Breast implant story

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Wednesday, October 29, 2003

Forty per cent of women who responded to a Canadian survey of breast implant patients, asked to have their implants removed because of complications -- a figure that surprised even the researchers. Women who had breast implants were also more likely to visit doctors and specialists and were four times more likely to be hospitalized than women without the devices, the study found.

It is estimated that up to 200,000 women in Canada have breast implants. About 80% are performed for cosmetic augmentation, the remainder for reconstruction following breast-cancer surgery.

"This [cosmetic breast surgery] is a privately funded intervention -- women pay for it initially -- but when there are complications, it's the public system that bears the brunt of the financial burden," says Aleina Tweed, a surveillance epidemiologist with the B.C. Centre for Disease Control and lead author of the study, which was supported by the British Columbia Centre of Excellence for Women's Health.

Dr. Tweed stressed the study does not prove a cause-and-effect link. "This wasn't a study to lead us to say that because women got breast implants, they got sick, or they had problems. But, there is obviously something going on that is affecting their health, or women whose health does not support having a breast implant are still being given them."

The study comes as critics brace for the possible return of silicone-gel filled breast implants to the open market in Canada, and at a time when breast implants appear to be more popular than ever.

Two weeks ago, a U.S. Food and Drug Administration advisory panel voted in favour of lifting a ban on silicone-gel breast implants. The controversial devices were pulled from the market in the United States and Canada in 1992, following reports linking them to arthritis, vascular disease and a range of autoimmune disorders. Currently, the implants are available in Canada only through the government's special access program, but at least one manufacturer is seeking Health Canada approval to make its implants widely available.

"We're very concerned because we know Health Canada pays attention to what goes on at the FDA," says Kathleen O'Grady, of the Canadian Women's Health Network.

The B.C. researchers are calling on Health Canada to create a national breast implant registry to track the long-term health risks of the surgery and to more quickly alert women to potentially faulty devices. Several countries, including the United States and the U.K., have such registries. Dr. Tweed checked the health records of 147 consenting women in B.C. who had breast implant surgery using either a saline or silicone-gel implant. Almost two-thirds had silicone-gel implants as their first set of implants. The women were compared with 583 women in B.C. whose anonymous health records were chosen at random and who were believed not to have had implants.

Dr. Tweed found women with breast implants were about four times more likely to be admitted to hospital over the 11-year study period, and significantly more likely to see doctors, chiropractors, massage therapists, anesthesiologists and other specialists.

Women with implants were more likely to be hospitalized "electively," as compared with an urgent or emergency case, and they were more likely to see general and plastic surgeons when they went into hospital. For example, 21% of the women with implants saw a plastic surgeon, versus 2% for women without implants.

Of the breast-implant group, 92 women agreed to answer questions about their experience. Half reported having one additional breast-implant related surgery; 23% had two; 28% had three or more. Thirty-seven of the women, or 40%, had their implants permanently removed.

"It's an astonishingly high number," Dr. Tweed says.

Scar capsules can form around breast implants, which can cause breast hardness and pain. Implants can also deflate, rupture or leak. There were no significant differences in hospitalizations between the women who had saline implants and those with gel-filled implants.

Most of the women who completed the questionnaires rated their health as "excellent" or "good" compared with other women their age.

However, half had been diagnosed with at least one chronic illness, and one-third "felt that they had lost or quit their job or reduced their hours because of health problems," the study says. Most said the problems started after they got their breast implants.

Ottawa plastic surgeon Dr. Bryan Callaghan, who has been in practice for more than 20 years, says it is "very uncommon" for cosmetic surgery patients to have their implants removed. "It's an extremely small number." He also noted that, during the "silicone-gel phobia" in the early 1990s, many women had their silicone implants replaced with saline ones, "largely for peace of mind."

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