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June 16th 2008- I used to have a section here on this web site that told the gruesome tale of my 2nd mastectomy & reconstruction
done by Leiterri's plastic surgery office in Spartanburg. First let me say this, this man is an arrogant know it all. If you
have a stage iv bc dx, he doesn't really want to do this surgery for you. Hell, what's the point you're good as dead, right?
WRONG, I managed to get a pitiful job done out of him and lived with that botched job for almost 4yrs. He did stupid things.
Leaving too much room and stretching the one side to over a C cup. The orig mastectomy side was too tight to ever hardly get
past a B which was fine with me. Did he think I wanted at least one D sized boob to be happy? Did he ask. No, he just did
what he wanted to do. I wanted saline, he sold me on silicone. OMG!!!! What a mistake. I trusted him. Doesn't everyone trust
a KNOW IT ALL SNOB? This story goes on. But I'll spare you, the reader, of my grumble of something I can't change now. I do
want you to know this. Scar tissue forms around loose silicone and causes more unecessary pain. It has made some people very
sick. But I guess it's still on the market because it hasn't killed anyone. It almost killed me. While I was having this crap
cleaned out of my chest, an artery was nicked. I was rushed back into the OR and that was repaired. I spent an extra couple
of days in the ICU getting blood. My surgeon was wonderful. He appologised for his mistake, treated me as an equal and that
made a world of difference. I'm finding I prefer the more down to earth less arrogant folks. They remember your face. Waiting
rooms are smaller. The first one I ever had work on me had put me in remission for going on 5yrs. My current Onc at the ever
growing Spartanburg Cancer Center doesn't give me that special care. Even though they boast being part of the Houstan Texas's
Team, they can't get their communications together. I've read my reports about things I didn't say. It was a nurse's accident
that let the "cat out of the bag" about my ruptured implant. That little thing they forgot to tell me about when
they told me my last PET scan, 6months ago, was fine. Who's PET scan were they reading. My next self venture is gonna be into
the uptake they saw in the scan in my liver
An Article my mom sent me after my ordeal with these issue. My Pet scan did reveal an area of uptake in my liver too. The
Pet Scan was back in 12/08. I just got having implants removed 6/13/08
Silicone breast implants: correlation between implant ruptures, magnetic resonance spectroscopically estimated silicone
presence in the liver, antibody status and clinical symptoms
D. T. Sharpe
Plastic Surgery Unit, Bradford Royal Infirmary, 9 Duckworth Lane, Bradford BD9 6RJ, UK
The controversy regarding the potential harmful effects of silicone from breast implants has been raging for over 10 yr.
During this period this has led to a great number of medical papers, many of which had political, social and legal bias. Indeed
at the height of the controversy, despite being peer reviewed, many papers were published that came from two clearly identifiable
camps. On the one hand the rheumatologist with a legal vested interest and Food and Drugs Administration (FDA) employees anxious
to justify their position, and on the other hand plastic surgeons backed by breast implant manufacturers with a clearly financial
vested interest.
At last, however, we are beginning to see papers which are soundly based on epidemiological studies of enormous size [1]
and studies based on the life expectancy of the modern breast implant [2].
It is still quite difficult, however, to sort out the truly neutral paper from the biased cohort of patients assembled
via attorneys with claimed medical injuries. Equally plastic surgeons and implant manufacturers in the past have been guilty
of bland assumptions of no harm based on little more than anecdotal evidence and poor audit of results.
A clear pattern is beginning to emerge. First of all, there is no clear silicone-induced connective tissue disorder associated
with breast implants and this has been established by independent agencies such as the American Medical Association, the Independent
Review Group, the Institute of Medicine and Judge Pointer's Scientific Panel.
Local complications and symptoms due to capsular contracture, localized silicone leakage and the deficiencies of the implant
shell causing palpable irregularities have become the main issues. Rheumatologists, I am sure, will agree that there is a
group of women, typically of the age range of Gaubitz's paper [5], who suffer from vague aches and pains, lethargy and depression,
that has coincidentally become associated with the presence of breast implants, which has given rise to the concept that silicone
gel can cause a multiplicity of symptoms. The scientific evidence for the connection is such that silicone gel could be regarded
as just as likely to protect against these symptoms as responsible for causing them, yet the very vagueness of these symptoms
should not necessarily be a reason to dismiss them. An investigator should be ever vigilant to ensure that silicone itself,
or the associated factors of its implantation into the body, does not indeed cause some pathology of sort.
