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There is only one way for individuals to evaluate these questions. We must examine the detailed evidence for ourselves. We cannot be led only by the histories of individual pain and suffering. Most of those histories are real, but the evidence of disease itself does not make a link to implants as the cause. Perhaps a large number of women without implants would suffer the same level of discomfort and disease. Let us as scientists, putting aside the real emotions of the women with painful experiences with implants, examine the evidence . Perhaps we must seek truth in a larger context, the context in which science and decision making interact. Three facts seem clear when we consider problems with breast augmentation implants:
We see the courts assigning responsibility to Dow Corning and other companies for these effects. Can we come to a conclusion for ourselves as to responsibility?
Useful Background Information
On the basis of the information available the IRG (of the UK Department of Health) concluded that:
i. Silicone gel breast implants are not associated with any greater health risk than other surgical implants.
ii. Whilst it is recognized that there are a number of local complications such as capsularcontracture and gel bleed, the incidence of ill-health in women implanted with silicone gel breast implants is no greater than in the general population. In particular, there is no evidence of an association with an abnormal immune response or typical or atypical connective tissue diseases or syndromes.
iii. Children of implanted women are not at increased risk of connective tissue disease.
iv. The information provided to women undergoing breast implantation is often inadequate.
In the light of the conclusions drawn and at the same time bearing the mind the concerns raised by some implanted women, the IRG has made a number of recommendations covering:
i. The adequate provision of information prior to breast implantation, in order to assist women in making informed decisions about whether to proceed to implant surgery.
ii. The need for extending principles of good clinical practice and clinical audit across some areas of the private sector.
iii. Areas that require future research include the incidence of rupture and the investigation of conditions such as low-grade infection, which may account for some of the non-specific illnesses noted in some implanted women.
It is the intention that the IRG continue to meet to consider any new evidence on issues relating to breast implants or associated health concerns, setting out additional recommendations as necessary.
July 14, 1998
In addition to the risks of infection and bleeding present in all surgery, other risks are associated specifically with breast implants.
The adverse effects from breast implants fall into two categories. First are known risks that are clearly associated with these devices. Second are problems that have not been scientifically associated with breast implants, but have been reported by some women who have them. Scientists are conducting research to determine if an association does exist between these reported problems and breast implants.
Breast implants are not lifetime devices
and cannot be expected to last forever. Some implants
deflate (or rupture) in the first few months after
being implanted and some deflate after several years; yet
others are intact 10 or more years after the
From 1985 until March 3, 1997, FDA received 104,413 adverse reaction reports for silicone gel-filled breast implants. During the same time period, there have been 23,798 adverse reaction reports for saline-filled implants. (Because these figures come from all databases, there may be a few duplicate reports.) The greater number of reports for silicone implants does not necessarily mean that there are far more problems with silicone gel-filled implants. The greater number of reports may reflect that many more women have received silicone implants than saline implants.
Most of the health concerns about breast implants are related to silicone. Even if a silicone gel-filled breast implant does not rupture, small amounts of the silicone gel may migrate ("bleed" or "sweat") out of the implant into the surrounding tissue. There has been continuing concern that this escaped silicone might cause harmful effects, including connective tissue and related disorders and cancer.
Connective tissue and related disorders: These disorders of the body's immune, or "defense" system are related to the connective tissues of the body (connective tissues include mucous, fibrous, fat, cartilage and bone tissues which support body structures and bind body parts together). These illnesses include autoimmune disorders such as lupus, scleroderma and rheumatoid arthritis, as well as disorders such as fibromyalgia and chronic fatigue syndrome. Some women with breast implants have experienced these disorders, as well as a variety of symptoms that could be related to the immune system. These symptoms include pain and swelling of joints; tightness, redness or swelling of the skin; swollen glands or lymph nodes; unusual or unexplained fatigue; swelling of the hands and feet; excessive hair loss; memory problems; headaches; and muscle weakness or burning. However, symptoms such as these may be present in persons without connective tissue disease, or without breast implants. So it is unclear at this time whether the signs and symptoms experienced by these women are related to their implants. In some cases, women have reported a reduction in symptoms after the implants were removed; in other cases, there was no change in symptoms after the implants were removed.
understand that individual cases cannot prove or disprove
a connection between immune-related disorders and breast
implants. First, as stated above, many of the
various symptoms experienced by some women with breast
implants are not specific to connective tissue disorders.
Many people without these disorders experience some of
these symptoms from time to time. Second, even if a woman
with breast implants develops an immune-related disease
such as lupus or rheumatoid arthritis, there
Studies have shown that some women with silicone gel-filled breast implants produced antibodies to their own collagen (a connective tissue protein), but the incidence of these antibodies in the general population is currently unknown. Further, it is not known whether the presence of these antibodies means an increased risk of actually developing an immune-related disorder. So this study does not tell us whether there is a link between breast implants and immune-related disorders.
studies have been completed recently, which provide
substantial -- but not complete -- information about any
possible link between breast implants and immune-related
disorders. For example, a study of breast implants and
connective tissue diseases, conducted at the Mayo Clinic,
compared the medical records of 749 women with breast
implants in Olmsted County, Minnesota, with a similar
group of women from the same area who did not have
implants. The conclusion was that there was no increased
risk of defined connective tissue diseases among the
implant recipients. Another study, conducted in
A 1996 study by Hennekens et al., also at the Harvard Medical School, is the largest yet to look at the past experiences of women with breast implants. Almost 400,000 women (nearly 11,000 with breast implants) completed questionnaires for the study. The study showed a small but statistically significant increase in the risk of connective tissue disease reported by women with breast implants. The study indicated that over a 10-year-period, women with breast implants were 1.24 times more likely to report having a connective tissue disease than women without breast implants. The increase in risk applies to all of the connective tissue diseases taken together; when calculated individually, the risk for each of these diseases was not statistically significant. According to the Hennekens study, less than 1 percent of women with breast implants will develop connective tissue diseases associated with the implants. Thus, like previous studies, the Hennekens study found that the substantial majority of women with breast implants do not develop typical connective tissue diseases.
The Hennekens study has certain limitations in its design. For example, self-reported disease was not confirmed by medical record as it is in most clinical studies. Also, only 1/4 of the women asked to participate returned the questionnaire. And the study considered all breast implants together, so if the risk of silicone gel-filled and saline-filled implants is different, this study would not have shown this difference. For all these reasons, the true risk may be different than that reported in the study.
None of the human studies described above can completely resolve the question of whether silicone gel-filled breast implants increase the risk of connective tissue disease or related disorders. First of all, except for the Hennekens study, none of them have been large enough to rule out the possibility that the implants could cause immune-related disorders in a small subset of women who have them. Secondly, since these studies were largely designed to find out whether women with the implants had certain well-defined immune-related diseases, they cannot exclude the possibility that some women with implants might develop other signs and symptoms related to the immune system that don't conform to "classic" disease descriptions. In other words, these studies do not resolve the question of whether the variety of symptoms some women report might be related to their implants.
Cancer: At this point there is no scientific evidence that silicone gel-filled breast implants can increase the risk of cancer in women, but we cannot completely rule out this possibility. Average follow-up time of completed studies in women has been too short to fully resolve this question.
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