Author: Kenneth S. McCarty, MD, PhDAffiliations:
Director of Endocrine Oncology, Comprehensive Breast Care
Center Pittsburgh Cancer Institute, Professor of Internal
Medicine and Pathology, University of Pittsburgh School of
Medicine, Pittsburgh, USAPublished in: Innovations in Oncology
Nursing Vol 10, No 1, 1994 Reprinted with permission from
Since breast implants first came on the market 30 years
ago, approximately one million women in the United States
have had these devices surgically inserted for reconstruction
following mastectomy or breast modification to enlarge or
reshape their breasts. Most are filled with a silicone gel;
however; about l0% contain saline (salt water). Until recently,
both gel-filled and saline implants were available to virtually
any woman who wanted them.The use of silicone gel-filled
implants is controversial, and various opinions exist about
who should be permitted to receive breast implants, what
type should be used, and what purpose they should serve.
Q. What advice do you give to breast cancer patients
regarding silicone gel-filled breast implants? What factors
influence your advice to these women (age, disease state,
A. I advise patients who desire reconstruction following
mastectomy that there are a number of options for reconstruction.
In most cases either saline or silicone gel-filled implants
involves less demanding surgical procedures than do flap
procedures (removal of skin from another area of the body
to replace breast tissue) and gives equal appearances. In
terms of the safety of silicone implants, there are no credible
studies which show that the implants cause disease or adversely
affect patients.Unfortunately, there is insufficient information
to exclude the possibility that some patients will have
adverse reactions. In the majority of patients who have
had adverse reactions and whose courses I have reviewed,
alternate and often treatable conditions could be identified
that probably led to the symptoms, and these need to be carefully
looked for in patients with complaints that are being attributed
to implants. One of the most frequent conditions is menopausal
symptoms or incomplete hormone replacement.The stage of
the breast cancer and the patient's age are not factors
in choosing the approach to breast reconstruction, except
insofar as this might influence surgical risk. Otherwise
it is the woman's choice.
Q. How has the usage of silicone gel-filled and saline
implants changed since the beginning of the Food and Drug
Administration (FDA) investigation?
A. The usage of silicone gel-filled implants has changed
dramatically since Dr. Kessler (FDA Commissioner) first
criticized the use of these implants. The most dramatic
change is the general panic, even among patients who were
not and are not experiencing problems with their implants.
This mental anguish about potential problems, which may
be reported by patients but not observed by examiners, has
altered the decision-making process regarding the selection
of any form of reconstruction.
Q. What are the latest findings and reports regarding
the inability to perform an accurate mammogram due to the
placement of silicone gel-filled breast implants?
A. Mammography can be adequately performed with implants in
place. It does involve specific maneuvers and must be done
cautiously so as not to rupture the capsule (fibrous tissue
surrounding the implant) when the breast is compressed.
Q. What are your recommendations for follow-up and future
cancer screenings after a woman has an implant placed?
A. The recommendations for follow-up are the same after implants
are placed as they are in patients who have not been reconstructed
or whose reconstruction was achieved using a flap procedure.
These recommendations include physical examinations and laboratory
evaluations while additional cancer therapy, necessary to
treat any remaining cancer cells, is in progress (usually
up to the first 6 months after diagnosis), every 3 months
thereafter for the first year, every 6 months for the next
3 years, and then annually.
Q. What is being done to investigate the long-term effects
of silicone implants such as immune-related disorders and
A. A number of studies are under way to assess the long-term
effects of silicone implants. The studies must distinguish
the type of implant and separate patients with urethane-coated
implants and those with silicone elastomer implants. Remarkably,
the frequency of breast cancer is lower in patients with
silicone breast implants than in the general population.
The frequency of autoimmune diseases (such as lupus erythematosis
or scleroderma) appears to be similar to that in non-implanted
controls, but adequate research has not been performed in
Q. What other complications related to implants can occur,
and how often do you see women with these complications?
A. The principal complications related to implants are local
effects such as infection at the site, distortion after rupture
of the implant, and scarring. The frequency of complications
varies widely and is dependent upon the technique used as
well as the individual¿s physical makeup.
Q. If you could share one message about silicone gel
implants with health care professionals and lay persons,
what would that message be?
A. The silicone gel-filled implants serve a genuine purpose,
and the ratio of risks versus benefits still appears to
be excellent, compared with alternatives. The widespread
publication of anecdotal complications has caused more harm
than any actual complication I have seen or of which I am
aware. This fact notwithstanding, if someone wishes to have
an implant removed, no objections to having this done should
Questions and Answers:
About the Use of Breast Implants