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Breast Implants: Don't Take Away the Right To Choose


Wall Street Journal - November 4, 1991 --- As a plastic and reconstructive surgeon from Southern California, I am used to hearing wisecracks from people who think my practice caters solely to human vanity. But vanity can also be a healthy motivation - a way to cope with the impact of breast cancer, for example.

No one said it better than Rose Kushner, who was a prominent advocate for breast cancer patients. She said that after she had her mastectomy, she was reminded of her cancer every day, when she looked in the mirror. But after breast reconstruction, she was able to forget about her cancer and get on with her life.

Now a small, misguided group of dissatisfied patients is putting pressure on the Food and Drug Administration to pull breast implants off the market, with an FDA decision due by January. These women - whose suffering I do not wish to denigrate - are being used as pawns by litigation attorneys who seek big cash awards from the manufacturers of implants. Dr. Sidney Wolfe's Washington-based Public Citizen Health Research Group even sells packets of information designed to help plaintiffs' attorneys for $750.

There is little evidence of major complications from the implants, and even minor complications are relatively few. Connective tissue diseases are no more common among women with implants than among women in the general population. The most common side effect, excessive-hardness, requires medical intervention in less than 5% of patients. But I'm afraid politics, and not science, will determine the outcome for millions of American women who may face the future without breasts.

I sympathize with the FDA, which is overworked, understaffed and has been under fire from Congress. But what the advocates are calling for - a ban of implants - is way out of line with the facts.

There's talk now that the FDA is pondering making implants available only to women who have lost breasts to cancer. Does the FDA understand that if manufacturers lose 70% of their market - seven out of 10 breast implant operations are for cosmetic reasons - that they will pull out of the market and safety studies will cease? We are leaving mastectomy patients with very few options. Tissue flap procedures are major surgery, costing four times what implants do; you need a lot of tissue to create a breast and scarring is common.

Besides, how arrogant it is for the medical establishment or the government to decide that women, informed of all the risks, cannot make their own decisions! No one dreamed of taking tampons away from women when the product was linked to toxic shock. And women who use Accutane for severe acne take it at the risk of extreme birth defects or death to a developing fetus. Won't warning labels and product information suffice for breast implants until all the studies are completed? Many women will take that risk because they feel it is far less than the benefits.

Already women are suffering the ill effects of this controversy. Some insurance companies have begun denying health coverage to women with implants for any disease of the breast. And this is in the absence of any ruling whatsoever from the FDA on implants' safety.

The fact is, there is no reason either to ban implants or to limit their use. But try telling that to women who were once happy to have their bodies restored but are now fearful of what they have heard about the supposed ill effects of breast implants. Women who want implants for cosmetic reasons are targets of rage and insult. Do we direct the same level of rage at the man who elects to have his lovehandles removed with liposuction?

We plastic surgeons who oppose a government ban are accused of having a great financial stake in keeping an "unsafe" product on the market. Believe me, I have more to lose in performing a procedure that isn't considered safe. Unhappy patients are litigious patients.

I have had over 1,000 patients who have opted for breast implant surgery, and I can tell you that each one of them had a very good reason for having the procedure. The vast majority are happy with their decision and would do it again. And these are the key words - "their decision." Anti-implant groups have no right to interfere with what a woman chooses for her own body.

Dr. Stevens is chief of surgery at Daniel Freeman Marina Hospital, Marina Del Rey and Beverly Hills, Calif.

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