What to Do With Aging Breast Implants

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What to Do With Aging Breast Implants

By Searing

HealthDay Reporter

SUNDAY, March 26 (HealthDay News) -- For the estimated

three million American women with breast implants, one

thing remains certain: At some point, they will need

to be replaced or removed.

Breast implants do not last forever -- whether they

are filled with silicone gel or saline, or whether

they were done to reconstruct a breast after a

mastectomy or to augment the size or shape of a

breast.

Knowing just when that time has come, however, and

what to do if you suspect it has, is not always

simple.

Fuentes, 77, of Potomac, Md., a retired attorney

and co-founder of the National Organization for

Women, encountered that conundrum last year when she

suspected problems with the silicone-gel implant she

had gotten 15 years earlier after a mastectomy. She

thought it had hardened and gotten smaller and feared

it was leaking.

She consulted her oncologist, the surgeon who had

performed the mastectomy and the plastic surgeon who

had performed the implant, and she also scrolled the

Internet for background. But opinions and advice were

conflicting:

Get a mammogram to see if the implant has ruptured,

one doctor suggested.

Don't get a mammogram, a women's Web site warned, as

the compression could cause the implant to break.

Have an MRI, the FDA urged on its site, noting that

that's the best way to detect a rupture.

An MRI wasn't necessary, another doctor told her.

" The quality of advice people get is very spotty, "

said Dr. Spear, chief of plastic surgery at

town University Hospital in Washington, D.C.,

and immediate past president of the American Society

of Plastic Surgeons.

So what's a woman to do?

Anyone concerned about an implant should " start off by

seeing a doctor, a plastic surgeon " preferably, Spear

said. If the original surgeon cannot be reached or the

woman is uncomfortable with the surgeon's opinion, he

recommended going to a clinic that specializes in

implants or finding a plastic surgeon associated with

a university.

That's when Fuentes' saga really began. First she

consulted the doctors who had treated her initially.

" All of these doctors are top guys, " she said. " I had

a lot of respect for them. " But, she said, two of them

" said to me, 'Your breast hasn't changed,' " which she

considered " a little presumptuous. "

She also was not comfortable with their nudging her to

have a mammogram, given what she had read on the

Internet and heard from friends.

" You've got to learn to go with your gut, " Fuentes

said. " But so many women, if a doctor tells them

something -- that's it. "

Fuentes insisted on an MRI, her doctor relented, and

the MRI revealed a ruptured implant.

She asked a plastic surgeon in Cleveland to remove the

implant, replace it with a saline version and

reconfigure her breasts to ensure symmetry. But she

said the surgeon insisted on an ultrasound of the

implant beforehand, an option no one else had

proposed. It, too, showed a rupture, and the surgery

went on as planned.

Dr. Michele Shermak, chief of plastic surgery at s

Hopkins Bayview Medical Center in Baltimore, said she

also uses ultrasound to evaluate implants.

" A mammogram, like any plain film X-ray, is not good

at seeing soft-tissue problems, " Shermak explained.

For detecting breast cancer, the American Cancer

Society recommends regular mammograms, and Shermak

indicated that advice should apply to women with and

without implants. " Compression should not be a

problem " for women with implants, she said.

But for detecting possible rifts in an implant,

" mammograms are really not the best way to go, " she

said.

" Ultrasound is usually the first test that I'll do, "

Shermak said. She described it as " easy technology "

and a test that most medical offices could perform.

" MRI would be the next step, " she said. " The MRI is

very good, very specific, very sensitive. " She

described it as " almost too precise in some cases " as

it tends to detect " any little thing that looks a

little bit abnormal. "

In Fuentes' case, however, the MRI and ultrasound were

on target. Her surgery took 4-1/2 hours, in part

because " the implant had collapsed and had silicone

all over it, so it was difficult to remove, " Fuentes

said she was told by the surgeon.

Saline leaking from a broken implant appears to pose

no danger, but opinions differ on the effect of

escaping silicone.

If silicone leaks, " the body walls it off, " Shermak

explained. " The body normally develops scar tissue to

things it doesn't see as itself. The scar tissue

effectively becomes a shell around the implant. "

However, Spear said that " the risk of it even locally

causing mischief is pretty low. "

Both surgeons said that for any woman unnerved by

those thoughts or having other fears about an implant,

removing the implant is usually the appropriate

option.

" You only need to treat or remove the implant if the

patient is symptomatic, " Shermak said. " But I would

never say 'don't do it,' if that's what the woman

wants. "

More information

To learn more about breast implants, check the U.S.

Food and Drug Administration's Breast Implant and

Consumer Handbook.