Dr. Zuckerman ... Ask The Experts on Breast Implants Post Mastectomy

http://canoe.talksurgery.com/consume...les/z0001.html

Dear Ms. Zuckerman, I have been recently diagnosed with breast cancer
and it seems that a mastectomy may be a solution. I am worried about
losing my femininity and wonder if you can give me some advice on what
you think of breast implants post-mastectomy.

~~~~~

The decision of whether to get breast implants is an especially
difficult one for mastectomy patients. There are risks and benefits,
and if you know what they are, you can make a reasonable decision that
makes sense for you.

If you have not yet had a mastectomy, it's important for you to know
that for about 80% of the women newly diagnosed with breast cancer in
the U.S., a lumpectomy with radiation is just as safe as a mastectomy.
Unfortunately, many women who have mastectomies are not fully informed
about lumpectomy as an option. This is especially true for women in
the South and West, as well as women with older doctors or who are
treated at community hospitals rather than university-based hospitals.
If you've already had a mastectomy, then you have several choices in
addition to breast implants:

No reconstruction, and see how you feel.


Reconstruction with your own tissue, in conjunction with a "tummy
tuck" or other procedure, where tissue is moved, while still attached
and "alive" from one part of your body to another. These are called
"autologous tissue transfer" operations, and are thought to last a
lifetime. There are several different kinds. This kind of surgery is
more time-consuming, expensive, and has more risks in the short-term
because it is more complicated than implant surgery. The safety of
this kind of surgery is especially dependent on the skill of the
surgeon, but there is some evidence that there may be more problems
with fat necrosis (the transferred fat tissue dying) for women who
smoke. Many women are very happy with the results, because it is
"really their own body" but there are no studies of large numbers of
women to determine how safe these surgeries are for most women.
There are two kinds of implants:

silicone gel breast implants


saline-filled silicone breast implants
Silicone gel breast implants have never been "approved" by the FDA as
safe or effective, and there are few published studies regarding their
use by mastectomy patients. One of the reasons why gel implants are
considered riskier than saline, is that when they break, the silicone
gel can migrate to other parts of one's body, including the arm or
even to vital organs. Silicone gel implants are available to
mastectomy patients who are willing to participate in research
designed to evaluate their safety. Given your concern about safety,
silicone gel seems the most risky of your options.
Unfortunately, very little is known about the long-term safety of
saline breast implants. All breast implants have a silicone "envelope"
but saline implants are filled with salt water, whereas silicone gel
implants are filled with silicone gel. Saline breast implants were
recently approved by the FDA, but with many caveats suggesting that
the long-term safety and effectiveness is in doubt. For example,
approximately three out of four mastectomy patients reported at least
one complication during the first three years of having a saline
breast implant. These complications included infection, pain,
hardness, and the need for additional surgery.

All surgery for breast implants, whether silicone gel or saline, has
risks. These include the risk of infection, hematoma (blood or tissue
fluid collecting around an implant), the risk that one or both of the
implants will have to be removed (requiring additional surgery), and
the potential costs of repeated surgeries if the implants are
replaced. Mastectomy patients seem to have more problems than
augmentation patients.

All breast implants will eventually break, but it is not known how
many years the saline breast implants that are currently on the market
will last. Studies of silicone breast implants suggest that more than
half break within 6-10 years, and more than 80% break within 15 years.
Some break during the first few months or years, and some last more
than 15 years. It is expected that saline implants will last a similar
number of years.

There are other well-documented "local complications" that can result
from breast implants. For example, all implants are "foreign bodies"
and the woman's body reacts by forming a capsule of scar tissue around
the implants that can become too tight for the implant. If that
happens, the breasts can become very hard, misshapened, and painful as
a result, which can result in having the implants removed and/or
replaced. This "capsular contracture" is a common problem, although
there is no general agreement about how common it is or how many women
consider it a serious problem.

The published epidemiological studies have not proved that systemic
disease is caused by breast implants. However, some mastectomy
patients believe that the illnesses that resulted from their implants
caused them more grief than the breast cancer.

Several researchers have shown that bacteria can grow in the saline
implant, and have expressed concerns about those bacteria being
released into the body if the implant breaks. No research has ever
been done to determine what the risks are if a contaminated implant
breaks.
The risk of implants for smokers has not been studied, but there is
some research showing that silicone in the breast area can irritate
the lungs. Since smoking also damages the lungs, the risks of implants
for smokers needs to be studied.
If silicone can cause autoimmune diseases or other systemic diseases
in some women, such a risk is expected to be smaller for an implant
filled with salt water rather than silicone gel. However, even saline
implants can leak small amounts of silicone or platinum into the body,
which come from the "envelope" of the implant. The long-term health
risks of those leaks are unknown.

Many doctors advise their patients to choose some kind of
reconstruction to "feel whole again." However, a recent study by Anne
Kasper, Ph.D. found that many reconstruction patients were
disappointed by the results and were not any happier than those who
had not had reconstruction. For example, one woman told me that she
sometimes feels like her breast implants get in the way "like balls of
salt water" between herself and her husband, when they make love.

How a woman feels about herself after a mastectomy is influenced by
many things, especially her health, and the support of her family and
her friends. Although most women want to look as good as possible,
reconstruction is only one aspect of how a woman feels about her body
and herself.

I am not a medical doctor and can't make medical recommendations.
However, I am an experienced researcher and I am confident that
research information can help you make decisions that are not
dependent on a clinical assessment of your health.

Unfortunately, there are few published studies on the safety of breast
implants for mastectomy patients, and therefore most doctors can't
provide a great deal of objective information to their patients.
Rather than just asking your doctor for advice, I suggest you also
speak with other patients, especially those who made their decisions
at least 5 years ago. And if you decide on surgery, be sure to choose
a board certified surgeon who is very experienced, and speak to
several previous patients who had surgery several years ago as well as
recent patients.

Diana Zuckerman, Ph.D.
Executive Director
National Center for Policy Research for Women and Families

www.BreastImplantInfo.org


~~~~~~~~~~

www.BreastImplantAwareness.org/
Studies, News, Support Groups, Legal