| Ilena Rose 2006-09-27, 9:30 pm |
| http://bmj.com/cgi/eletters/326/7388/527#30343
PAPERS:
Total and cause specific mortality among Swedish women with cosmetic
breast implants: prospective study
V C M Koot, P H M Peeters, F Granath, D E Grobbee, and O Nyren
BMJ 2003; 326: 527-528 [Full text] Rapid responses: Submit a response
to this article
Rapid responses published:
To soothe the savage breast
Nancy P. Bruning (7 March 2003)
Cause for suicide?
Rogene Schorer (7 March 2003)
Implants, Suicide, and Cancer
Diana M. Zuckerman (9 March 2003)
Breast Implants: hype and realities.
Kamal Kumar Mahawar (9 March 2003)
Pyschopathic or normal response to illness?
Patty Faussett (10 March 2003)
Response to implants and suicide study
Ruby Rahn, Parkville, MO 64152, USA (11 March 2003)
One womans 15 years experience with silicone breast implants
Diana L Reynolds (11 March 2003)
Cosmetic breast implants
Carolyn R Wolf (13 March 2003)
Breast Implants: Promoting Good Mental Health
Kathleen VF Nye (13 March 2003)
Authors miss most important clue
Ilena Rosenthal (14 March 2003)
Re: Breast Implants: hype and realities.
Carolyn R. Wolf (14 March 2003)
Body Dysmorphic Disorder?
Jordan Klesmer (25 March 2003)
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To soothe the savage breast 7 March 2003
Nancy P. Bruning,
author, breast cancer survivor, patient advocate
250 Cabrini Blvd. , NY, NY 10003
Send response to journal:
Re: To soothe the savage breast
Email Nancy P. Bruning:
nbrun...@aol.com
I can't help but wonder if the excess suicide in women with breast
implants might be related not to some pre-implant psychological
condition but to a condition induced by failed implants. I have met
many women with terrible results due to local complications, who
require multiple follow up corrective surgeries which are often not
successful. Systemic reactions are still being debated, but there is
irrefuatble evidence that serious local complications occur frequently
and as a result, women may be worse off than before the cosmetic
surgery. Perhaps it is the realization that they will need to spend
the rest of their lives living with scarred, misshapen breasts, and
perhaps local pain as well that makes suicide an option.
Competing interests: Author of "Breast Implants: Everything You Need
to Know," Hunter House Publishing Co., 2003
Cause for suicide? 7 March 2003
Rogene Schorer,
no appointment - speaking an implant woman
U.S. A. 71909
Send response to journal:
Re: Cause for suicide?
Email Rogene Schorer:
In my opinion, one reason so many implant women commit suicide is the
general denial, an inability to treat our illnesses, on the part of
the medical profession. Our symptoms are so strange and diverse they
are extremely hard to diagnose in the brief period doctors have to
spend with a patient.
This disregard for implant women extends from the medical profession
to the media and government agencies. As a result the families of
implant women do not understand the gravity of our situation and often
lose patience.
Accompanying the lose of health is the loss of career, health
insurance, savings, home, self-esteem, and often family. . . All this
for something touted by the plastic surgery industry as a device to
improved self-esteem (at their gain and our loss).
The loss of family and community support is the most devastating of
all . . . suicide becomes a poor, but attractive, solution.
Competing interests: None declared
Implants, Suicide, and Cancer 9 March 2003
Diana M. Zuckerman,
President
National Center for Policy Research for Women & Families, 1901
Pennsylvania Ave, NW, Washington, DC
Send response to journal:
Re: Implants, Suicide, and Cancer
Email Diana M. Zuckerman:
The findings provide an interesting comparison and are for the most
part consistent with a study by the National Cancer Institute in the
U.S. conducted by Dr. Louise Brinton et al. However, the Brinton et al
study found an increase in suicides and some cancers compared to other
plastic surgery patients. If women who undergo plastic surgery have
more psychological problems than the general population, that would
not explain the difference between suicide rates of breast
augmentation patients compared to other women who underwent
liposuction, rhinoplasty, and other plastic surgery at a similar age.
The Brinton results suggest that the increased vulnerability of
plastic surgery patients is not the only explanation for the increased
risk of suicide. Compared to most other plastic surgery patients,
implant patients suffer from complications that tend to increase over
time. Implant manufacturers report that many implant patients need
additional surgery within the first three years, and that ruptures and
other complications continue to increase over time. Our Center
receives letters every week from women whose implants are broken and
who are unable to afford to have them removed. Many of these women are
quite desperate, especially in cases where silicone is migrating to
other organs. Other women describe deformities and pain caused by
their implants. Although Swedish women apparently have better access
to medical care if complications arise, some of these complications
are extremely difficult to fix. It is certainly possible that such
problems may cause an increase in suicides.
