"Junk Doctors?" "Junk Reports?"

Date: Thu, 2 Sep 1999 06:46:57 -0500

From: "Ruby Bartlett"

About 24% Complication Rate Found Among Breast-Implant Patients

By Peter Modica

[Medical Tribune: Family Physician Edition 38(7): 1997. © 1997

Jobson Healthcare Group

Nearly one in four women with breast implants experiences localized complications that require additional surgery, according to a study of 749 women who received implants between 1964 and 1991.

After five years, the rate of complications was significantly higher for women who had implants following mastectomy for breast cancer (34%) and for prophylactic mastectomy (30.4%) than for women who had cosmetic implants (12%), researchers led by Sherine E. Gabriel, M.D., M.Sc., of the Mayo Clinic in Rochester, Minn., reported in The New England Journal of Medicine (1997;336:677-682).

Tissue damage caused by a mastectomy, along with the effects of radiation and chemotherapy, can increase the risk of breast-implant complications in these women, according to breast-implant experts.

Complications, which occurred in 23.8% of patients, included capsular contracture, implant rupture, hematoma, wound infection and wound seroma, Dr. Gabriel and colleagues reported.

Capsular contracture accounted for two-thirds of the complications, the researchers reported.

Of the 749 patients, 532 had cosmetic implants, 125 had implants after mastectomy for breast cancer and 92 after prophylactic mastectomy.

In the United States, as many as 2 million women have undergone breast implantation, the researchers noted in their report.

But "this report shouldn't alarm anyone, especially the cosmetic patients," because the rate of complications was fairly low in this study, said David L. Larson, M.D., professor and chairman of plastic and reconstructive surgery at the Medical College of Wisconsin in Milwaukee.

"These are local wound complications not related to the type of implant [used] or to the systemic problems traditionally associated [with implants] in the past," Dr. Larson said.

Though capsular contracture can make the breast "look unnatural, feel unnatural and, in some instances, can cause discomfort that is bothersome," it is a "benign problem and not one that will cause illness," Dr. Larson said.

Stephen J. Mathes, M.D., professor and head of plastic surgery at the University of California, San Francisco, School of Medicine, agreed.

"The formation of a collagenous sheath around the breast implant is a normal physiologic response to a nonbiodegradable foreign body," Dr. Mathes wrote in an editorial accompanying the report by Dr. Gabriel and colleagues.

"Capsular contracture may be considered a complication when the extent of breast distortion or firmness causes the patient to become dissatisfied with the surgical results," he wrote.

Despite the risk of capsular contracture, most patients express satisfaction with cosmetic implants, Dr. Mathes commented.

John William Little III, M.D., a clinical professor of plastic surgery at Georgetown University School of Medicine in Washington, D.C., concurred, noting that in a previous survey, 95% of women with implants were satisfied and said that if they had to decide again, they still would elect to have implants.

"Anyone who uses breast implants today must let their patients know that there is a maintenance issue involved," and that some long-term problems can occur, said Dr. Little, who also is the past president of the Plastic Surgery Educational Foundation, a research and education arm of the American Society of Plastic and Reconstructive Surgery.

Breast implantation "isn't a perfect alternative to keeping the breast, but as a compromise, it works well for many women," he said.

These risks also have been significantly lowered over the last decade with the newer implants, he added.

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