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I have no experience with this, but saw the following article and
decided to type it in.
From the November edition of Sojourner, Viewpoints section, a
letter from Esther Rome, commenting on an interview with Dr. Love,
which was evidently printed in the October issue of Soj. (I don't
have the October issue.)
Are Breast Implants Really Safe? by Esther Rome
I am representing the Boston Women's Health Book Collective at a
U.S. Food and Drug Administration task force to write booklets for
distribution to women who are planning to have silicone breast
implants. Implants are used to make breast larger (augmentation)
or to create a breast-like shape after mastectomy (reconstruction).
(There are other methods of reconstruction that involve moving
various muscles to the chest area. Each has advantages and
disadvantages, but that discussion is beyond the scope of this
article.) Among other information, task force members have
received a rather hair-raising summary of the literature prepared
by the FDA scientific staff. As a result of my recent research I
believe that some of Susan Love's information, in the October issue
of Sojourner is misleading.
Although I certainly support Dr. Love's assertion that doctors
should not tell their clients what to do, it is equally important
to note that a woman cannot make an informed decision without
sufficient information. Her interview gives an incomplete story on
the safety of silicone implants.
First of all, it is difficult to assert that silicone implants are
safe. The studies, mostly sponsored by the manufacturers, are
often poorly done. One reliable source indicated to me that Dow
Corning does this deliberately so that if the study shows problems
with the silicone it can then be discounted. In spite of the
methodological criticisms of the studies, there are enough problems
cited with implants to require further studies.
It is difficult for researchers to study long-term consequences of
silicone implants because there is no registry of silicone implant
users. Plastic surgeons often do not encourage long-term
follow-up or make a point of trying to trace their previous
clients. In addition, insurance has only recently started to cover
the costs of reconstruction, and so there are not many women who
have had reconstruction for more than 10 years.
Dr. Love rejects the notion that silicone could cause cancer
because breast cancer incidence has not risen. (It has risen
somewhat recently, according to incidence reports in the past year.
But this is irrelevant in discussing a particular subgroup of women
since the incidence in one group could be rising while in another
it could be falling. Secondly, silicone implants (not injections)
have been around only a little more than twenty years, so a rise in
cancer incidence might only be beginning to show now.
(Incidentally, a figure of 20 million implants must be a typo. The
Plastic Surgeon's Professional Society estimates that 2 million
women since the early 1960s have had implants.) Thirdly, it is
possible that silicone would tend to stimulate cancers in other
parts of the body besides the breast. We simply do not know enough
to say one way or the other if silicone implants increase cancer in
humans.
There is strong suspicion that the polyurethane-coated implants do
promote cancer. To reduce capsular contracture -- the shrinking
and hardening of scar tissue that forms around a foreign body --
the polyurethane is designed to flake off the surface of the
implant in a number of months. One of the breakdown products, if
the polyurethane degrades, is a substance that was used in nail
polish and was banned because it is carcinogenic. Careful
follow-up of the cancer incidence of women with implants is needed.
Dr. Love discounts the cancer risk from silicone but does not
address any of the other possible problems that can occur. The
most common is capsular contracture. The FDA estimates that the
incidence is around 25 percent although various studies find the
incidence anywhere from 0 to 70 percent. This condition can become
painful and sometimes disfiguring, requiring further surgery.
Another reason for repeated surgery with implants is that they may
not end up in the right place once healing takes place. A recent
package implant from Dow Corning specifically warns against using
the product with women who are not willing to undergo further
surgery.
No one will vouch for the longevity of the rubberlike silicone
container that encloses the silicone gel. It can break, sometimes
spontaneously and sometimes after severe external compression. If
the implant breaks, the situation isn't really that much different
from that if the silicone had been injected. The loose silicone
creates such a health risk that, as Dr. Love notes, the FDA made
injecting it illegal. It is imperative that an operation be
performed to get the silicone out as soon as possible. It is
unlikely that all of the silicone can be removed.
If the container doesn't break, silicone gel still "bleeds" through
the wall of the implants. The wrapper cannot be impermeable to the
gel inside. No one knows how much comes through in actual use,
although seepage has been measured in the laboratory. The
manufacturers claim that the silicone that seeps through stays in
the breast, but no can document this assertion. Silicone has been
found in other parts of the body, sometimes years later.
Silicone travels to other parts of the body through the circulatory
and the lymphatic system and can cause lumps in other parts of the
body which cannot be distinguished from possible cancer except by
removing and examining them. This can cause unnecessary surgery
and distress for someone who already may be worried about
recurrences of cancer.
Silicone, previously thought to be inert, is not. It attracts fat
and hormones such as progesterone and estrogen. No one knows if
this has any significant biological effect.
There are a number of studies, all with methodological problems,
that indicate that silicone implants may trigger autoimmune
problems, such as certain kinds of arthritis, scleroderma, or
lupus. This is an area that needs further research, but women who
have a family history of these problems should be cautious.
Dr. Love asserts that implants don't affect the usefulness of
mammography. That is inaccurate, according to the American College
of Radiology. With the proper technique, a technician can get an
image of most of the breast, generally with twice as many
"pictures", and thus twice as much radiation. Even though this is
relatively little radiation, it is twice as much as would be
necessary without implants. Also, a small portion of the breast
still IS obscured by the implant.
There are many questions and few answers about silicone and
silicone implants. Even knowing this, many women will still choose
to use them. But it is unfair to women not to tell them that they
are taking part in an experiment.
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Esther Rome is co-author of The New Our Bodies, Ourselves.
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Here is a response from the basenote author...
-Jody
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Hi,
I thought I add a few more comments about exactly what this has been
like for me.
It's hard to explain the pain I've been having but it's pretty
excruciating. Not a day in the last 5 months has been painless. It
appears that it is only getting worse. I'm basically starting to
break. Chronic pain is doing a job on me in every
aspect....psychologically, mentally and physically.
I realize that this kind of surgery is radical. Especially, for my
age. My doctor, though he is male, has been interested in FBD for quite
some time. I feel very comfortable with him. I will be seeing a
plastic surgeon in about a week at UMASS Medical Hospital for a
consult. That will be my second opinion as far as I'm concerned.
I'm not left with a lot of choices. At least that's how I feel. My
doctor has given me every single treatment there is minus the surgery.
I know that because of the research I've done.
I'm going out on short term disability shortly. It's getting too hard
to come into work and keep my job performance up. I'll let you know
how things turned out when I get back. Hopefully, an end to this is in
the near future.
Thanks for listening.
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