Implants: Some thoughts

By AnthonyLast updated: Friday, December 30, 2011 • Save & ShareOne Comment

Not all the fuss about Pip this month concerns Douglas Booth’s performance in Great Expectations. The French government has promised to foot the bill for 30,000 French women to have their breast implants supplied by Poly Implant Prothese (PIP) removed. One investigation has found a higher rupture rate of these implants, and non-authorised silicone gel was used in their manufacture. Concerns have spread throughout the world, here in Bulgaria (for example), and the Venezuelan government has duplicated the French response in part.

In the UK, government has indicated that removal of the implants is not advised with the health minister Lansley saying “an operation entails a risk and we don’t want to recommend going down that road.” It’s worth remembering that the French are acting on the basis of a higher rupture rate (the MHRA suggest the rupture rate is lower), and not concerns about a heightened risk of cancer. MHRA commissioned toxicity testing of PIP breast implant filling found no toxicity safety issues and testing by the French has confirmed this. There is also no confirmed link with cancer. Yet, for those with the implants it must be a difficult situation, especially if they see other governments acting differently. If their wasn’t a serious issue, why would the French do this? Some women also do not have the financial means to act on their fears.

I thought about having an operation for years and then in 2007 I took out a bank loan to get the surgery. But now I am in debt as I am not working and can’t pay off these faulty implants.[.]

I am really scared these implants are like a ticking time-bomb waiting to explode.

There are risks associated with breast implant removal, along with the normal risks of additional surgery (infection, risks of general anaesthetics etc) implant removal can lead to an unbalanced look and corrective breast asymmetry surgery might be required. There will also be more noticeable scarring. The FDA have an excellent page on breast implant risks, and that includes the risks of implant removal (May not be safe link for work). Twenty percent of women have breast implants removed within 8-10 years, and without replacement undesirably puckering and sagging can occur. You do wonder how many women are told that figure before implantation.

It is also worth noting that the risk of breast implant rupture is not confined to the PIP implants, but exists with all breast implants.

In France, it is arguable that more women may experience bad outcomes from the attempt to fix the problem, than would if the implants were left in place and the government dealt with the smaller amount of women who might experience a ruptured PIP implant. In France some of the complications of the breast implant removal are being dealt with, they recommend replacement implants as part of the surgery. In Venezuela, where Chavez has called breast enlargement “monstrous”, the government will not offer breast implant replacements, which may lead to an increased risk of cosmetic failure for the women involved.

So the UK government’s stance seems entirely appropriate based on the evidence, and the French response might well increase harm. However,  it is increasingly difficult for difference decisions to be made in different countries. Lack of action in the UK can be depicted as negligent behaviour, when compared to the compassionate response of the French. A UK lawyer for women with ruptured PIP implants sees the French decision as the correct response (ignore the erroneous headline of that news piece, read the text).

What is disappointing appears to be the lack of interest in some of the plastic surgery industry, who appear unwilling to engage with the women concerned:

I belong to a PIP implants support group on social media and I know other women who have the implants – we have been completely abandoned by the private surgeons who have used these implants.

It’s one thing for the government to take an evidence-based stance on the implants, but it would be nice if those organisations who dealt with these women in the first place did appropriate follow-up. That might mean funding surgery in some women in whom the fears cannot be allayed, but in many might only require some open discussion, reassurance and monitoring. The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) have issued a statement suggesting women should “return to their original implanting clinic, but if that is not possible they may choose to consult one of our members.  All BAPRAS members are fully registered plastic surgeons holding the highest qualifications in their field and able to offer objective advice on individual circumstances.” However, they do not cover all plastic surgery, and there is no ABTA-style scheme for plastic surgery as there is for package holidays. That’s particular concerning for those treat their plastic surgery as a package holiday.

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One Response to “Implants: Some thoughts”

Comment from dt
Time 3/1/2012 at 6:59 pm

(Is it BAAPS or BAPRAS?)

Good overview. One point to remember is that those women who have undergone implants for cosmetic reasons alone will have already been counselled and cautioned about the (long) list of complications. The rate for these is fairly low, but presumably was quite acceptable at the time to those who had implants, and they consented to the procedure,in a fully informed manner I trust. Why should these women think they are only now sitting on a “ticking time bomb”, if they were told that these might be a timebomb in the first place?

(My feelings here are coloured by the knowledge that a friend of mine’s wife died after getting septicaemia post surgery for cosmetic reasons).

These women are now in a position where although they may be perfectly well, they think they are not, and want the implants removed/replaced at the taxpayers expense. They may have a higher than expected risk of complications, but I would argue that if so far there have been no complications, then why on earth should the implants be removed? If there is a demonstrable higher risk of malignancy, that might be one reason to act, but unless the implant has ruptured or is leaking (a scan will suffice to tell this) then reassurance is all that is required. This is the rational action, but I am afraid that there will be a significant number of women, many with legal backup, pushing for unnecessary action.