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Let’s Keep Abreast of the Mammary Implant Controversy

Breast augmentation surgery is an operation that involves changing the size of the breasts by using implants. While some women resort to this kind of procedure for purely aesthetic reasons, others do it to restore their curves after a mastectomy. Whatever the motivation may be, numerous women have at least thought of increasing the volume of their breasts, the ultimate symbol of femininity. It’s no coincidence if breast augmentation is the most popular cosmetic surgery in the world. In Quebec alone, between 8000 and 8500 augmentation mammoplasties are performed each year. It is therefore important to shed light on the subject based on scientific facts and by considering the actual risks involved with this surgical procedure.

Dr Charles Guertin

I wrote this article to dispel the numerous misconceptions surrounding breast implants. This text is all the more necessary as the subject has recently been the center of a controversy in the news media. In order to ensure that women who want more generous breasts make an informed decision, their assessment must be based not on fear, but on scientific data.

What to Expect During Surgery

Breast augmentation surgery is performed under general anaesthesia. Most of the time, an incision is made either in the infra-mammary crease, around the areola or under the armpit and the implant is placed above or below the breast muscle. Intended to increase breast volume, the implants are small round pockets filled with saline or silicone. In most cases, I recommend silicone implants to my patients because they have a more natural look and texture. They also have the advantage of being made of a thick and cohesive silicone gel that does not leak into the body if punctured.

chirurgies augmentation mammaire

The Risks of Breast Implants

Breast implants have many benefits, but they also carry some risks. Like any type of surgery, the insertion of this object into the body can lead to some complications, such as infections, bleeding and swelling. These minor problems are inherent to any surgical procedure. Breast augmentation, however, involves certain risks that are specific to this particular surgery and that patients must be aware of before going under the knife.

Contrary to popular belief, breast implants are not permanent. They have a limited life span of ten to twenty years. According to registered cases, after a decade, the risks of puncture tend to increase. In the event of a perforation, the implant must be removed and replaced, if the patient desires so. It should also be noted that implants could complicate the interpretation of mammograms.

Rupture is not the only complication that requires surgery. Over time, implants may appear deformed. The scar tissue surrounding the implant can squeeze the implant and tighten it. Now compressed, the implant hardens and becomes uneven. This phenomenon is called capsular contracture. Surgery is the only way to fix it. Surgery is also required if the implant is displaced.

The "Breast Implant Illness"

Some people believe that silicone implants cause autoimmune diseases known under the name of "breast implant illness". These people have recently expressed themselves in social networks and news media, thus reviving the debate on breast implants.

In the 1990s, similar concerns existed with silicone implants. These concerns led to a moratorium on their use, imposed by the Food and Drug Administration and Health Canada. Following the moratorium, an extensive study on the subject was conducted and after several years, researchers concluded that there was no correlation between silicone implants and the symptoms related to autoimmune diseases. In 2006, the two federal agencies approved their reintroduction in the United States and Canada.

Breast implants do not increase the chances of developing breast cancer or other life-threatening diseases. A Canadian study published in 2006 examined the causes of death among women who had breast implants in Quebec and Ontario. Of the 24,558 women who were followed during this study, it was unable to establish any causal link between breast implants and serious diseases, such as cancer. In fact, the number of deaths due to serious illnesses was lower than expected in patients who received implants.

To date, the "breast implant illness" is not recognized by the scientific community. I would like to point out, however, that breast implants continue to be rigorously studied and that plastic surgeons are working diligently with the Canadian government to create a national breast implant registry in Canada.

The More Serious Potential Risks of Breast Implants

Despite reassuring scientific evidence, recent studies have reported some cases of anaplastic large cell lymphoma associated with BIOCELL textured surface breast implants. Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is a rare and treatable type of cancer that forms in the scar tissue surrounding the implant. In the event of a BIA-ALCL diagnostic, the removal of the implant and its capsule is required.

These studies have reported 28 confirmed incidents of women with BIA-ALCL in Canada. Out of these 28 incidents, 24 are associated with a specific type of product: BIOCELL textured surface breast implants.

BIOCELL is the name of the textured shell that is made for NATRELLE® breast implants. Manufactured by Allergan, this textured shell is designed to help keep the implant in place once inserted into the body.

Textured breast implants were introduced to the market over 30 years ago, and were somewhat prevalent for a time. However, today the majority of women receiving breast augmentation opt for smooth implants, which have not been associated with BIA-ALCL.

Currently, Health Canada is working closely with its international counterparts, including the FDA, to exchange breast implant data. Furthermore, the agency is expected to conclude its study on the safety of breast implant in the spring of 2019. At that time, the federal agency will inform the Canadian public and health care providers regarding their use.

Recalls and safety alerts

Health Canada advises Allergan of its intent to suspend its licences for Biocell breast implants as a precautionary measure

The Benefits of Breast Implants

The majority of women who have breast implants are happy with them. Although many are concerned about the long-term risks, research has generally failed to link breast implants to serious diseases. The advantages of the procedure outweigh the disadvantages. Especially from a psychological viewpoint, these benefits should not be trivialized.

Over time, breasts can lose their shape or volume and become flaccid. There are several reasons for this phenomenon: breastfeeding, weight loss and aging. Women who want to tighten flabby breasts can resort to breast augmentation surgery. Augmentation mammoplasty can also correct breast asymmetry and reconstruct the breast of those who have undergone a mastectomy.

Breast augmentation surgery allows women not only to improve their figure, but also to feel good about themselves and to build their self-esteem. This physical improvement has significant psychological effects. But for the procedure to be a success and to meet expectations, women must be well informed and ensure regular postoperative follow-ups with their doctor.

To sum it up, this article was intended to dispel the confusion around breast implants. It was intended to draw an accurate picture on a topic that has been much talked about in the news and which lately has caused a lot of concern. I wanted to reassure women, both those who have breast implants and those who are thinking about it. Plastic surgeons are first and foremost medical doctors. Their priority is and always will be the safety of their patients.