"Well, how long would these next ones last? I would be in my 60s when I had to do this again, and who wants to have surgery unnecessarily when you are 60 something?" says Marion.
Although the long-term effects of silicone in the body are still uncertain, many plastic surgeons don't see the leaking of modern implants as a health concern. "The actual silicone that's within the implants is inert. So if the silicone gel leaks, it doesn't travel through the body, it doesn't cause systemic problems. So the MRI is really detecting a cosmetic concern," says New York City plastic surgeon Matthew Schulman.
Oily Silicone versus Gel
But there have been more serious outcomes. Annette Knecht got silicone implants in 1991 following a double mastectomy. For years afterward she felt ill, suffered multiple bouts of pneumonia, had trouble breathing and pain in her chest. Doctors reassured her it wasn't her implants. "We had a CT scan done, and it showed OK — everything looked fine, so we didn't worry about it," says Knecht. But no one ever told her to get an MRI — something the FDA now recommends that women with silicone implants get every few years. As it turned out, Knecht's implants had leaked; a biopsy found silicone in her lymph nodes and in her lungs. She is currently disabled and awaiting a lung transplant — all, she says, for vanity. "We're about four generations removed from those implants," says Schulman, the plastic surgeon. He explains that implants have undergone big changes since the early 1990s, when Knecht received hers. Back then they contained a runny liquid silicone. "The silicone implants of today are what we call a cohesive gel — it's essentially like a jelly. So the jelly may ooze a little bit, but it will not run out like an oil," says Schulman.
Sid Wolf of the nonprofit watchdog group Public Citizen is among critics who point out that the data in the FDA report sample just a fraction of the nearly 400,000 women who receive breast implants each year. Moreover, that data are limited to just the last two or three years — not enough, Wolf says, to make any real claims about the long-term safety of the implants. "There is a huge deficiency of long-term data at a time when we know that the longer these devices are in, the more problems ... occur," says Wolf.
Still, there are plenty of satisfied customers among the nearly 400,000 women who receive breast implants each year. Not only have the number of women choosing breast implants for augmentation risen by nearly 40 percent in the last decade, Schulman says that in his practice, 80 percent of them are choosing silicone over saline. What's more, he says few of them follow the recommendations to get routine MRIs to screen for leaks. Schulman says that the rates of complications for silicone implants are roughly the same as for saline — though he feels these complications can be minimized by choosing an experienced surgeon. Still, he warns his patients that no procedure is without risks — and additional surgeries are a very real possibility.
"Your young breast implants don't last forever," says Schulman. "They may leak, they may rupture, and you may decide you want a different size. So you have to at least expect that sometime in your life, you are going to need a reoperation. And if you are 100 percent against having another surgery related to these implants, then it's something you should reconsider."
Source: NPR Morning Edition
