Glamour magazine article of November 2000

Picture the following imaginary scenario. You are thinking about having a baby. You imagine how enjoyable it will be to have a child, watching the growth and progress through the years. And then one day you pass a magazine rack and spot a fashion magazine cover announcing: "Pregnancy Horror Stories! Why women are opting out!" and so you open it up and read about a few women who ran into health problems, with graphic depictions of their very unhappy experiences with their pregnancies. The article leaves you with the impression that those problems happen to a lot of women. Although you would like the benefits of having a child, you think to yourself: "Well, those things won't happen to me if I don't get pregnant." And you decide against it.

The article in question is comparable in some ways, and warrants some amplification, much discussion, and some corrections. There are several points that I want to establish here:

1. I do not intend to criticize the magazine or its publishers for printing the article. Fashion magazines are not investigative journals; their staff cannot be held to that high standard. They exist to sell magazines for their advertisers, not to resolve complex medical issues. Yes, it is strange that a magazine devoted to women's appearance issues would publish an intensely negative article about breast enhancement, but a scary article does boost circulation. It is unrealistic to expect fashion magazine editors to verify that every article is correct and presented with complete balance, and even unreasonable to expect them to avoid cheap sensationalism. For that reason, I think there is no need to write letters to the editor complaining about the misinformation and bias in this article.
2. Although the article contains multiple inaccuracies and distortions, I do not blame the author. I do not believe she wrote it with any intent to mislead or deceive. An inappropriate choice of words, or two phrases unwisely placed side-by-side, can give the wrong impression without actually stating an untruth. It seems that during the preparation of that article the author relied upon coaching and assistance from some members of anti-implant groups. Nevertheless, there are several sentences in the article that suggest that the author was really making an attempt to be fair and balanced.
3. I believe that the two patients discussed really did experience the symptoms that the article describes, but I am skeptical about the explanations given. I do not think that their stories were made up. I do not consider those women to be hypochondriacs, and I feel only sympathy for them. The questions are: what was the real nature of their illnesses, what caused them, how solid is the evidence by which we know what that cause was, and just how often has this been proven to occur?
4. The vast majority of women with breast implants do not have the problems described, and in fact surveys have shown that a very high percentage (96%, 97%, and 98% in different studies) of women are happy with their implants and would do it again. The condition described in the article is so rare that not only have most plastic surgeons never seen a case of it, but also most do not even know a plastic surgeon who has seen a case.
5. Not having ever seen a case of fungus or bacteria in an implant such as described in all my years of practice since 1979, including removal of many hundreds of implants (usually for replacement) I took the opportunity to call the plastic surgeon who was featured in the article. She seemed quite knowledgable about implants, but did admit that the one patient described was the only one of her patients whose implants were reportedly found to contain remnants of infection, and that was after they were sent through the mail out of the country. She saw three black-looking implants, but had none other tested. A variety of substances, including antibiotics, will turn a black color over the years.
6. My comments about the laboratory in Canada must not be construed as criticisms of the director thereof, nor are they to be viewed as questioning either his personal honesty or integrity. He has long been an outspoken critic of breast implants and has testified as such in numerous lawsuits, and although I disagree with many of his published conclusions, I am not questioning his character. It is the methods and published results of the laboratory he directs that come into question. I have had a personal interaction with that laboratory, in which they mishandled and mislabelled an implant sent to them for analysis.

Why was that article written? The FDA approval of saline implants in mid-2000 was a real setback to the small but vocal group of men and women dedicated to the cause of getting breast implants off the face of the earth forever. These people have a remarkable devotion to the concept that society needs to be changed to eliminate the fact that the size of woman's breasts has any influence on her life whatsoever. Certainly that ideal has some merit in theory, but these people want to change society by denying women the choice of augmentation, and preventing women from getting implants by making them no longer available. Soon after the FDA approved implants, this group went into high gear, and started preparing articles such as this one, which is only the first.

Their basic contention seems to be this: because, in their opinion, no woman should ever have breast implants anyway, if even one woman in a million has a problem with implants, that is too many, and therefore no woman should be permitted to get implants. Put another way, unless implants are perfect and completely risk-free for each and every woman, they should be banned because they serve no useful purpose according to these people. Having been unsuccessful in their attempts to force the FDA to ban implants, they are now on a campaign to scare women with horror stories.

Once again, here are the actual statistics.
These are from the Mentor corporation package insert;
the figures from McGhan corporation are similar.

• 94.62% not removed at all
• 1.98% replaced for size or style change
• 1.23% for deflation/leak
• 0.87% for capsular contracture
• 0.87% for appearance problem
• 0.28% for infection
• 0.12% for hematoma or seroma
• 0.04% breast cancer

OK, I am done criticizing the article for its incomplete, misleading, inaccurate, and biased information. This is my opportunity to acknowledge my own bias. I well know that implants are not free of problems - real ones, not just made up ones. But I have seen first-hand, as have most plastic surgeons, the tremendous positive impact that implants have had on the lives of thousands of women. As has been well-documented in the literature, women find that having implants can facilitate their lives, enhance their self-esteem, and make many of the basic activities of life much easier and more pleasurable for them. Reconstruction patients consistently report the importance to them of the sense of return to wholeness that implants can give them. Augmentation patients (and most especially their partners and friends) note an increased confidence in their approach to life and in their relationships.

Wouldn't it be nice if the size of a woman's breasts, or even their presence or absence, made no difference in their lives? I would grant that in theory, but the real facts of human life have been otherwise for thousands of years of recorded history. Breasts have a tremendous impact upon a woman's life, and implants have made a great deal of difference for millions of women. Many people object strenuously to that fact of human social life, and they want to begin altering the situation by eliminating implants, effectively denying women the right to choose to have them. My opinion is that women deserve the right to make that choice for themselves.

One good thing which has come out of the extremely close scrutiny under which implants were placed by the FDA is that the patient brochures and package inserts are crammed full of information, so that all patients are now fully informed about just about every conceivable possibility no matter how rare. It is unfortunate that the information is presented in a very confusing and muddled way that makes understanding actual data very difficult, but it does result in only committed and determined patients deciding to go through with surgery.

Now, setting aside my criticisms of this particular article, what about the basic question: is there any possibility that a woman with breast implants may feel unwell because of something involving her implants? My opinion is: Yes. There is a theory that the presence of normally harmless bacteria on the outer surface of implanted devices (breast implants, pacemakers, hip joints, heart valves, penile implants, testicular implants etc) might make susceptible individuals feel unwell, with flu-like or other symptoms. These bacteria reside in breast ducts, and in fact in all of our skin pores, and are most often Staph epidermidis. But I consider it possible that some people can develop symptoms from this, and I think I have seen a few cases since 1979. Most plastic surgeons are not in agreement here, and it is very difficult to prove. This has been discussed at meetings by me since the early 90's, and published by me in 1994. I inform all patients about that theoretical possibility, which is included in my written consent forms for any type of implant surgery.

Are implants the perfect, ideal medical device? No, that has not been invented yet. But so far they are the best solution to a problem many women face. To say to these women that they should not be allowed to have implants, because we wish life did not make an issue out of breasts, is to deny women a known solution to those problems.