The decision of whether to get breast implants is an especially difficult
one for mastectomy patients. There are risks and benefits, and if you know
what they are, you can make a reasonable decision that makes sense for you.
If you have not yet had a mastectomy, it's important for you to know that
for about 80% of the women newly diagnosed with breast cancer in the U.S., a
lumpectomy with radiation is just as safe as a mastectomy. Unfortunately,
many women who have mastectomies are not fully informed about lumpectomy as
an option. This is especially true for women in the South and West, as well
as women with older doctors or who are treated at community hospitals rather
than university-based hospitals.
If you've already had a mastectomy, then you have several choices in
addition to breast implants:
- No reconstruction, and see how you feel.
- Reconstruction with your own tissue, in conjunction with a "tummy tuck" or
other procedure, where tissue is moved, while still attached and "alive" from
one part of your body to another. These are called "autologous tissue
transfer" operations, and are thought to last a lifetime. There are several
different kinds. This kind of surgery is more time-consuming, expensive, and
has more risks in the short-term because it is more complicated than implant
surgery. The safety of this kind of surgery is especially dependent on the
skill of the surgeon, but there is some evidence that there may be more
problems with fat necrosis (the transferred fat tissue dying) for women who
smoke. Many women are very happy with the results, because it is "really
their own body" but there are no studies of large numbers of women to
determine how safe these surgeries are for most women.
There are two kinds of implants:
- silicone gel breast implants
- saline-filled silicone breast implants
Silicone gel breast implants have never been "approved" by the FDA as
safe or effective, and there are few published studies regarding their use by
mastectomy patients. One of the reasons why gel implants are considered
riskier than saline, is that when they break, the silicone gel can migrate to
other parts of one's body, including the arm or even to vital organs.
Silicone gel implants are available to mastectomy patients who are willing to
participate in research designed to evaluate their safety. Given your
concern about safety, silicone gel seems the most risky of your options.
Unfortunately, very little is known about the long-term safety of saline
breast implants. All breast implants have a silicone "envelope" but saline
implants are filled with salt water, whereas silicone gel implants are filled
with silicone gel. Saline breast implants were recently approved by the FDA,
but with many caveats suggesting that the long-term safety and effectiveness
is in doubt. For example, approximately three out of four mastectomy
patients reported at least one complication during the first three years of
having a saline breast implant. These complications included infection,
pain, hardness, and the need for additional surgery.
All surgery for breast implants, whether silicone gel or saline, has
risks. These include the risk of infection, hematoma (blood or tissue fluid
collecting around an implant), the risk that one or both of the implants will
have to be removed (requiring additional surgery), and the potential costs of
repeated surgeries if the implants are replaced. Mastectomy patients seem to
have more problems than augmentation patients.
All breast implants will eventually break, but it is not known how many
years the saline breast implants that are currently on the market will last.
Studies of silicone breast implants suggest that more than half break within
6-10 years, and more than 80% break within 15 years. Some break during the
first few months or years, and some last more than 15 years. It is expected
that saline implants will last a similar number of years.
There are other well-documented "local complications" that can result
from breast implants. For example, all implants are "foreign bodies" and the
woman's body reacts by forming a capsule of scar tissue around the implants
that can become too tight for the implant. If that happens, the breasts can
become very hard, misshapened, and painful as a result, which can result in
having the implants removed and/or replaced. This "capsular contracture" is
a common problem, although there is no general agreement about how common it
is or how many women consider it a serious problem.
The published epidemiological studies have not proved that systemic
disease is caused by breast implants. However, some mastectomy patients
believe that the illnesses that resulted from their implants caused them more grief than the breast cancer.
Several researchers have shown that bacteria can grow in the saline
implant, and have expressed concerns about those bacteria being released into
the body if the implant breaks. No research has ever been done to determine
what the risks are if a contaminated implant breaks.
Dear Ms. Zuckerman,
I have been recently diagnosed with breast cancer and it seems that a mastectomy
may be a solution. I am worried about losing my femininity and wonder if you can give me some advice on what you think of breast implants post-mastectomy.
The decision of whether to get breast implants is an especially difficult
one for mastectomy patients. There are risks and benefits, and if you know
what they are, you can make a reasonable decision that makes sense for you.
