Institute of Medicine issues implant report

The safety and efficacy of breast implants was called into question in 1991 with a frenzy of media activity. Now the much-awaited final report on the safety of breast implants has been released after more than two years of investigation.

The Institute of Medicine of the National Academy of Sciences finally released its 440-page report at the request of the Congress of the United States. This landmark report states, "Women with breast implants are no more likely than the population at large to develop cancer, imunologic disease or neurologic problems."

They further stated that implants pose no threat in breast-feeding or to unborn babies, and there is no plausible evidence of any autoimmune diseases related to the implants.

Breast augmentation is a surgical procedure to enhance the size and shape of a woman's breasts. This may be done for a number of reasons:

To enhance the body contour of a woman who feels that her breasts are too small.

To correct a decrease in breast volume after pregnancy.

To balance a significant difference in breast size.

As a reconstructive technique following breast surgery.

There are two major types of breast implants. The first is a silicone shell that is filled with a saltwater solution known as saline. The second is a silicone gel. A third type of implant is a combination of the two.

The Food and Drug Administration has determined that gel implants, at the present time, should only be available to women participating in approved studies.

Breast augmentation is a relatively straightforward surgical procedure. Any surgical procedure carries attendant risks and specific complications. The major problems with breast implants are local and not life-threatening complications. These problems include implant rupture or deflation, capsule contracture, and, rarely, infection or pain.

Some women may develop secondary problems, such as severe capsule contracture, which would necessitate implant removal. Implants are man-made and will not last forever. The risk is cumulative over time, and many women should anticipate the need for having more than one implant in their lifetime.

Most implant companies offer some kind of replacement policy or lifetime replacement of implants if needed.

Some women report their nipples become oversensitive or under-sensitive. There may be small patches of numbness around the incision, but most of these symptoms will disappear with time and only rarely are permanent.

When planning breast augmentation surgery, the condition of the breast and skin tone are assessed. If the breasts are sagging, there may be a recommendation for a breast lift. The surgical procedure will be described to you, as well as the type of facility at which the surgery will be performed and the costs that are involved.

Most insurance companies do not consider breast augmentation to be medically necessary; therefore, they do not generally cover the costs of this procedure.

When looking for a plastic surgeon, I recommend that the surgeon be certified by the American Board of Plastic Surgery. This guarantees that the individual has graduated from an accredited medical school, has had at least five years of a surgical residency, has passed comprehensive oral and written exams and has been in practice for more than two years.

I would also recommend that the plastic surgeon be a member of the American Society or Plastic Surgeons. You will also need to be comfortable with your plastic surgeon and the information you have received during your consultation.

For many women, the results of breast augmentation are exceedingly satisfying. Regular examinations and routine mammography for those in the appropriate age group at the prescribed intervals are recommended for health maintenance.

The decision to have breast augmentation is a highly personal one. The most important thing is how you feet about it. When you have met your goals, your surgery is a success.

(Rosellen Meystrik, MD, FACS, is with St. John's Physicians and Clinics.)