About 80% of silicone breast implants are for cosmetic purposes, and 20% for breast
reconstruction after surgery, mainly for cancer. A review of their safety [1] does
not include details of any formal searching. Women who have breast implants, perhaps
reflecting the fact that they are predominantly for cosmetic purposes, are different
from their sisters who do not have implants. They are much less likely to be obese,
drink more, be younger at first pregnancy and first birth, have a history of
terminated pregnancies, to have used oral contraceptives, have more sexual partners
and use hair dyes.
The finding of high levels of silicone in women with implants does not substantiate
a causal relationship between silicone and reported disease. Silicone is a common
mineral, and is used in food, beverage and cosmetic industries. It is used in
medicine, and over a lifetime an insulin-requiring diabetic may inject up to 50 grams
of silicone, and have substantial bodily exposure to silicone. Some of the suspected
problems with silicone breast implants have been looked at in detail:
Capsular contraction
Formation of a capsule around an implant is part of the inflammatory response to a
foreign body. Contracture of the capsule results in moderate to extreme hardening of
the breast, tightness, pain or deformity. The overall incidence was 17% in 1454
breasts in 749 women, with five-year rates of 12%, 34% and 30% for cosmetic, cancer
or cancer prophylactic surgery. It also occurs with saline implants.
Implant rupture
The proportion of implants expected to be intact is 89% after eight years, falling
to 5% after 20 years (Figure).
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Cancer
No epidemiological study has found an increased risk of breast cancer in women
with breast implants compared to those without.
Interference with breast cancer detection
Current advice from the American College of Radiology says that adequate breast
examinations can be achieved with currently available mammographic techniques.
Autoimmune disease
The paper examines the association of silicone with immunological reactions and
links with connective tissue disorders. The epidemiological information was
almost universally negative. One, large, study of health professionals found a
very small, statistically significant increased risk of connective tissue
diseases in women with breast implants. The weight of evidence was against the
implants causing any generalised disease.
Comment
This paper is let down because it does not have a search strategy, although
there are 77 references. For anyone wanting to find the best information for
themselves or patients on risks associated with breast implants, this would be a
good place to start.
Reference:
- PC Gerszten. A formal risk assessment of silicone breast implants.
Biomaterials 1999 20: 1063-1069.
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