Category Archives: Reconstruction Decision

Questions to Ask Your Surgeon Before Breast Reconstruction


If you’re considering breast reconstruction after breast cancer treatment, it can be hard to know what questions to ask. The first question is one that you need to discuss with your oncologist, not with a plastic surgeon: Should I get a mastectomy or a lumpectomy?

It is important to realize that women undergoing lumpectomy for early-stage breast cancer live at least as long – possibly longer – than those who undergo a mastectomy. It is also important to understand that if you have a mastectomy with reconstruction, your breasts will be numb – you will not have any feeling.

If you are seriously considering mastectomy with reconstruction, you will want to consider the different options for reconstruction:  breast implants or reconstruction with fatty tissue from your tummy or back (that’s called autologous tissue transfer). Here is more information about those options: http://www.breastimplantinfo.org/diagnosed-breast-cancer-options-breasts-3/.

Breast Implants After Mastectomy: Risks You Need to Know

Diana Zuckerman, PhD

The complication rate for getting breast implants after mastectomy has been described by experts as “alarmingly high and arguably unacceptable,”1 even though most of the information about complications is based on studies that were paid for by companies that make breast implants or silicone.

How safe are breast implants and how many women have complications after getting reconstruction with breast implants after a mastectomy? When the Food and Drug Administration (FDA) approved breast implants, they acknowledged that the complication rate is very high for all women, especially those undergoing reconstruction after a mastectomy. What the FDA did not know, however, is that early-stage breast cancer patients that undergo mastectomy and reconstruction with breast implants are 10 times as likely to commit suicide as other early-stage breast cancer mastectomy patients.

Complications from Implants

We do not know why the suicide rate is so high for mastectomy patients with breast implants, but we do know that complications are very common. For example, a study conducted by implant manufacturer Inamed (now called Allergan) found that 46% of reconstruction patients needed additional surgery within the first 2 to 3 years after getting silicone gel breast implants 2. Not surprisingly, the implant maker did not publish an article describing this high complication rate, which was more than twice as high as the 21% reported in a study funded by a company that makes silicone (Dow Corning).1

Why was the complication rate lower in the Dow Corning study? One explanation is that the women in that study had breast implants for an average of only 23 months, compared to 2-3 years in the Inamed study. Even so, the Dow study found that 31% of the women developed at least one serious complication and 16% developed at least 2 serious complications in that short period of time. The Inamed study reported that 25% underwent implant removal, 16% experienced Baker III-IV capsular contracture (which is painful breast hardness), 6% experienced necrosis (death of breast tissue), 6% had other types of breast pain, and 6% had an implant that ruptured, and other women reported infections and other complications.2  This shows that both studies found very high complication rates despite a short follow-up of less than 3 years.

The Dow-funded study concluded that “reconstruction failure (loss of implant) is rare.” Of course, it should be rare after less than 2 years. In contrast, when Inamed used Magnetic Resonance Imaging (MRIs) to detect rupture, they found that 20% of reconstruction patients had ruptured implants by the third year;3 but very few ruptures were detected without MRIs. Since Henriksen did not use MRIs. Since the Dow Corning study did not use MRIs to detect rupture, they couldn’t accurately count the number of failed implants.  Moreover, FDA scientists concluded that the risk of rupture would likely increase exponentially every year.4

Many plastic surgeons claim that the Institute of Medicine concludes that breast implants are safe. However, the Institute of Medicine report was completed in 1999, years before most research was conducted. Most research on breast implant patients was published after 1999, making the report very outdated. Many of the studies reported higher levels of diseases or symptoms among women with breast implants, which would have reached statistical significance if the studies were larger and women were followed for a longer period of time.

Can implants cause cancer or other serious diseases?

