In a quest for youth and beauty, more than 2 million U.S. women have asked doctors to pump up their breasts with plastic implants.
Now, more than 25 years after the first silicone implants were done, some women are raising serious questions about the results.
Some say the implants make their breasts hard and sore.
”It was like wearing two grapefruit,” says a 49-year-old woman from Salinas, Calif.
Others say the implants have ruptured, causing potential health problems. Marianne Hopkins, of Sebastopol, Calif., says in a lawsuit that she suffers from arthritislike aches and pains, as well as mixed connective tissue disease, a potentially serious disorder.
The Food and Drug Administration announced in April that it would require implant manufacturers to prove the devices are safe. Yet many plastic surgeons, irate over the move, say the FDA action is likely to frighten some women away from a procedure that is mostly safe.
”It`s like discouraging people from going to a freeway because of the risk of an auto accident,” says Dr. Garry Brody, a plastic surgeon in Southern California and spokesman for the American Society of Plastic and Reconstructive Surgeons.
Some women are contending, however, that their implants have been responsible for a bumpy ride, if not a serious accident.
Most are reluctant to talk publicly about their problems because they are embarrassed.
”Many of us are in the closet,” says the Salinas woman, who is married and has two grown children.
She wants breasts more beautiful than nature and age have given her, so she has had surgery three times to implant a small plastic pouch filled with silicone inside her breasts. After the first time, in 1967, her breasts turned hard within months.
”I didn`t want to go to the beach and lay on my back,” says the woman, who withheld her name. ”I had these two mountains that stuck straight up in the air.”
Her problems were caused by a common reaction to the implants: the growth of scar tissue inside the breast. As the scar tissue grows to form a thick capsule around the implant, it can cause the breasts to become hard and sometimes sore.
Doctors now know that the reaction, known as ”capsular contracture,”
occurs in varying degrees in up to 40 percent of women who have breast implants.
Although somewhat displeased, the woman did nothing about it.
”I just learned to live with it,” she says. ”It was tolerable. There was no pain.”
But by 1980 she had grown tired of the problem and decided on new implants. This time her doctor prescribed some exercises to minimize scar tissue growth around the implants. As instructed, she massaged the tissue around her implants, only to be startled one day by the results.
”There was a definite pop,” she says. ”Then my breast went flat. It frightened me.”
Four years later, when she noticed lumps in the lymph node under her left arm, she went back to the doctor. He found pieces of silicone, the filler material from the implants, in her lymph node. When he removed the left implant, he found it had ruptured and spilled silicone all over the inside of her chest.
”He said it was a mess,” she says.
For all of her problems, the Salinas woman appears to be healthy. But other women contend that their implants have hurt their health. The biggest manufacturer of silicone breast implants, Dow Corning Corp., faces more than 90 lawsuits from women across the nation.
Some, like Hopkins, of Sebastopol, say they have suffered a severe immune-system reaction after their implants ruptured. Her symptoms include arthritislike aches and pains, fatigue and the potentially serious mixed connective tissue disorder, according to a 1988 lawsuit she filed against Dow Corning.
According to the lawsuit, Hopkins was suffering from a ”profoundly debilitating disease” that forced her to take medicine that caused a severe ulcer and left her too weak to continue her job of 16 years.
No one knows how many other women have had problems like Hopkins` and whether they are all caused by breast implants. Although the implants have been on the market for more than 25 years, there are no large-scale human studies to determine how many women are likely to have problems with them.
So far, evidence linking breast implants with health troubles comes from animal studies and some human case reports published in medical journals. Because the case reports describe individual patients rather than a large study group, no one knows if the problems are rare or commonplace.
Some medical experts say this uncertainty leaves them concerned about safety.
”Despite estimates that 2 million women bear these devices, we cannot even quantitate the short-term risks for these consumers,” said Dr. Norman D. Anderson, a surgeon at Johns Hopkins and former FDA consultant, in recent testimony before Congress.
One consumer group has been calling since 1988 for the FDA to remove all breast implant models from the market, contending that they are a serious health hazard.
”We did not think they were safe then,” says Dr. Sidney Wolfe, head of the Public Citizen Health Research Group based in Washington, D.C. ”If anything, there is even more evidence that they`re not safe now.”
Yet other doctors say problems will occur in some women regardless of whether they have breast implants.
”It`s a very common operation,” says Dr. Alexander Ellenberg, of San Jose. ”Whenever you have 2.5 million women out there, some of them are going to get arthritis. Some of them are going to get cancer.
”And some of them are going to get poison oak.”
Ellenberg and many other plastic surgeons say the vast majority of their patients are happy with their breast implants. One 1990 survey by the American Society of Plastic and Reconstructive Surgeons found 92.5 percent of breast implant patients said they were satisfied with the results.
Yet Ellenberg says doctors must be careful to inform their patients of the risks that accompany any kind of surgery, including breast implantation.
California state legislators are considering a bill that would require doctors to provide written information to their patients on the disadvantages, side effects and risks involved with silicone implants and injections. The bill passed the assembly April 11 and will go before the state senate in May. Meanwhile, many women continue to choose breast implants, sometimes repeatedly, to correct any problems.
The Salinas woman had surgery a third time after enduring problems with her first two sets of implants. She doesn`t think they should be withdrawn from the market.
”I`d like to see more studies,” she says. ”How do they know if there aren`t some problems out there that can potentially be corrected?”
But she believes most women want to keep the option of choosing breast implants. Women who have had their natural breasts removed because of cancer may feel a special need to restore the contours of their body.
”I believe in our society that there is an enormous amount of pressure for women to be attractive and there`s an awful lot of attention given to a female figure,” she says.
Given that motivation, some women will choose discomfort and aggravation if they can have bigger breasts. Her husband has a lot to do with it, she says. ”He`s always liked them.”
These groups have information on the benefits and risks of breast implants:
– The American Society of Plastic and Reconstructive Surgeons has free brochures on breast implant surgery and other cosmetic surgery. Call 1-800-635-0635.
– Command Trust Network, a patient-support group, has information on breast implants available by writing P.O. Box 17082, Covington, Ky. 41017. Enclose a self-addressed, stamped envelope and $1 to cover costs. Information: 1-606-331-0055.
– The California Society of Plastic Surgeons offers information and patient referral. Details: 1-800-722-2777.
