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

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http://canoe.talksurgery.com/consumer/articles/z0001.html

Dear Ms. Zuckerman, I have been recently diagnosed with breast cancerand 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 whatyou think of breast implants post-mastectomy.

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The decision of whether to get breast implants is an especiallydifficult 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 knowthat for about 80% of the women newly diagnosed with breast cancer inthe U.S., a lumpectomy with radiation is just as safe as a mastectomy.

Unfortunately, many women who have mastectomies are not fully informedabout lumpectomy as an option. This is especially true for women inthe South and West, as well as women with older doctors or who aretreated at community hospitals rather than university-based hospitals.

If you've already had a mastectomy, then you have several choices inaddition to breast implants:

No reconstruction, and see how you feel.

Reconstruction with your own tissue, in conjunction with a " tummytuck " or other procedure, where tissue is moved, while still attachedand " alive " from one part of your body to another. These are called

" autologous tissue transfer " operations, and are thought to last alifetime. There are several different kinds. This kind of surgery ismore time-consuming, expensive, and has more risks in the short-term

because it is more complicated than implant surgery. The safety ofthis kind of surgery is especially dependent on the skill of thesurgeon, but there is some evidence that there may be more problemswith 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 ofwomen 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 assafe or effective, and there are few published studies regarding their

use by mastectomy patients. One of the reasons why gel implants areconsidered riskier than saline, is that when they break, the siliconegel can migrate to other parts of one's body, including the arm oreven to vital organs. Silicone gel implants are available to

mastectomy patients who are willing to participate in researchdesigned 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 gelimplants are filled with silicone gel. Saline breast implants were

recently approved by the FDA, but with many caveats suggesting thatthe long-term safety and effectiveness is in doubt. For example,approximately three out of four mastectomy patients reported at leastone 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, hasrisks. These include the risk of infection, hematoma (blood or tissuefluid collecting around an implant), the risk that one or both of the

implants will have to be removed (requiring additional surgery), andthe potential costs of repeated surgeries if the implants arereplaced. Mastectomy patients seem to have more problems thanaugmentation patients.

All breast implants will eventually break, but it is not known howmany years the saline breast implants that are currently on the marketwill 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 morethan 15 years. It is expected that saline implants will last a similar

number of years.

There are other well-documented " local complications " that can resultfrom breast implants. For example, all implants are " foreign bodies "

and the woman's body reacts by forming a capsule of scar tissue aroundthe implants that can become too tight for the implant. If thathappens, the breasts can become very hard, misshapened, and painful asa result, which can result in having the implants removed and/or

replaced. This " capsular contracture " is a common problem, althoughthere is no general agreement about how common it is or how many womenconsider it a serious problem.

The published epidemiological studies have not proved that systemicdisease is caused by breast implants. However, some mastectomypatients 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 salineimplant, and have expressed concerns about those bacteria beingreleased into the body if the implant breaks. No research has ever

been done to determine what the risks are if a contaminated implantbreaks. The risk of implants for smokers has not been studied, but there issome research showing that silicone in the breast area can irritate

the lungs. Since smoking also damages the lungs, the risks of implantsfor smokers needs to be studied. If silicone can cause autoimmune diseases or other systemic diseasesin some women, such a risk is expected to be smaller for an implant

filled with salt water rather than silicone gel. However, even salineimplants 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 ofreconstruction to " feel whole again. " However, a recent study by AnneKasper, Ph.D. found that many reconstruction patients were

disappointed by the results and were not any happier than those whohad not had reconstruction. For example, one woman told me that shesometimes 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 bymany things, especially her health, and the support of her family andher friends. Although most women want to look as good as possible,

reconstruction is only one aspect of how a woman feels about her bodyand herself.

I am not a medical doctor and can't make medical recommendations.However, I am an experienced researcher and I am confident thatresearch 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 breastimplants for mastectomy patients, and therefore most doctors can'tprovide a great deal of objective information to their patients.

Rather than just asking your doctor for advice, I suggest you alsospeak with other patients, especially those who made their decisionsat least 5 years ago. And if you decide on surgery, be sure to choosea board certified surgeon who is very experienced, and speak to

several previous patients who had surgery several years ago as well asrecent patients.

Zuckerman, Ph.D.Executive DirectorNational Center for Policy Research for Women and Families

www.BreastImplantInfo.org

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www.BreastImplantAwareness.org/

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