Regarding the risks associated with breast implants

risques liés aux implants mammaires - risks associated with breast implants

 

The risks associated with breast implants are currently receiving a lot of attention in the media.

 

I believe it is important to avoid becoming sensationalistic by better understanding the possible complications of implants.

 

First of all, any surgical implant (knee, hip, injectable such as hyaluronic acids, etc.) involves risks. The decision to use an implant should be based on weighing up the benefits sought versus the potential inconveniences or complications that may result.

Naturally, when it comes to interventions that are not medically vital or required, as is the case for breast implants, the tolerance of the scientific and regulatory community (government regulatory agencies [Health Canada, FDA]) is very low.

There has been a moratorium in North America on silicone breast implants following multiple allegations of various sequelae. This moratorium of more or less 10 years has allowed for studies that have repeatedly demonstrated the safety of silicone implants for general health. These studies have been carried out by many medical authorities and are totally independent of the companies producing breast implants.

The studies clearly demonstrate that there are no greater risks of autoimmune diseases or of developing any type of cancer following breast augmentation using silicone implants compared to an equivalent non-operated population. On the contrary, for a reason that was not explained, there was a decrease in almost all types of cancer except for two types that were not associated with the breasts.

For autoimmune diseases, the risk was the same in the control group. Since the average age at which women undergo breast augmentation surgery is the same as that at which autoimmune diseases appear, a woman with implants can develop an autoimmune disease without any causal relationship.

 

Anaplastic Large-Cell Lymphoma [BIA-ALCL]

Most recently, cases of cancer associated with implants have been reported in the global medical community: anaplastic large-cell lymphoma[BIA-ALCL]. To date, 625 cases of this type of cancer have been reported. Unfortunately, 16 cases led to deaths; mainly due to the fact that the cancers were treated late as this type was previously unknown. Case analysis has allowed epidemiologists to trace a very convincing causal element: the macro-rough texture of some new implants (Allergan is currently being pointed at with its Natrelle brand silicone prostheses).

 

Let’s talk risk statistics

Let’s introduce the term micromort: 1 micromort is a unit of risk and equals one-in-a-million chance of death for patients or individuals.

– The risk of developing ALCL [Large Cell Anaplastic Lymphoma] in a patient with 2 textured prostheses is 4 deaths in 10 million or 0.4 micromort[1].

– In comparison, the risk of death following a day of skiing is 0.8 micromort. Therefore, the risk of death following several hours of skiing is twice as high as wearing textured implants for a lifetime.

– Drinking only once, 0.5 liters of red wine or walking 27 kilometers carries a risk of death of 1 micromort.

In North America, 80% of breast implants used for patients are saline implants. The majority of these implants are smooth and non-textured and not even macro-textured. Textured implants are used mainly for surgical revision and for the prevention of capsular contraction. I, personally, do not use any textured implants. So the risks associated with textured breast implants do not concern my facilities.

 

IN SHORT: DON’T PANIC

The statistics regarding the risks associated with breast implants that are textured are not directly related to the development of an autoimmune disease.

ALCLs are extremely rare and if there is confirmation that they are exclusively related to some macro-textured implants [in any case, a small minority of the implants used], our regulatory agencies [Health Canada and FDA] will certainly take the necessary measures to correct the situation.

 

[1] Aesthetic Surgery Journal, Volume 37, Number 8, September 2017, Pages 855-973, p. 889.

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