Issue link: http://viewer.e-digitaleditions.com/i/85232
086: health&wellbeing BREAST IMPLANTS Good but not perfect WORDS BY: STUART MCNICOLL GOOD BUT NOT PERFECT With the recent controversy over the PIP breast implants manufactured in France, there has been renewed interest in the safety of breast implants. The PIP company quite illegally exchanged the medical grade silicone in their implants for industrial grade silicone. Problems started to be noticed with an apparently higher rupture rate than normal and that the silicone seemed more irritant to the body's tissue. Eventually the fraudulent activities of the company were identified, the products have been withdrawn worldwide and the company has become bankrupt. There is thought to be some 300,000 implants which have been sold around the world over the last two years containing this defective industrial grade silicone. The medical profession and regulatory authorities are grappling with this problem. Should the implants be electively removed and replaced? Who will pay for this surgery? Fortunately, it appears that only very low numbers (10) of patients have had these implants inserted by New Zealand Plastic Surgeons. Attempts have been made to contact all of these patients and the situation remediated. There will, however, be other patients who have had their breast augmentations overseas or by non-qualified cosmetic surgeons that may have or be concerned that they have PIP implants in situ. Most members of the New Zealand Association of Plastic Surgeons offer free consultation to any of these women who are concerned about this problem. There have also been kind offers from reputable breast implant manufacturers to donate replacement implants at a greatly reduced price. Currently there is no clear-cut consensus on whether elective replacement of these implants should be performed in the absence of any signs, symptoms or radiological evidence of rupture. This brings us back to the original question, how safe are breast implants? Perhaps it is useful to review the history of breast implants. The first breast implant was invented by an American Plastic Surgeon, Thomas Cronin, in conjunction with Dow Corning Corporation in 1962, and first used in 1963. The first patient to have a breast augmentation was actually seeing Dr Cronin for the pinning back of her ears and he offered to do that for free if she would allow him to trial these new implants on her. It is believed she still has these implants today. Breast implants rapidly became popular and widely used until the early 1990s when it was realised there were a large number of patients having some problems such as capsular contraction (implants going hard) or silicone leakage. It was also suspected that these implants might be causing cancer or autoimmune diseases like rheumatoid arthritis. Because of these concerns, the FDA banned the use of silicone gel containing implants in America in 1992. American Plastic Surgeons could only use saline containing implants for cosmetic breast enhancement. Subsequent research, however, demonstrated there was no relationship between development of cancer and/or any autoimmune diseases in relation to silicone gel breast implants. There were also significant improvements in developments in breast implant technology making them much safer; • The use of a highly sticky semi-solid filling instead of liquid silicone, so that if the silicone bag containing the filler ruptured then the contents would not leak out. • The use of texturing of the surface of the implant to reduce the incidence of capsular contraction (breast implants going hard). Rupture and leakage of the silicone gel into the body's tissues was causing silicone granulomas (painful lumps) and the spreading of silicone to the lymph nodes in a high number of patients with early generations of silicone implants. Once the silicone gel inside the implants was made semi-solid, now called highly cohesive, the leakage problem has