Patient Questions

QUESTION

Should I Not Get Breast Implants Due to my Family History of Breast Cancer?

I am in my 50's and my breasts are "sagging" but I do not want the scars associated with a lift. Is there a problem with getting either a saline or silicone implants with regards to an increased breast cancer risk? Is it better in this case to go under the muscle? My mother developed breast cancer in her 70's. Is that a reason I should not get implants?

ANSWER

Breast implants and cancer risks

Thanks for your question.

I am not aware of any CURRENT data the unregistered poster marlene sorma is referencing that supports her position; the NCI data from the 80s did find a statistically insignificant finding that masses might be detected later but this has been countered by more recent studies.

Every current study I know of actually supports the fact that women with submuscular implants (90% of the implants done today) actually detect palpable breast masses EARLIER than women without breast implants.

The reason for this has been debated (do women with breast implants pay more attention to their breasts? Do breast implants make the mass easier to palpate?).

In addition - since this is an important topic - let's review the data... from NCI (the NCI data still remains one of the largest studies regarding this topic) -

In 1992, researchers at the National Cancer Institute (NCI) initiated a study on the long-term health effects associated with breast implants. It is estimated that between 1.5 million and 2 million women in this country have had breast implants since they first appeared on the market in 1962.

One of the longest and largest studies to date on the health effects of implants, the NCI report involves 13,500 women with an average follow-up time of 13 years.

*Most previous investigations have looked at the health effects over a shorter time period, typically less than 10 years, and have been too small to evaluate uncommon diseases.*

The purpose of the study is to evaluate the effect of implants on the risk of:

* Developing breast cancer; * Developing cancers other than breast; * Dying from all causes of mortality; and * Developing connective tissue disorders.

Before we get to the results let's debunk some of the conspiracy theory arguments before we even hear them...

Because of the highly controversial and political nature of the study, maintaining objectivity was a particularly important issue. The following steps were taken to ensure scientific objectivity:

* The study was funded entirely by the government, not by plastic surgeons, implant manufacturers, or other special interest groups.

* Government scientists, not manufacturers of implants or plastic surgeons, designed and provided scientific oversight for the study.

* To participate in the study, plastic surgeons had to agree to allow investigators to see all of their records, not just records for selected patients. The investigators obtained detailed information on factors which could affect health status.

The Results

* The NCI researchers found no association between breast implants and the subsequent risk of breast cancer.

In addition, they found no link between breast cancer risk and number of years of follow-up, nor with any particular type of implant. There was no significant difference in breast cancer mortality between the implant and comparison patients.

Reference: Brinton LA, Lubin JH, Burich MC, et al. Breast Cancer Following Augmentation Mammoplasty (United States). Cancer Causes & Control 2000; 11(9):819–827.

* Women with breast implants were not at an increased risk for connective tissue disorders when their records were reviewed by two independent rheumatologists who did not know if the women had an implant or not.

According to initial reporting by an implant patient questionnaire, there appeared to be a two fold increased risk for developing rheumatoid arthritis, scleroderma, systemic lupus erythematosus, and Sjogren's syndrome in this population. NCI researchers were able to access only 34–40% of these patients' records who reported being diagnosed with a connective tissue disorder. When these records were reviewed by two independent, board-certified rheumatologists who did not know if the patient had an implant or not, the rheumatologists found between 17–30% of the diagnoses likely. As a result, the risk for developing a connective tissue disorder due to breast implants, while still somewhat elevated, became statistically non-significant. Further research including records linkage, standardized diagnostic criteria for rheumatoid disorders, and clinical exams, is needed to understand if a relationship exists.

Reference: Brinton LA, Buckley LM, Dvorkina O, et al. Risk of Connective Tissue Disorders among Breast Implant Patients. American Journal of Epidemiology; 2004;160; 619–627.

The NCI study reviewed patients implanted BEFORE 1989. Subsequent studies have supported the NCI findings as well as amplified on other issues (such as palpable breast masses being easier to detect with subpectoral implants @marlene sorma) - in addition, these are complicated scientific questions... even if you (wrongly from the literature I've reviewed) assume that you detect a palpable mass later - there's no change in mortality or morbidity associated meaning that the consequence of that later finding may not matter at all (again from the literature I've reviewed).

In our San Francisco area office we consistently stay current with the literature and take the time to discuss these issues with our patients. Be sure your plastic surgeon does the same for you! Like anything in medicine - these are complicated issues because human beings are complicated!

I hope this helps.

It's a lot of data and this is just the tip of it but hopefully it gives you a place to start...

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