Experts around the world now agree that breast implants can cause a type of cancer of the immune system called ALCL (anaplastic large cell lymphoma).  In fact, there is now a specific diagnosis called breast implant associated ALCL (BIA-ALCL).  If caught early, removal of the breast implants can be very effective, but if not treated quickly it can be fatal. 5

The link between breast implants and other cancers remains controversial.  Studies paid for by plastic surgeons or implant companies tend to conclude that breast implants are safe. Since breast implants can cause cancer of the immune system, it seems logical that implants might have an impact on other diseases of the immune system or other cancers.  For example, FDA scientists reported a significant increase in fibromyalgia and several other autoimmune diseases among women whose silicone gel breast implants were leaking, compared to women with silicone implants that were not leaking outside the scar tissue capsule.4 In addition, scientists at the National Cancer Institute (NCI) found a doubling of deaths from brain cancer, lung cancer, and suicides among women with breast implants compared to other plastic surgery patients.6 National Cancer Institute scientists concluded that more research was needed to determine if implants increase the risk of cancer or autoimmune diseases.5,6

The Bottom Line

Many women choose mastectomies to “get rid of the cancer once and for all” hoping that it is the safest strategy for dealing with breast cancer.  However, research shows that women who have lumpectomies live longer than women with the same diagnoses that chose mastectomies instead. Research makes it clear that there are many complications from breast implants that often keep women needing additional surgery and medical help in the years after breast cancer is removed, including the possibility of cancer of the immune system.  Unfortunately, many women tell us that their doctors did not warn them about these risks. [Read a New York Times article about a woman with ALCL here.]

Some of the information from this article was based on Dr. Zuckerman’s article published in Archives of Surgery, Vol 141, pages 714-715. The original article can be found here.

Unnecessary Mastectomies: Are Breast Cancer Patients Given Accurate Information About Their Options?

Diana Zuckerman, PhD, National Center for Health Research: February 2008

It is shocking but true: approximately one out of every two American women who have a breast removed as treatment for cancer do not need such radical surgery. Whether a woman undergoes a mastectomy or a lumpectomy (which removes the cancer but not the breast) depends less on her specific diagnosis than on other factors, such as where she lives, her income and health insurance, where she receives medical care, her age, and when her doctor was trained.

Although it’s been known for years that lumpectomy and other breast-saving surgeries are just as effective as mastectomy for patients in the early stages of breast cancer, in most parts of the country most of the women who receive an early-stage diagnosis will undergo the more radical and disfiguring surgery. Limited information and biased recommendations are undermining breast cancer patients’ choices.

Articles published in some of America’s most prestigious journals show that many of the more than 182,000 women who are newly diagnosed with breast cancer every year do not have access to all the information they need to make the treatment choices that are best for them. This raises questions about what doctors know and what they are telling their patients.

In addition, mastectomy is often followed by “reconstructive” breast surgery that involves the use of synthetic breast implants or tissue transfers from other parts of the body. These reconstructive surgeries have risks, but the lack of published epidemiological studies means that many of the women making these decisions have limited information about their safety.

After all the research that has been done on the safety of lumpectomies, why are so many women undergoing mastectomies they don’t need and then having reconstruction that can cause serious problems? One reason may be economic. In many facilities, it’s actually cheaper to remove a breast than it is to perform a lumpectomy and provide the necessary follow-up radiation therapy.

Some striking research findings include:

• In some hospitals, all breast cancer patients had mastectomies, regardless of their diagnosis. In one large urban hospital serving mostly poor women in Texas, 84% of the women with early stage breast cancer had mastectomies and only 16% had lumpectomies.

• In a study of 157 hospitals, patients treated by doctors trained before 1981 were less likely to have lumpectomies or other breast-saving surgery than women who had younger doctors.

• One study indicated that women getting mastectomies were more likely to have followed their doctors’ recommendations, but women getting lumpectomies were more likely to have obtained a second opinion, and felt more actively involved in making the decision.

• A study of 175 surgeons found that even doctors who know that lumpectomy is as safe as mastectomy may persuade their patients to get mastectomies by making subtly biased recommendations. Other studies showed that some women were not even told that lumpectomies were an option.

Women deserve better. Breast cancer patients should make the choices that are best for them, wherever they live and no matter how affluent they are. We need to do a better job of making sure that all doctors and their patients have accurate, unbiased information so that women can make those choices, no matter who they are, or who provides their medical care.

The National Center for Health Research is an independent, nonprofit think tank in Washington, DC, which “translates” medical and scientific information into news that can be used by consumers, policy makers, and the media. Contact us for more information or visit our Web site at www.center4research.org.

All articles are reviewed and approved by Diana Zuckerman, PhD, and other senior staff.