOCELL textured implants is approximately 6 times the risk of BIA-ALCL with textured implants from other manufacturers marketing in the U.S. and continued distribution of Allergan's BIOCELL textured breast implants would likely cause serious, adverse health consequences and potentially death from BIA-ALCL.