Children affected by breast implants

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PROBLEMS YOUR CHILDREN BORN AFTER IMPLANTATION COULD HAVE! INCREASED URINARY NO3(-) + NO2- AN NEOPTERIN EXCRETION IN CHILDREN BREAST FED BY MOTHERS WITH SILICONE BREAST IMPLANTS: EVIDENCE FOR MACROPHAGE ACTIVATION

Author: Levine JJ; Ilowite NT; Pettei MJ; Trachtman HAddress: Division of Gastroenterology and Nutrition, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA.Source: J Rheumatol, 1996 Jun, 23:6, 1083-7Abstract:OBJECTIVE: To determine whether children breast fed by mothers with silicone implants (BFSI) have increased urinary excretion of nitric oxide (NO) metabolites and neopterin, whether these are associated with esophageal dysmotility, and whether in vitro incubation of macrophages with silicone increases NO synthesis. METHODS: In a case-control study based on laboratory investigation, 38 BFSI children (17 male, 21 female, mean age 7.1 +/- 3.6 years, range 0.5-16.5) were compared with 30 controls (14 male, 16 female, mean age 8.4 +/- 3.5 years, range 2.5-17). Urinary NO was quantitated using the Griess reaction. Urinary neopterin was determined by radioimmunoassay. Murine macrophages were cultured with or without silicone and NO production assayed. RESULTS: Urinary NO and neopterin were significantly increased in BFSI children compared with controls. There was a significant inverse relationship between urinary neopterin excretion and the severity of esophageal dysfunction. In vitro nitrite production was nearly 60% higher in macrophages grown on silicone compared to other growth conditions. CONCLUSION: BFSI children have evidence of macrophage activation and this is associated with esophageal dysmotility. In vitro data support the proposal that silicone exposure causes macrophage activation.

LACK OF AUTOANTIBODY EXPRESSION IN CHILDREN BORN TO MOTHERS WITH SILICONE BREAST IMPLANTS

Author: Levine JJ; Lin HC; Rowley M; Cook A; Teuber SS; Ilowite NTAddress: Division of Gastroenterology and Nutrition, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA.Source: Pediatrics, 1996 Feb, 97:2, 243-5OBJECTIVE: We determined systematically the prevalence of autoantibodies in children born to mothers with silicone breast implants and the relationships with clinical symptoms and methods of exposure. METHODS: Autoantibody expression was determined in 80 children born to mothers with silicone implants and in 42 controls. A clinical assessment score was assigned to each patient. Antinuclear antibodies as well as antibodies to mitochondrial, smooth muscle, striational, myocardial, parietal cell, reticulin tissues, or subcellular compartments were measured by indirect fluorescent assay. Antibodies to nRNP (U1-RNP/snRNP); Sm; SS-A; SS-B; Scl-70; thyroid microsome; immunoglobulin (Ig)G, IgM, and IgA antibodies to cardiolipin; and antibodies to native and denatured human types I and II collagen were measured by enzyme-linked immunosorbent assay. Serum complement components C3 and C4 and IgM rheumatoid factor were measured by nephelometry. RESULTS: Autoantibody prevalence was not significantly different between children born to mothers with silicone implants and controls. The presence of autoantibodies was not related to the children's clinical symptoms or to the method of exposure. CONCLUSIONS: Determination of autoantibody production is of limited clinical utility in the evaluation of children born to mothers with silicone breast implants.

