- Diana Dickieson loved her new breasts. She had always
been frustrated by her boyish figure, which failed to develop much in the
way of curves even after she had become a mother. But breast implants made
the self-employed hairdresser feel more feminine.
-
- Other people didn't particularly notice, she explains
from her salon in Nelson, B.C. "I'd always worn a padded bra, and
the implants I got were really small."
-
- But they made a big difference to how she felt -- emotionally
and, eventually, physically.
-
- Just a couple of months after her implant surgery, the
glands in her neck and chest became very swollen, she developed kidney
pain, her hair fell out and she stopped menstruating. Unable to diagnose
the problem, her family doctor sent her to a gynecologist. Focusing on
the lapsed period, he recommended she undergo hormone therapy, a treatment
usually prescribed for menopausal women. She was 24.
-
- Neither physician thought that her implants were in any
way related to her problems, and dismissed her questions about a possible
link.
-
- "I had been really fit and healthy," she says,
"and now I was a basket case. I got the flu and colds all the time,
I developed all these food allergies... I couldn't eat; I would be doubled
over in pain, crying... My husband didn't know what to do."
-
- Finally, in desperation, Ms. Dickieson turned to the
Internet in search of some answers.
-
- Discovering women with implants who had the same symptoms,
she printed off pages of research and testimonials and marched them down
to her doctor's office. He called a few hours later. "You need to
get those implants out," he told her.
-
- Two years later, she has much more energy, but continues
to suffer from food allergies, kidney damage and night chills. "I
was healthy before, but I've wrecked my body. And there are thousands of
women like me. I feel sick about it."
-
- How representative is Ms. Dickieson's experience? Did
her implants cause her symptoms? The truth is that no one really knows.
Most of the available research hasn't tracked patients over a long period
of time.
-
- But many women have experienced a range of health symptoms
debilitating enough to have their implants removed, and the U.S. Food and
Drug Administration continues to caution women against the possibility
of serious effects. One Canadian official estimates that women who with
breast implants use the health-care system up to 10 times more often.
-
- Despite the bad press implants garnered in the early
nineties when silicone ones were banned over health concerns, women are
seeking breast-augmentation surgery in record numbers. Over the past decade,
the figure for implant operations in North America increased seven-fold.
-
- The women typically fall into two categories: those in
their late teens or early 20s who have not yet had children and are not
satisfied with what nature gave them, and women in their 30s unable to
come to terms with their post-childbirth bodies. Most of them say they
just want to look "normal," even when their own partners disagree.
-
- Shelley (all the women identified by their first names
only have asked to have their identities protected), a Calgary fundraiser
and mother of two, says, "I just wanted to look like what North American
women are supposed to look like."
-
- Depending on the source of your information, what North
American women "are supposed to look like" has become increasingly
artificial. But since implants are now evident on many of the most photographed
pop singers and Hollywood stars, it's increasingly difficult to tell what
"normal" is any more.
-
- "A particular breast shape is being marketed through
the media," says Diane Pacom, a sociology professor at the University
of Ottawa who studies the influence of popular culture. "We're buying
into the image of a perfect breast. But it's manufactured."
-
- Some plastic surgeons credit Pamela Anderson. Ever since
the world's most famous surgically assisted starlet bounced her way down
a California beach in the hit TV series Baywatch, implants have had a particularly
high profile.
-
- In recent months, a Calgary bar and an Ottawa radio station
both made headlines by sponsoring breast-implant giveaway contests. If
the promotions didn't set out to define larger breasts as "normal,"
they certainly reinforced them as "desirable."
-
- And each generated hundreds of applicants.
-
- Lucy, a 39-year-old nurse living in Ottawa, wasn't one
of them.
-
- By the time the local pop-music station started promoting
its "Breast Christmas Ever" contest, she already had her implants.
Married, with one child, she had undergone augmentation surgery 18 months
before in pursuit of a more proportional look.
-
- "I lost 60 pounds after my pregnancy," she
says. "I went from a size 14 to a size 5, and my breasts lost all
their form. I couldn't look at myself."
-
- Her experience isn't uncommon.
-
- Shelley, in addition to her implants, receives regular
injections of Botox. "It's in vogue among professionals," she
says. "I get it every four months to make myself look better."
-
- She is as happy with her implants as she is with the
Botox. Although she describes her post-surgery experience as "more
painful than childbirth," four years later, Shelley loves the end
result. She talks about being able to wear evening gowns without having
to stuff her bra and says that even though her husband doesn't think her
implants feel natural, he sees that she's happier.
-
- In contrast to the stereotype of men being universally
attracted to super-sized profiles like that of Ms. Anderson, Marie's boyfriend
also preferred her breasts in their natural state. Lucy says her husband
actively discouraged her from the surgery, insisting that she didn't need
larger breasts and expressing concerns about the health risks.
-
- Nancy, who works in the cash office of a Vancouver grocery
store, says her husband was fine with the idea of implants, "as long
as he didn't have to pay for them." As it turned out, she needed a
loan to help cover the costs because of the major complications she experienced
within 24 hours of her initial surgery. One breast developed a hematoma,
she began to bleed through the bandages, and there was a lot of swelling.
The subsequent emergency operation left her more scarred and $11,000 in
debt.
-
- "It took me a year to feel comfortable with them,
like they weren't going to burst," she says. Lying on her stomach
gave her "the heebie-jeebies," and she kept herself hunched over
because of the pain. Two years later, however, she says it was all worth
it.