Gaubitz's paper [5] is notable in that it demonstrates quite clearly that silicone does leak from breast implants, that
54% of women having ruptured implants have detectable silicone in the liver, as well as finding it in the livers of 22% of
patients who did not have a ruptured implant. Control patients, who for many years have had renal dialysis using silicone
tubes, did not appear to show evidence of deposition in the liver. The mechanism whereby this silicone is transmitted is not
due to the soluble nature of silicone, which is hydrophobic, but to the phagocytic engulfment of minute droplets of silicone
in and around the breast capsule which are transported via the natural lymphatics and bloodstream to the liver where death
of the macrophage leaves a minute droplet of silicone. Over time this accumulation can clearly be demonstrated by stimulated
echo acquisition mode (STEAM) magnetic resonance (MR) spectroscopy.
The paper [5] also shows that antinuclear antibody (ANA) positivity is no indication of ongoing autoimmune process in
women with silicone breast implants, as the rate of ANA positivity was comparable in the control group of breast cancer patients
and those with hormone substitution. Twenty-four patients (26.6%) had MR documented implant rupture. MRI scan is the investigation
of choice for determining the intact status of silicone gel breast implants [3]. However, the average age of implants investigated
was over 9 yr, and this means that the majority of these would belong to a second generation of implants, i.e. those with
a thinner shell which have a much higher incidence of rupture compared with the modern third generation implants with a low
incidence of rupture [4]. There is, however, no evidence that the modern third generation of implants does not still leak
significant amounts of silicone and one cannot assume that, were the study to be performed on patients with modern implants
at a time equivalent to 9 yr following implantation, that a similar incidence of hepatic silicone would not be found.
However, the main conclusion of Gaubitz's paper [5] is in my opinion valid in that it finds no difference between the
incidence of hepatic silicone in both ruptured or non-ruptured implants. Fifty per cent of the patients who underwent the
implantation of breast implants were post-mastectomy patients and in this case the implants were placed under the muscle and
are more subject to trauma and a much higher incidence of rupture [4]. This would also account for the patients with nodules
and wrinkling localized close to the silicone breast implant as the absence of breast tissue overlying the implant makes these
findings more easy to detect [4]. The high incidence of complaints of arthralgias, myalgias and tingling and numbness of the
fingers which appeared in the questionnaires of the 90 patients of this study may be accounted for by the fact that nearly
40% of the women were members of an association of ‘silicone damaged women’. This must indicate a degree
of selection bias as in the UK the membership of similar groups is of the order of a thousand compared to a total population
with implants of approximately 250 000. I would be a lot more comfortable in assessing the validity of Gaubitz's paper [5]
if I knew precisely which criteria were used for patient selection, and whether patients were selected from a large cohort
of breast reconstruction and augmentation patients taken at random.
Overall the paper is reassuring to those of us still using silicone gel breast implants as it shows that the obvious psychological
and self-esteem benefits of the use of silicone breast implants in post-mastectomy patients and those wishing for augmentation
are not counter-balanced by a significant morbidity of patients suffering from the effects of silicone damage. It does, however,
point to the need for establishing the true benefits to patients of breast reconstruction and augmentation in each case, so
that these can be properly juxtaposed against potential harm and long-term effects. No one should have breast implants as
a fashion accessory, equally the ability to rebuild and enhance the sexuality of disadvantaged women is a choice that must
remain open in a free society.
References
1. Hennekens CH, Lee IM, Cook NR et al. Self-reported breast implants and connective-tissue diseases in female health
professionals. J Am Med Assoc1996;275:616–21.[Abstract]
2. Peters W, Smith D, Lugowski S. Failure properties of 352 explanted silicone gel breast implants. Can J Plast Surg1996;4:55–8.
3. Dobke MK, Middleton MS. Clinical impact of breast implant magnetic resonance imaging. Ann Plast Surg1994;33:241–6.[ISI][Medline]
4. Collis N, Sharpe DT. Silicone gel-filled breast implant integrity: a retrospective review of 478 consecutively explanted
implants. Plast Reconstr Surg2000; 105:1979–85; discussion 1986–9.[ISI][Medline]
5. Gaubitz M, Jackisch C, Domschke W, Heindel W, Pfleiderer B. Silicone breast implants: correlation between implant
ruptures, magnetic resonance spectroscopically estimated silicone presence in the liver, antibody status and clinical symptoms.
Rheumatology2002;41:129–35.[Abstract/Free Full Text]
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