It is also important to note that the Brinton study found that
augmentation patients were three times as likely to die from lung
cancer and other respiratory diseases compared to other plastic
surgery patients, even though augmentation patients were no more
likely to smoke than other plastic surgery patients. Although the
augmentation patients who died of lung cancer were all smokers,
augmentation patients who smoked were more likely to die than other
plastic surgery patients who smoked. Since silica exposure is linked
to lung cancer, it is possible that leakage from silicone implants
increases the risk of lung cancer among smokers by irritating or
damaging the lungs. It is unfortunate that the Koot et al study
apparently did not statistically control for smoking, because it is
possible that they too would have found an increased risk of lung
cancer linked to breast implants, even among smokers.
A flaw of the Koot et al study is that it included women who had
breast implants for less than one year. This certainly weakens the
power of the statistical analysis, since one would not expect implants
to cause mortality in such a short time. In contrast, the Brinton et
al study included women who had breast implants for at least 8 years.
Even that is not ideal; it would be more appropriate for a study of
implants and cancer to only include women who had breast implants for
at least 10-15 years.
Diana Zuckerman, Ph.D. President National Center for Policy Research
(CPR) for Women & Families 1901 Pennsylvania Avenue, NW Suite 901
Washington, DC 20006 202 223-4000 www.center4policy.org
Competing interests: None declared
Breast Implants: hype and realities. 9 March 2003
Kamal Kumar Mahawar,
Senior House Officer
Caithness General Hospital, Wick KW1 5NS
Send response to journal:
Re: Breast Implants: hype and realities.
Email Kamal Kumar Mahawar:
Dear Sir/Madam, I think it has something to do with all the hype
surrounding breast implants. Many of these women are suffering from
"poor self image" and are easily attracted by the media created hype.
They start thinking that it is the end of all their problems, which
however is not true. Not unexpectedly, implants fall short of their
expectactions. We know that implants are not a solution to this
problem. More effort should be concentrated on helping them improve
their self image and not in reinforcing the myth. They should be
actively discouraged from choosing this option and must instead be
taught to respect their "body".
Competing interests: None declared
Pyschopathic or normal response to illness? 10 March 2003
Patty Faussett,
Management
89052
Send response to journal:
Re: Pyschopathic or normal response to illness?
Email Patty Faussett:
I hope this study will help to confirm the fact that implants carry
more serious risks than now thought. However, this comment really gets
to me.
"Given the well documented link between psychiatric disorders and a
desire for cosmetic surgery, the increased risk for death from suicide
may reflect a greater prevalence of psychopathology rather than a
causal association between implant surgery and suicide.3 "
I have seen this allusion several times in regards to the women who
have committed suicide after getting implants. Of course, we may not
know the real reasons the women have killed themselves, but I can tell
you that almost every single one of the women I have spoken to or
communicated with that was sick has thought of suicide at one time or
another. I think that most women don't carry out the actual act of
killing, and so the numbers of suicidal women are way higher than
these studies show. I speak from personal experience, as I was often
suicidal, or had thoughts of wanting to die during my illness. Since I
no longer feel that way, I take exception to the idea that I am
psychopathic to begin with. That is simply not the case. I am a
normal, average human being. The plain and simple truth is that the
illness we suffer from, when our immune systems are destroyed and we
cannot even function, is what causes us to have suicidal thoughts. We
no longer feel the desire to struggle through each day. We no longer
have motivation to live. We feel no hope or way out. We want our
suffering to end. We don't see an end in sight, when doctors keep
telling us that our illness is in our heads when we know darn well
that there is something wrong but no one can tell us what or why or
how to get better. I have had discussions with other women that
confirms this tendency to suicidal thought, and I am astounded at how
many have said they wanted to commit suicide because of their illness,
but have not done so because of husbands, children or parents. This
idea that we are psychopaths already and that is why there are more
suicides is just plain wrong! It is the illness that makes us want to
die, not a mental dysfunction that was already in place. How can we
get that idea across? How can we make others understand just how
devastating this illness is to us when all the other tests come out
normal? How can this suicidal tendency from breast implants be
quantified? This is one piece of the puzzle that needs answering, so
professionals can understand just how devastating breast implants are
for those that become ill, because all we ever hear is how much of a
confidence builder breast implants are--and THAT IS TRUE UNTIL WE GET
SICK. I had much more confidence in myself after I got breast
implants. I was happier than I had ever been in my life. I was not a
psychopath! But my illness at its worst took away my desire to live,
and I felt like a social paraiah. I remember those dark days well,
though I would rather forget.
Thankfully, I am doing so well today that I am almost back to normal.
