Questions and Answers About the Use of Breast Implants
Author: Kenneth S. McCarty, MD, PhD. Affiliations: Director of Endocrine Oncology, Comprehensive Breast Care Center
Pittsburgh Cancer Institute, Professor of Internal Medicine and
Pathology, University of Pittsburgh School of Medicine, Pittsburgh,
USA. Published in: Innovations in Oncology Nursing Vol 10, No 1, 1994
Reprinted with permission from publisher
Since breast implants first came on the market 30 years ago,
approximately one million women in the United States have had these
devices surgically inserted for reconstruction following mastectomy
or breast odification to enlarge or reshape their breasts. Most are
filled with a silicone gel; however, about l0% contain saline (salt
water). Until recently, both gel-filled and saline implants were
available to virtually any woman who wanted them. The use of silicone
gel-filled implants is controversial, and various opinions exist
about who should be permitted to receive breast implants, what type
should be used, and what purpose they should serve.
Q. What advice do you give to breast cancer patients regarding silicone gel-filled breast implants? What factors influence your advice to these women (age, disease state, etc.)?
A. I advise patients who desire reconstruction following
mastectomy that there are a number of options for reconstruction. In
most cases either saline or silicone gel-filled implants involves
less demanding surgical procedures than do flap procedures (removal
of skin from another area of the body to replace breast tissue) and
gives equal appearances. In terms of the safety of silicone implants,
there are no credible studies which show that the implants cause
disease or adversely affect patients. Unfortunately, there is
insufficient information to exclude the possibility that some
patients will have adverse reactions. In the majority of patients who
have had adverse reactions and whose courses I have reviewed,
alternate and often treatable conditions could be identified that
probably led to the symptoms, and these need to be carefully looked
for in patients with complaints that are being attributed to
implants. One of the most frequent conditions is
menopausal symptoms or incomplete hormone replacement.The stage of
the breast cancer and the patient's age are not factors in
choosing the approach to breast reconstruction, except insofar as
this might influence surgical risk. Otherwise it is the
woman's choice.
Q. How has the usage of silicone gel-filled and saline implants changed since the beginning of the Food and Drug Administration (FDA) investigation?
A. The usage of silicone gel-filled implants has changed
dramatically since Dr. Kessler (FDA Commissioner) first criticized
the use of these implants. The most dramatic change is the general
panic, even among patients who were not and are not experiencing
problems with their implants. This mental anguish about potential
problems, which may be reported by patients but not observed by
examiners, has altered the decision-making process regarding the
selection of any form of reconstruction.
Q. What are the latest findings and reports regarding the inability to perform an accurate mammogram due to the placement of silicone gel-filled breast implants?
A. Mammography can be adequately performed with implants in
place. It does involve specific maneuvers and must be done cautiously
so as not to rupture the capsule (fibrous tissue surrounding the
implant) when the breast is compressed.
Q. What are your recommendations for follow-up and future cancer screenings after a woman has an implant placed?
A. The recommendations for follow-up are the same after
implants are placed as they are in patients who have not been
reconstructed or whose reconstruction was achieved using a flap
procedure. These recommendations include physical examinations and
laboratory evaluations while additional cancer therapy, necessary to
treat any remaining cancer cells, is in progress (usually up to the
first 6 months after diagnosis), every 3 months thereafter for the
first year, every 6 months for the next 3 years, and then annually.
Q. What is being done to investigate the long-term effects of silicone implants such as immune-related disorders and cancer?
A. A number of studies are under way to assess the
long-term effects of silicone implants. The studies must distinguish
the type of implant and separate patients with urethane-coated
implants and those with silicone elastomer implants. Remarkably, the
frequency of breast cancer is lower in patients with silicone breast
implants than in the general population. The frequency of autoimmune
diseases (such as lupus erythematosus or scleroderma) appears to be
similar to that in nonimplanted controls, but adequate research has
not been performed in this area.
Q. What other complications related to implants can occur, and how often do you see omen with these complications?
A. The principal complications related to implants are
local effects such as infection at the site, distortion after rupture
of the implant, and scarring. The frequency of complications varies
widely and is dependent upon the technique used as well as the
individual's physical makeup.
Q. If you could share one message about silicone gelfilled implants with health care professionals and lay persons, what would that message be?
A. The silicone gel-filled implants serve a genuine
purpose, and the ratio of risks versus benefits still appears to be
excellent, compared with alternatives. The widespread publication of
anecdotal complications has caused more harm than any actual
complication I have seen or of which I am aware. This fact
notwithstanding, if someone wishes to have an implant removed, no
objections to having this done should be raised.
Disclaimer. Send comments to:
ditors@oncolink.upenn.edu
Dr Kenneth S. McCarty
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