În ultimul deceniu, lumea jocurilor de noroc s-a schimbat radical în România, în special cu apariția noi cazinourilor online. Această tendință, alimentată de progresul tehnologic și de comoditatea jucătorilor, a transformat complet modul în care românii se bucură de jocurile lor preferate.
Una dintre caracteristicile marcante ale cele mai cazinouri noi 2023 este folosirea tehnologiilor de ultimă oră. Acestea oferă jucătorilor o experiență fluidă și captivantă, cu grafică impresionantă și sunete imersive. De asemenea, varietatea jocurilor disponibile a crescut semnificativ. De la sloturi tradiționale la jocuri de masă și până la cazinouri live cu dealeri reali, opțiunile par nesfârșite. Însă, nu doar diversitatea jocurilor face apel la jucători. Noile cazinouri online aduc o serie de beneficii incontestabile. Jucătorii pot accesa platformele oricând și de oriunde, având nevoie doar de o conexiune la internet. În plus, promoțiile și bonusurile oferite sunt deseori mult mai generoase decât cele din cazinourile tradiționale, oferind oportunități suplimentare de câștig.
In preparation for augmentation or reconstruction with implants, it is important to understand the implant options available. Implants vary in their shell, fill material, and shape. Each implant has pros and cons. Although there is not a “perfect” implant, it is our goal to find the implant that most satisfies your preferences. This resource reviews the different implant options so that you can make an informed decision regarding the implant that is right for you.
NSPS is dedicated to making sure our patients feel informed about their options in regards to implants and how they may contribute to their health. We continue to follow updates on Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). For additional information, follow the links below.
BIA-ALCL is a rare type of non-Hodgkin’s lymphoma, which has found to be associated with textured implants. Although this cancer is affiliated with specific breast implants, it is cancer that affects the immune system, and is not, in fact, a type of breast cancer. Cancer has been found in the fluid surrounding the implant, or in the scar tissue that encapsulates the textured implant, but has not been found in the breast tissue itself. This cancer, if found early is highly treatable and curable.
According to the American Society of Plastic Surgeons, BIA-ALCL has an estimated lifetime risk of between 1 in 2,207 to 1 in 86,029 in women with textured devices implanted. In the cases that have been identified, the implants have been in place between 8-10 years.
The most common presenting symptom in patients with diagnosed BIA-ALCL is an enlargement of the breast, which is most likely indicative of a fluid collection around the textured implant. Other symptoms may include hardening of the breast with associated pain, asymmetry between the breasts, or a lump that is increasing in size.
If a patient develops suspicious symptoms, such as unexplained breast enlargement or a growing lump, further evaluation is warranted. This includes imaging, such as an ultrasound or MRI. If there is fluid around the implant or a noted mass found upon imaging, a needle biopsy or fluid aspiration will be obtained. CD30IHC is the specific marker tested for BIA-ALCL and is necessary for making a confirmed diagnosis.
Textured implants, both silicone, and saline have been found to have the highest association with the development of BIA-ALCL. There have been no associations with increased risk of BIA-ALCL based on the fill of the implant but is more directly related to the textured shell.
Textured implants were originally appealing to patients because the shape of the implant provided a more natural appearance of the breast as opposed to the more idealized appearance of a round implant. However, due to the association between textured implants and BIA-ALCL, smooth round implants are the preferred implant of choice for both augmentation and reconstruction.
The smooth round implant has been studied for decades and has not been found to have an association with the development of any medical conditions. For this reason, both saline and silicone smooth round implants are the safest implants to use.
While there is not sufficient evidence that directly links textured tissue expanders to an increased risk of the development of BIA-ALCL, the FDA has recommended the discontinuation of textured tissue expanders. Because tissue expanders are not permanent devices, it is unclear whether or not the temporary exposure to the textured device can increase the risk of developing BIA-ALCL.
According to the research and data that has been collected, there is no evidence that links a specific implant fill to an increased risk of developing BIA-ALCL. The cancer is linked to the textured shell of the implant.
After a confirmed diagnosis of BIA-ALCL, additional imaging is recommended to determine if the disease is localized or has spread to other parts of the body. This is most commonly done utilizing a PET or CT scan. The imaging will help guide treatment, which can include surgery to remove the breast implant and scar tissue surrounding the implant, or a lymph node biopsy if there is suspicion of spreading disease. Patients are typically followed with imaging for two years following the removal of the implant and any cancer. Further treatment with chemotherapy and radiation may be warranted depending on the extent of the disease.
With the recent news of ALCL (Anaplastic Large Cell Lymphoma) and BII (Breast Implant Illness), we have been encountering many patients that desire implant removal. If this is something you are interested in leaning more about, we are here to help. Some patients will ask specifically about the “en bloc” procedure. This en bloc procedure means taking the implant and capsule out as one unit, without entering the capsule. The term “en bloc” is a term used in cancer excisions when there is concern that any cut that touches the tumor will lead to increased risk of tumor recurrence. We feel that this term is not appropriate for removal of breast implants and capsules as there is no evidence that ALCL or BII are impacted by cutting across the capsule and it can lead to unnecessary increase in fear over the risks associated with this surgery.
There are many differing opinions around issues such as this, but what is important to know is that we can and do perform a lot of implant and capsule removals. We are happy to discuss our approach in more detail, but we do prefer to remove the implant, and then the capsule, as it creates less trauma to the tissue and is a safer procedure in that regard. Some patients will be hesitant about this approach, and we understand! We don’t believe that entering the capsule to remove an implant causes any additional possible risk of cancer cell transmission, and again, our goal is to perform the safest surgery for you. We will, indeed, remove the entire implant and capsule and send it to pathology for confirmation of any disease process. If you have more specific questions related to your implants, please feel free to call us at (312) 266-6240.