Reasonably safe? Breast implants and informed consent

Abstract

ORE than 300,000 women in the United States and many more around the world undergo surgery with breast implants every year, either to replace breasts lost to cancer or to increase the size of healthy breasts. 1 When a woman decides whether to get breast implants, she must consider how that decision will affect her health and her life. Despite dozens of studies published in peer-reviewed journals that indicate implant problems, and informational booklets on implants required to be given to women before surgery in the United States, our non-profit center, the National Research Center for Women & Families,* has received thousands of calls and e-mails in recent years from women all over the world who tell us that their plastic surgeons did not adequately warn them about the risks of breast implants or fully advise them about their options when problems arise. Many women with leaking implants and the pattern of autoimmune symptoms typical of women with such leaks tell us that their physicians assured them that their leaking implants did not pose a health risk and could not possibly be causing their health problems. In this commentary, I will focus on what research tells us about the risks and benefits of breast implants, then discuss what we do not know and consider the informed consent process for women who choose breast implants. Breast augmentation is performed under intravenous or general anaesthesia, and a pocket is created under the breast tissue or muscle. Invented in the 1960s for breast augmentation, and not widely used for either augmentation or reconstruction until the 1980s, breast implants consist of silicone envelopes filled with silicone gel or saline. The patient is told to wear a surgical bra for about two weeks and avoid strenuous exercise for 4–6 weeks.