What Do Women Need to Know and When Do They Need to Know It?

Susan Wood, and Scott L. Spear. “What do women need to know and when do they need to know it?.” Plastic and Reconstructive Surgery. 2007.

When a woman decides whether or not to get breast implants, she must consider how that decision will affect her life. In their 2007 article, “What Do Women Need to Know and When Do They Need to Know It,” Dr. Susan Wood and Dr. Scott Spear discuss the known and unknown risks involved in breast implants. They point out that it is the healthcare professionals’ responsibility to provide patients with information and to help them weigh the risks and benefits, but that “it is also a challenge to women to seek information, ask good questions and carefully consider the answers.”

The article is especially important because it shows substantial agreement between Dr. Susan Wood, a well-respected women’s health expert, and Dr. Scott Spear, a consultant to breast implant manufacturers and the former president of the American Society of Plastic Surgeons.

Health and Cosmetic Risks

The authors state that there are known risks. Breast implants do not last forever and women will need additional operations to replace ruptured implants. Ruptures of saline breast implants are obvious, but ruptures of silicone gel implants are often “silent,” meaning that there are no obvious signs or symptoms. The authors point out that magnetic resonance imaging (MRI) is the most accurate way to detect a rupture. They note that mammograms are often inaccurate in detecting rupture and can actually cause more harm. If an implant is already ruptured, the pressure from a mammogram could cause the silicone gel from the implant to leak outside the capsule.

The authors discuss how the removal of implants is more complicated than the initial surgery, especially if an implant has ruptured and the silicone has leaked into the surrounding tissue. Replacing broken implants also has risks: “After a second surgery, the risk of more complications, especially capsular contracture and rupture is higher than before. Revisions or secondary corrections do not reduce the need or likelihood of future surgery.” Women must not only consider the cost of the initial surgery, but of “follow-up operations, removal and replacement, and additional costs for mammography and magnetic resonance imaging…Also, insurance companies may drop coverage or raise premiums for women who have undergone breast implant surgery.”

Breast cancer detection is another potential problem. Implants can hide cancerous tumors during a mammogram. To make mammography more accurate for women with breast implants, “the additional views of the breast with implants require a specially trained technician and will cost more, take more time, and expose the woman to more radiation.” Since most women wanting breast implants plan to have them for the rest of their lives, it is important to stress these issues,  especially those who are at high risk of breast cancer.

Unknown Risks

There are still many things we don’t know about breast implants, and an “unknown risk is not the same as no risk.”  Most importantly, clinical studies for today’s breast implants only followed patients for the first 3-4 years after getting implants, even though implants may last up to 10 years. As a result, we don’t know for certain how long implants will last and how they will affect the body. We do know that many women will need to undergo surgery, and that the need for additional surgery continues every year because of complications and rupture.

More research is needed, and meanwhile some women need to be especially cautious about implants. For example, “differences in keloid formation, scarring, capsular contracture and other complications in African-American women are a potential problem that has not been studied in breast implants and thus remains unknown,” and women with autoimmune diseases were excluded from the implant makers’ clinical trials because of concerns about “whether silicone breast implants have the potential to disrupt the immune system.”

Research has also found a significant increase in suicides and some types of cancer for breast augmentation patients compared with other plastic surgery patients. And, there is the possibility that women with breast implants will have difficulty breastfeeding or that silicone or other implant substances may leak into their breast milk.

The article stresses that since breast augmentation is a choice with life-long implications, women should take the time and the care to consult with health professionals and look over the relevant literature to assess both the known and the unknown risks before undergoing these procedures. After gathering the information, the authors recommend that women take at least two weeks to assess the physical, psychological and financial consequences of breast implants before making their decisions.

Read the original article here.