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Silicone Implants Preferred After Mastectomy

Breast Cancer Patients Increasingly Choosing Silicone Over Saline for Breast Reconstruction, Study Finds
By
WebMD Health News
Reviewed by Laura J. Martin, MD

Nov. 8, 2010 -- Despite their troubled history, silicone implants are back and breast cancer patients are increasingly choosing them over saline for breast reconstruction. 

Now a new survey finds that women who opt for silicone implants following mastectomy tend to be happier with their reconstructed breasts, although satisfaction with both types of implants was high early on. 

Women who had radiation following mastectomy were less happy with surgical outcomes overall, and women with implants regardless of the type tended to become less satisfied with their reconstructed breasts over time. 

Memorial Sloan-Kettering Cancer Center reconstructive surgeon Colleen M. McCarthy, MD, who led the study, says the findings will help doctors counsel patients facing breast reconstruction. 

“We have suspected that most women like the look and feel of silicone a little bit better, but now we have the data to show it,” she says. “We can say, ‘This is what women who have been through this are telling us.’”

Silicone Concerns Remain for Some

But that doesn’t mean silicone is the best choice for everyone, McCarthy adds. 

The message to breast cancer patients with concerns about the long-term safety of silicone is that satisfaction with saline implants was also high, she says. 

Introduced in 1968, silicone implants were widely used until 1992, when they were banned by the FDA amid fears that they caused lupus and other auto-immune diseases. 

These fears were not borne out by the research, and the FDA lifted the ban in November 2006. 

In the four years since, silicone has once again become the most widely used implant for breast augmentation and breast reconstruction following mastectomy.

Industry analyst Global Markets Direct predicts that silicone implants will account for 90% of the breast implant market in the United States by 2015, up from 30% in 2007. 

McCarthy says even though the evidence found silicone implants to be safe, many breast cancer patients still don’t want them. 

She says in her own practice, about 50% of patients choose saline implants even after they are told the cosmetic outcomes may be slightly better with silicone. 

“The quote I hear over and over is, ‘I just don’t need anything else to worry about,’” she says. “The FDA said silicone implants are safe and we believe that as well, but patients have to feel comfortable with them. It is their choice.”

Silicone or Saline? Patient Should Choose

And one important question about the safety of silicone implants remains unanswered, McCarthy says.

“No one has ever done a study to examine what happens if a woman has a leaking silicone implant for a long period of time, and, of course, that study will never be done,” she says.

Because implant ruptures are usually not felt, women who have silicone implants are advised to have MRI screenings beginning three years after the initial implant surgery and every two years thereafter to look for ruptures.

The newly published report included about 500 women who had had reconstruction following mastectomy one to eight years before completing a survey designed to explore satisfaction with their reconstructed breasts.

The survey revealed that women who had radiotherapy after having their breasts removed were the least likely to be satisfied with their reconstructed breasts, no matter which implant they had.

This comes as no surprise to American Society for Aesthetic Plastic Surgery president Felmont Eaves, MD, who practices in Charlotte, N.C.

“After radiation, it is much harder to get a satisfactory result,” he tells WebMD. “There is likely to be scar tissue, which impacts outcomes. And there is a higher incidence of complications.”

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