Monday, October 29, 2007

Another landmark comprehensive review of silicone breast implants now on the books from Vanderbilt. GO 'DORES!

The November issue of the journal, Annals of Plastic Surgery, features an up to date comprehensive review article on the state of research involving issues of safety surrounding silicone gel breast implants. Researchers from the Vanderbilt University Medical School-Ingram Cancer Center review several hundred related studies to produce this magnum opus. A story interview the lead researchers can be read on the Vandy News Service here.

This "snapshot" is the most thorough review of this topic since the landmark 1999 Institute of Medicine report and addresses the ongoing epidemiology studies thru the Fall of 2007. The body of literature continues to be remarkably consistent in that the weight of the epidemiological evidence does not support a causal association between breast implants and breast or any other type of cancer, definite or atypical connective tissue disease, adverse offspring effects, or neurological diseases.

From lead author, Dr. Joseph McLaughlin,

Few implantable medical devices have been investigated for safety hazards more extensively than silicone gel-filled breast implants,” said McLaughlin. “For almost three decades researchers around the world have been conducting in-depth studies on the health of women with implants to determine if there are significant health risks. The evidence is clear that implants are not linked to serious disease.”

An increased suicide rate from patients implanted 20-30 years ago has been the only consistent finding across several large follow-up studies. I've touched on that issue before on Plastic Surgery 101 (read here) on how inferring causation is likely incorrect as epidemiology suggested significantly higher psychiatric co-morbidity among women in those studies from the 1960's to early 1990's (so you'd expect higher suicide rates/attempts). I cannot imagine how you could ever effectively study this subject prospectively, particularly in the United States where medical records aren't centralized. Confusing things even more I'd submit is the recent rise in the United States of pharmacological treatment with mood-altering drugs (Prozac, Daypro, Xanax, anti-depressants, ADHD drugs, weight-loss medicines, etc...) for people who don't have classic or formally diagnosed depressive disorders. I see women (and men) all the time on such medicines prescribed by their family doctor or internist who would not meet strict medical criteria for what they're medicated for.

It would seem to me at this point that the most important issues left to characterize about existing silicone implants would be:

  1. Late rupture rates - what can we expect durability-wise at 12-15+ years out?
  2. Suicide rates - how to most effectively screen out unstable patients?


ANA said...

People with body dysmorphic disorder are likely to have plastic surgery. People with BDD have much higher suicide rates. It's probably difficult to screen out patients because, well, people lie about their true feelings and it's probably not suspicious unless someone keeps coming back. I wonder if epidemiologists are involved in this. Leathery skin is linked with future incidence of emphysema. Certainly, leathery skin doesn't cause the disease.

PlatinumSuzy said...

Gee, What a coincidence! Dr McLaughlin was a paid consultant for Inamed. Who would have thunk????????????

Annals of Plastic Surgery - Fulltext: Volume 52(6) June 2004...
Reprints: Joseph K. McLaughlin, International Epidemiology Institute, .... Dr. McLaughlin served as a consultant to Inamed during the October 14-15, 2003, ...

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