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Implants: keeping abreast of developments

There isn’t an increased cancer risk. We’re uncertain whether there is an elevated rupture risk

January 11, 2012 | By:

With the PIP scandal, it hasn’t been a happy 50th birthday for silicone implants. The artificially enhanced Linda Franklin, 56, gives the facts - and her own reaction

Jonathan Yeo_9

Up to ten million women around the world have had breast implants. Photo of a painting by {a href=”https://high50new.wpengine.com/archives/culture/cosmetic-surgery-yeos-take-on-the-boob-job” target=”_new”}Jonathan Yeo{/a}

With the current crisis over breast implants, some of us who have them are wondering if ours will rupture any day soon and stuff our chests with mattress filling. We might be questioning why we bothered in the first place. So it’s a good time to take the long view and keep our heads – even if we might lose our tits – amid the panic.

Of course it’s wrong if a manufacturer put profit first and used industrial rather than medical-grade silicone in an invasive device. But what about the reality for women with implants? Because, chances are, you don’t know if yours were made by the French company Poly Implant Prothese (PIP) or not.

I had my job done when ‘slim and boyish’ didn’t work as I got older, so I decided to change my proportions. I wasn’t given a choice of implant manufacturer. My options were of type, i.e. silicone gel or saline. I chose the former because I understood the latter can rupture and deflate over the course of an evening, which would be quite disconcerting.

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Surgeons don’t ask patients to decide on the manufacturer of such devices, and the PIP implants had been approved by the Medicines and Healthcare products Regulation Agency (MHRA) for medical use and carried a CE, or medical conformity, mark.

Most of us, then, won’t know if we have a PIP implant inside us unless we’ve already had problems or until we ask our surgeons. But surgeons move and retire, patients move and change names, not all records are kept properly – and so not everyone concerned has already been alerted.

The first steps

I Googled my surgeon and emailed for information. This is a pro-active first step for anyone wondering where she stands (though I’m still waiting for an answer).

Meanwhile, we can comfort ourselves that it’s not just us. Women have been boosting their breasts since Victorian times, at considerable risk to themselves. In 1895, Dr Vincenz Czerny used a patient’s own fat, and in 1899 doctor Robert Gesurny tried paraffin injections to plump things up.

In the first half of the 20th century, surgeons experimented with glass balls, ground rubber, ivory, ox cartilage, synthetic wool, sponges, tape and string wound into a ball. And in the Fifties, 50,000 American women had silicone injections that went lumpy and hard. (These poor guinea pigs had to have mastectomies.)

It was in 1961 that American plastic surgeons Thomas Cronin and Frank Gerow developed, with the Dow Corning Corporation, the first silicone gel implant, with the gel held in a protective membrane. In 1962, they inserted a pair into a Texan woman.

The silicone gel implant is now in its fifties and has been growing ever more popular. In 2011, the US Food and Drug Administration estimated that five to ten million women worldwide have had breast implants. In 2010, the NHS reckoned 8,000 women a year in the UK have the op: it is the most common cosmetic procedure performed on women. It’s popular because we all love breasts, and they’re synonymous with femininity itself.

But 40,000 women in the UK have PIP implants and there is conflicting information about them rupturing more easily due to the low-grade silicone used. Rupture risks have been put at one, five, ten per cent and more.

Evidence review

Such is the concern that Professor Sir Bruce Keogh, the NHS medical director, carried out a review of the hard scientific evidence, which came out late last Friday: “There isn’t an increased cancer risk. We’re uncertain whether there is an elevated rupture risk. We don’t have any evidence to suggest one way or the other – and we’re looking at that.

“The hard evidence we have as to whether or not this gel is more irritant suggests it probably isn’t [but], having said that, we know it’s more liquid.

“Finally [we reviewed] the risks of redoing this surgery. [Taken altogether] we don’t have hard evidence it is unsafe – which of course is not the same as evidence of safety.”

The NHS is offering consultation and treatment for worried women who have had them put in by the NHS – five per cent of the 40,000 affected – and the government expects the private sector to step up and do the same for the rest.

So much, so still-uncertain, really. For my part, it comes down to personal feelings. I’ve heard suggestions that all women with PIP implants should have them routinely removed and, once I know whether mine are or not, I can take a view.

But my initial reaction to that suggestion is: get off my tits! Even it does turn out I have PIP implants, I won’t rush to have them removed, as things are. Since having them, I’ve had plenty more surgery and am wary of the risks every time.

‘I like the contents of my bra’

And I don’t want the disruption to my life. Being realistic, I doubt getting a whole new breast job will readily be offered free of charge by my surgeon, and I wouldn’t expect a cash-strapped NHS to take responsibility. Besides, at the end of the day, I don’t want removal without a suitable replacement. I like the contents of my bra. That’s why I had the op.

While no one expected sub-standard implants, I’ve always known they degrade and that, after ten years, there is a one in ten chance of failure anyway. I have chosen to not worry about that, as I also understood that the body forms its own scar tissue around the implant as protection.

I was warned there is always risk of rupture, so I don’t let anyone squeeze or hug me too hard, and my mammograms are done by someone trained to deal with implants. I have always looked out for signs of trouble, such as pain, redness, lumps and hardening, and was warned that even then you can’t always detect leaking.

So I’m curious to know who made them but not – on the evidence so far – anxious. Sofa stuffing or not, they are a beloved part of me now: I’m not off my tits yet.