ESOPHAGEAL DYSMOTILITY IN CHILDREN BREAST-FED BY MOTHER WITH SILICONE BREAST IMPLANTS. LONG-TERM FOLLOW-UP AND TREATMENT

Author: Levine JJ; Trachtman H; Gold DM; Pettei MJAddress: Division of Gastroenterology and Nutrition, Schneider Children's Hospital, Albert Einstein College of Medicine, New Hyde Park, New York 11040, USA.Source: Dig Dis Sci, 1996 Aug, 41:8, 1600-3

Abstract: Our aims were to determine the long-term clinical and manometric follow-up of 11 children with previously documented esophageal dysmotility, who had been breast-fed by mothers with silicone breast implants, their response to prokinetic agents, and to analyze changes in macrophage activation. Seven of 11 children had subjective clinical improvement. Weight/height ratios remained the same or improved in 9/11. Biopsies at follow-up endoscopy were either normal or demonstrated mild esophagitis in 8/10. LES and UES pressures and percent propagation were not significantly different at follow-up, while wave amplitude significantly increased. Following intravenous metoclopramide, LES pressure, percent propagation, and wave amplitude significantly increased while UES pressure was unchanged. Urinary neopterin significantly decreased at follow-up, while urinary nitrates were unchanged. Esophageal dysmotility is chronic in this group of children, suggesting persistent autonomic nervous system dysfunction. Prokinetic agents may be useful in long-term management. The decreasing urinary neopterin levels suggest that, ultimately, there may be improvement in esophageal motility.

SKIN RASH AND ANTI-Ro/SS-A IN AN INFANT FROM MOTHER WITH SILICONE BREAST IMPLANTS

Author: Gedalia A; Cuéllar ML; Espinoza LRAddress: Dept. Pediatrics & Medicine, LSU School of Medicine, New Orleans, LA.Source: Clin Exp Rheumatol, 1995 Jul, 13:4, 521-3Abstract: An infant with erythematous rash born from a mother with silicone breast implants is described. The diagnosis of possible neonatal lupus was suggested based on the presence of the skin rash and positive Ro/SS-A antibodies in the infant and positive ANA and Ro/SS-A in the mother. Here is a reply I received from someone at La Leche League in response to my post that up to 64% of new mothers with breast implants cannot breastfed their babies. For the articles below, if need them, they are at the Saline Implant Library under "HOPE TO HAVE CHILDREN ONE DAY?" at Silicone Implant Survivors: http://www.geocities.com/HotSprings/8689/ Also, http://www.lalecheleague.org/ and search under "breast implants." They do have information posted such as medical journal articles on illnesses children often have whose mothers have breast implants but present positive cases also. Below in this post are also articles reporting the problems children of mothers who had breast implants during their pregnancy are having. Dear Barbara, La Leche League's mission is to support breastfeeding mothers and promote breastfeeding. While many of us privately agree with you (believe me, I wouldn't put foreign objects in me just to make men look at me), we have agreed to stick to our primarily purpose and let people dedicated to other causes officially lobby for them. The same goes for breast cancer, etc. Of course we privately are all for research and for ending it, but it is not part of our mission, except where it affects breastfeeding. Thus, we only deal with the effect of implants on breastfeeding. I sure wish young women would think about their future childbearing role before getting implants that may affect their ability to feed their babies healthy milk. I am not sure why you think LLLI is not on your side on this issue. Did you see our collection of articles on breastfeeding with implants? It certainly doesn't encourage people to run out and get them; rather it supports people who, for reasons of their own, did get them, and now want to breastfeed. That is supporting people, not supporting something that they did that they may now regret. Anyway, I am not an official representative of LLLI policy, just responding to you as a person. I will forward your note to our PR Department, which may be better able to respond to you. I am glad you care so much about this issue. You can rest assured that most of us who have successfully breastfed want others to have a chance to do so as well, and do not recommend implants to women of childbearing age. Sue Ann

