The Breast Implant Controversy: Psychosocial Implications

In the 1970s, a radical mastectomy represented the sole optionfor women with breast cancer. Years later, when the issue of qualityof life was raised, the era of reconstructive surgery, via siliconegel breast implants--internal prostheses, was born. For the firsttime, women had the opportunity to recreate body symmetry andbody integrity and in a sense reverse some of the horrors of mastectomy.There are various reasons for desiring breast implants--to feelwhole again; to be less preoccupied with having breast cancer;to avoid the discomfort and awareness of an external prosthesis;to be able to wear more styles of clothes; to feel more feminineand sexually desirable. "The overwhelming motive, however,is to enhance one's body image, to increase self-esteem, and toimprove quality of life," stated Wendy S. Schain, EDD, PsychosocialDirector of Adult Oncology at the Memorial Cancer Institute inLong Beach, California, at the 11th Annual International BreastCancer Meeting in Miami this past March.

The "Era of Terror"

"There are lots of reasons that women do want to have implants,and they ought to have the right for that option and be giventhe best information we have," Dr. Schain said. "Unfortunately,somewhere around 1988, Dr. Sidney Wolfe's consumer activist groupstarted what ought to be known as the 'era of terror.' And womentoday are still being terrorized, not only by irresponsible media,but also by activists who are saying that this and that diseaseis being caused by implants, by lawyers, and by a few physicianswho are charging inordinate fees for removal or modification ofthese devices."

Of course, there are certainly valid reasons for not seekingreconstructive surgery, including fear of promoting cancer recurrenceand the expense incurred, and the possibility in a given woman,that implants might cause a serious problem; like a bee stingcould cause a life-threatening shock reaction.

After breast implant surgery, some women have experienced physicaldifficulties, including breast pain, rupture, capsular contracture,joint pain, and fatigue. Although concrete data linking theseproblems to the implants have not been consistently documented,the value and safety of silicone implants have been questioned,perhaps in an attempt to identify a "problem-directed solution."The controversy surrounding the benefits versus the risks of suchdevices have become widely publicized, but substantive data regardingthe psychological side effects of breast implant surgery havebeen underreported or minimized.

Although Dr. Schain acknowledged that for some women implantsmay "create, trigger, or promote some type of serious disease,"she believes that most of the "psychological pain" reportedby women with implants is a result of the irresponsible media,not by problems from the transudate of the gels themselves. Publicsentiment and anecdotal reports have described the hazardous sideeffects of silicone gel breast implants, although the cause andeffect have not been established through objective controlledclinical trials.

In an attempt to evaluate both sides of the implant controversy,one study out of Duke University referred to by Dr. Schain documentedwomen's psychological reactions to the implant saga. Among thefindings, 76% of the women questioned said the reconstructionhelped them cope with cancer, whereas only 16% regretted theyhad undergone the reconstruction. In another related survey, 84%of the women who responded said the implants clearly improvedtheir cosmetic appearance, 87% said they helped their emotionalrecovery, and 66% stated they improved their quality of life.Dr. Schain questioned whether the women's physical complaintsand increased anxiety over them are actually linked to the implantsthemselves or the highly publicized controversy surrounding them.

The consensus of the various studies is that women with breastimplants represent a very diverse group, with responses rangingfrom "I am going to buy a spare before they are banned incase I need one" to "I want to remove mine, I do notwant to replace it, and I want to forget this experience."For women who desire explantation, psychological motives playa large part, especially if anxiety becomes overwhelming and thewoman becomes obsessed with real or anticipated problems. In addition,for many women, even some women who have undergone mastectomy,motives have changed over the years. Priorities have shifted,and the devices may not best serve their needs any more. For womenwho desire breast implants, lengthy informed consents are essential.Alternative procedures as well as the risks/benefits of the reconstructionmust be addressed.

"Neither the scientific community nor the public has a clearpicture of the problems of women with implants," concludedDr. Schain. Answers are needed to questions regarding the long-termsafety and viability of these devices. Furthermore, the findingsfrom various investigations must be disseminated responsibly.

"My friend Bill Little of Georgetown made a comment severalyears ago that I think is appropriate," Dr. Schain said."He said that what we need in reference to breast reconstructionis the assurance that we have soft breasts and the accumulationof hard data. For too many years, unfortunately, we have had theconverse--hard breasts and soft data."