Every year, some 300,000 women in the United States elect to have breast implants. Insurance providers who cover mastectomies are also required to cover reconstruction costs — but for women who undergo the procedure simply for cosmetic reasons, the implants cost about $3,700. That’s the average plastic surgeon’s bill — it doesn’t include anesthesia and facility fees.

But there may be an additional and unforeseen cost to these procedures. New research is showing an increase of cases of a new type of lymphoma — and it could be related to breast implants.

Scientists have encouraged all women with implants to receive regular screenings.

The Food and Drug Administration advises women that implants could increase the risk of contracting this cancer, which is called breast implant-associated anaplastic large cell lymphoma, or BIA-ALCL. FDA scientists have encouraged all women with implants to receive regular screenings, but they’ve stopped short of encouraging them to have the implants removed.

It’s tough to draw absolute conclusions about what causes the cancer and how to prevent it — especially with just 200 confirmed cases of it across the globe.

One study published in the Aesthetic Surgery Journal combined the input from doctors and researchers from all over the world. They concluded that BIA-ALCL was the result of chronic inflammation from bacteria on the surface of the implants. These bacteria overstimulated the production of T cells (an important cell in the immune system) — resulting in lymphoma.

Other reports are also alarming. One case study published in BMJ journals concluded that BIA-ALCL was resistant to traditional types of chemotherapy. In this case, a 43-year-old woman experienced discomfort and swelling eight years after her surgery. She had no familial risk for breast cancer. Her doctors began chemotherapy treatments, but her disease continued to progress in both the first and second stages of chemo. Finally, doctors resorted to a mastectomy and lymph node removal, followed by intense rounds of radiation. Only then did she move into remission.

Related: Largest Breast Cancer Study by NIH

Doctors cannot agree on which types of implants pose a greater risk than others. A panel of plastic surgery experts, who published their opinions in PRS Global Open, said that “any type of breast implant, regardless of cover, surface, fill, or manufacturer, can be associated with BIA-ALCL.”

[lz_bulleted_list title=”Anaplastic Large Cell Lymphoma” source=”http://www.fda.gov”]60 cases worldwide in 2011|5 to 10 million women with implants|Low but increased risk expected[/lz_bulleted_list]

But there is one type of implant that seems to set off the increased risk of cancer. “BIA-ALCL appears to be predominantly associated with textured implants,” said Dr. Mark Clemens, a plastic surgeon at MD Anderson Cancer Center in Houston. “To date, there has never been a case in a patient with only smooth implants.” He continued: “What aspect of texturing and why there is an association are being researched right now.”

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Experts agree larger implants and ruptured silicone implants increase the risk of BIA-ALCL. Implants are made to resist rupture — but that’s not guaranteed.

One patient received implants twice: first when she was 30 years old, then when she was 62 and had the original ones replaced. Her surgeon the second time around found that her previous implants had completely ruptured. “He told me he had to change his surgical gloves several times to get all the old implants out of my breasts,” the patient told LifeZette.

“I had mammograms and none had shown any problem or mass,” said a patient.

Once all the old gel was removed, the doctor discovered a mass of calcium behind the gel. This was especially startling, since the patient had been receiving regular mammograms. “It was unnerving to think I had had a mammogram and I’d been having them all along, and none had ever shown any problem or mass,” she said.

And since the mass had formed behind the implants, there was no way she could have detected it in a self-examination.

Amanda Nokes, a marketing and social media specialist in Ramsey, New Jersey, said she wouldn’t change her mind about getting implants — and that’s after having already gone through cancer and its associated treatments. She was diagnosed with stage three breast cancer in February 2015 and underwent nine months of treatments and surgery.

She opted for a double mastectomy, as it would reduce her chance of recurrence to 2 percent. Then she had reconstructive surgery. She considered all her options carefully with her plastic surgeon, and said she knew about the risk of lymphoma when she had the surgery.

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“There are all these ways I can get sick, and I can’t live my life in a bubble,” Nokes told LifeZette. “I need to do what’s right for my life. I really felt confident with my doctors, and I didn’t go online and read a lot of sob stories and reports. I didn’t want to put myself into a panicky tailspin.”

Her reconstructive surgery, she said, was an important way to feel like herself again. “Part of being a strong, feminine woman is having what you recognize as your own body. They don’t hurt. They look real. They make me feel complete.”

Would she recommend breast implants for other women? “Absolutely, 100 percent,” said Nokes.