LACTATION AFTER AUGMENTATION MAMMOPLASTY

Author: Hurst, NMAddress: Section of Pediatric Nutrition and Gastroenterology, Texas Children's Hospital, Houston, USA.Source: Obstet Gynecol, January, 1996, 87:1, 30-4Abstract: OBJECTIVE: To compare the lactation outcomes of breast-augmented women and nonaugmented women. METHODS: This study used a retrospective, comparative design. Demographic and descriptive data were obtained from client records maintained by a lactation support program at a large children's hospital in the southwest United States. The association between breast augmentation and lactation outcome in the two groups was investigated by obtaining data from these existing records. RESULTS: A significantly greater incidence of lactation insufficiency was found in augmented women compared with nonaugmented women (P < .001). Among 42 augmented women, 27 (64%) had insufficient lactation, compared with only three (less than 7%) of the 42 nonaugmented women. Augmented women who experienced sufficient lactation were equivalent in age, ethnicity, type of delivery, smoking, previous breast-feeding experience, and lactation course compared to augmented women with lactation insufficiency. However, the type of breast incision was significantly associated with lactation outcome. More specifically, it was the periareolar approach that was most significantly associated with lactation insufficiency (P < .01). The incidence of lactation insufficiency with the submammary-axillary approach was only statistically significant when compared with nonaugmented women. CONCLUSION: A significantly greater incidence of insufficient lactation was found among augmented women compared with nonaugmented women. The periareolar approach was most significantly associated with lactation insufficiency.

INFLUENCE OF BREAST SURGERY, BREAST APPEARANCE, AND PREGNANCY-INDUCED BREAST CHANGES ON LACTATION SUFFICIENCY AS MEASURED BY INFANT WEIGHT GAIN

Author: Neifert M; DeMarzo S; Seacat J; Young D; Leff M; Orleans M Address: Lactation Program, AMI St. Luke's Hospital, Denver, CO Source: Birth, March, 1990, 17:1, 31-8 Abstract: We conducted a prospective study of the associations between several biologic and surgical breast factors and the onset of lactation in 319 healthy, motivated, primiparous women who were breastfeeding term, healthy, appropriate for gestational age or large for gestational age infants. During the last trimester of pregnancy subjects' breasts were examined for surgical incisions, size, symmetry, and nipple protuberance, and women estimated their prenatal breast enlargement. At two visits in the first two weeks postpartum, infants were weighted naked, and mothers reported the magnitude of postpartum breast engorgement when their milk came in. Breastfeeding was evaluated at each visit, and interventions were recommended for problems, with emphasis on maximizing milk yield. Lactation was deemed sufficient when an exclusively breastfed infant achieved an average weight gain of 28.5 g or more per day between the two visits. Infants gaining less than 28.5 g per day with breast milk exclusively, and those requiring formula supplement returned for a third visit at or before 21 days of age, when final lactation outcome was assessed based on weight gain between the second and third visits. Within three weeks postpartum 85 percent of the mothers achieved sufficient lactation, whereas 15 percent had persistent milk insufficiency despite intensive intervention. Of the study population, 6.9 percent had undergone previous breast surgery. Women with periareolar breast incisions were nearly 5 times more likely to have lactation insufficiency than were those without surgery (relative risk [RR] = 4.55; 95 percent confidence interval [CI] = 2.21-9.43; P less than 0.001). Insufficient lactation was significantly associated with minimal prenatal breast enlargement (P less than 0.02) and minimal postpartum breast engorgement when milk came in (P less than 0.001). Although not statistically significant, women with inverted nipples were more likely to have lactation insufficiency compared with those with normal nipples (RR = 2.94; 95% CI 1.05-8.20; P = .07). The findings from this study indicate that certain biologic and surgical breast variables are associated with lactation insufficiency.

LACTATION: PHYSIOLOGY, NUTRITION AND BREAST-FEEDING

Authors: Neville, M. and Neifert, M. R.Source: Plenum Press, 1983, pages 343-344Address: University of Colorado School of Medicine, CO

MAMMOPLASTY ...Implants through a periareolar incision which damages this nerve will result in altered nipple sensation postoperatively and will probably interrupt the afferent limb of the neurohumoral reflex involved in prolactin and oxytocin secretion. NOTE: LACTATION AFTER AUGMENTATION MAMMOPLASTY above states even when an axillary (underarm) incision is made to insert breast implants, statistically, fewer of these woman can nurse than nonaugmented patients. Approximately 15% of women loss nipple sensation initially after augmentation mammoplasty and the rate climbs one study reports 75% by the time explanted.