-
- Marie echoes this sentiment, despite her own suffering.
She felt like she had been "run over by a truck" after her initial
operation: "I had a hard time breathing and talking. I couldn't sit
up or lie down on my own. I was in so much pain, I couldn't even open the
pill bottle. And then the day after the surgery, my left breast dropped
because the implant shifted."
-
- As a result, the scar that was supposed to be hidden
in the fold beneath her breast is now visible on the breast itself, and
one of her nipples is higher than the other. In addition, she says, "I
can always feel the implant on that side; it feels very heavy, really uncomfortable.
It looks like an egg; it doesn't look normal. The surgeon said if he were
to try to fix it, I'd have a huge bruise, huge scars. I didn't pay $6,000
to have it look this way!"
-
- Although breast cancer affects one in nine North American
women, post-mastectomy reconstruction accounts for less than 10 per cent
of breast-augmentation patients. The vast majority of women who get implants
for the first time are, as Diana Dickieson was, healthy.
-
- Epidemiologist Aleina Tweed recently published research
conducted through the B.C. Centre of Excellence in Women's Health finding
that women with implants had much more interaction with health-care providers
than women without, and were four times more likely to be admitted to hospital.
-
- Pierre Blais, a former senior scientific adviser to Health
and Welfare Canada who now conducts research on removed implants and serves
as an expert witness on behalf of those suing implant manufacturers, suggests
that Ms. Tweed's figures are "optimistic."
-
- He believes that the rate of health-care use among implanted
women is six to 10 times greater. Arguing that implant-design technology
hasn't significantly changed in 30 years, Dr. Blais calls implants "a
mortgage on the user's health and wealth."
-
- Indeed, 40 per cent of the women in Ms. Tweed's admittedly
small-scale study had had their implants permanently removed. Fifty per
cent had been diagnosed with at least one chronic illness; a third had
lost or quit their jobs, or reduced their hours because of health problems;
and more than half had difficulty doing housework or recreational activities
because of health problems. A majority of these women reported that their
health problems began after their initial implant surgery.
-
- But Ottawa-based plastic surgeon Bryan Callaghan, who
has been performing breast implants for more than 20 years, says there
is no evidence that definitively links implants to the range of symptoms
or diseases reported by women such as Ms. Dickieson, or those in Ms. Tweed's
study. Of the hundreds of patients he has operated on, he says, fewer than
2 per cent have returned requesting removal as a result of health concerns.
-
- Based on her research, Ms. Tweed's view is that "for
some women implants seem to be safe, but for some women they're not. We
don't know why. And so we don't know what we should screen for."
-
- In addition to the lack of long-term data, she says,
many women are reluctant to come forward. She and others have called for
a national breast-implant registry, like the one proposed last year in
a private member's bill in Parliament. She believes that a registry would
allow researchers to collect the data necessary to put to rest the ongoing
debate between plastic surgeons and manufacturers, who defend implants,
and those like Dr. Blais and many women themselves, who continue to raise
serious concerns.
-
- In the meantime, women who want implants appear prepared
to believe the former sources, and to discount the troubling information
available from the latter.
-
- But as Ms. Dickieson asks, her voice filled with anguish,
"Why would you take the risk?"
-
- - Shari Graydon is the Ottawa-based author of In Your
Face - The Culture of Beauty and You (Annick Press, 2004).
-
- The down side
-
- The U.S. Food and Drug Administration, in fulfilling
its health-protection mandate, has conducted a systematic review of available
scientific research. Its website features a comprehensive on-line handbook
about the health implications of breast implants, which includes the following
information:
-
- Breast implants will not last a lifetime. Either because
of rupture or other complications, they will probably need to be removed.
-
- Many of the changes to a woman's breast after implantation
may be cosmetically undesirable and irreversible.
-
- Once implants have been removed, patients may experience
unacceptable dimpling, puckering, wrinkling, loss of breast tissue, or
other undesirable cosmetic changes of the breast.
-
- Non-surgical treatments or subsequent operations may
be required to treat a range of complications including asymmetry, breast
pain, capsular contracture, chest-wall deformity, delayed healing, bleeding,
infection, inflammation, necrosis, nipple sensitivity, rupture, scarring
or rippling, among others.
-
- For more information about what is known about the health
implications of breast implants, including a review of the research relating
to neurological and connective tissue diseases from a neutral source, see:
http://www.fda.gov/cdrh/breastimplants/handbook2004
-
- In Canada see:
- http://www.hc-sc.gc.ca/english/women/facts_issues/facts_implants.htm
-
- Cosmetic changes
-
- The number of breast augmentations has steadily
- increased in North America since 1992 even though a
- moratorium was imposed on silicone implants that year.
- Breast augment-ations performed
- 1992 32,607
- 1994 39,247
- 1996 87,704
- 1998 132,378
- 2000 187,755
- 2002 236,888
-
- Breast-implant removals performed
- 1992 18,297
- 1994 28,655
- 1996 3,013
- 1998 32,262
- 2000 37,984
- 2002 43,507
-
- The data represents procedures performed by American
Society of Plastic Surgeons members certified by the American Board of
Plastic Surgery or the Royal College of Physicians and Surgeons of Canada.
-
- SOURCE: AMERICAN SOCIETY OF PLASTIC SURGEONS
-
- © 2005 Bell Globemedia Publishing Inc. All Rights
- Reserved.
-
- http://www.theglobeandmail.com/ealth/
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