I do have Hashimoto's, thanks to implants. I will have to take thyroid
meds for the rest of my life, and go back regularly for blood work to
tweek my dosages. It isn't fun. But I think I walked away from my
breast implant nightmare a lucky lady, relatively speaking. It was
only by the grace of God that I didn't commit suicide and become one
of those numbers.
Competing interests: Founder of Saline Support breast implant
support group on Yahoo groups
Response to implants and suicide study 11 March 2003
Ruby Rahn,
self employed
5740 NW Union Chapel Rd.,
Parkville, MO 64152, USA
Send response to journal:
Re: Response to implants and suicide study
Email Ruby Rahn, et al.:
To the Editor of the British Medical Journal:
I am responding to the recent study, Total and cause specific
mortality among Swedish women with cosmetic breast implants:
prospective study, published in the March 8, 2003 edition of the in
the British Medical Journal.
http://bmj.com/cgi/content/full/326/7388/527?eaf
Finding fault with those who have been harmed is a strategy used to
discredit the injured. It is the same strategy used by trial lawyers
to discredit women injured by other harmful acts like rape. If this
study is to be taken seriously, then one has to believe that millions
of women from around the world, who have had implants, must all have
low self-esteem or be mentality unstable.
We live in a world society where "image is everything" and that
message is constantly being fed to us in news reports, on billboards,
perfume and clothing ads in every magazine and newspaper. Doctors and
surgeons, in their direct advertising to the public, are also selling
and promoting their latest and greatest technology, which they assert
helps you feel better about being you.
We see extreme makeovers on television where the recipients of plastic
surgery exclaim how happy they are with the results and proudly tell
the world what a boost to their confidence the surgery gave them.
Everyone I know desires, to some degree, to improve their appearance,
does that make everyone mentally unstable?
The results of this study appear to me as a maneuver to deflect the
attention from some of the real problems of breast implants and other
medical devices. A few of the problems I have with the study are as
follows:
1.The study only included women who had breast implants for less than
one year. This is a major statistical flaw that impairs and prevents
factual analysis and accurate results. Suicide from having breast
implants does not happen within one year but over a period of years.
2.The fact that women have to endure multiple surgeries to correct
common complications as a result of ruptures and contractures and that
these complications increase over time would should be included in a
study on suicide and wasn't here.
3.Elastomers particles from the shell and silicone gel leaking from
ruptured implants migrate to distant organs include the lungs and
liver. A foreign body reaction to these materials and other
complications like cancer were also overlooked.
Perhaps the increase incident of suicide, once women have received
implants, was from exposure to platinum or other chemicals used in the
manufacturer and leach out from aging and degrading implants over a
period of time?
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd
=Retrieve&db=PubMed&list_uids=12589499&dopt=Abstract
If the women were mentally unstable before receiving implants, then
what does that say about the judgment and ethical conduct of the
doctors who put these products into unstable women? Couldn't that be
viewed as exploiting vulnerable women for profit?
I cannot help but see this study for what it is, just another tactic
in the ongoing discrimination to trivialize, discredit and demean
women injured by breast implants.
Sincerely,
Ruby Rahn
Competing interests: I was harmed by breast implants
One womans 15 years experience with silicone breast implants 11 March
2003
Diana L Reynolds,
n/a
disabled
Send response to journal:
Re: One womans 15 years experience with silicone breast implants
Email Diana L Reynolds:
I decided to get silcone breast implants in 1978 at the age of 29
because I was not happy with my small "B" size breasts. After
receiving the implants, I was elated by the way I looked in my cloths
and without cloths. Around 1984, I was experiencing a host of
different health problems like, unexplained rashes, a constant
low-grade fever, joint pain, hair loss and fatigue. I seen over 20
doctors in an 18 month time period, hoping one of them could find out
what was happening to me. But none of them could.
By 1990, my health problems continued to grow worse and included
constant infections, muscle weakness,numbness and tingling in
extremities, gastrointestinal problems, dry eyes and mouth, cold
sensitivity, tender-points on my body,cognitive problems such as
memory loss, inability to concentrate, and even clumsiness. My breasts
were hard and painful.I was told I might have Lupus. I was relieved, I
finally had a diagnoses of my symptoms.
In 1993, I was unable to hold a job because of missing too much work
for my health problems. It was like having the flu everyday. Both my
breasts were hard and had mis-shapened, one was moving up toward my
shoulder and had what felt like a bubble on the side near my armpit.
In November 1993 I had the implants removed. Both implants were
grossly ruptured as well as the scar capsules that surrounded the
implants, spilling silicone into my chest cavity. My natural breast
tissue had to be removed because silicone was inter-mingled throughout
my breast tissues and planes. Because I wanted and got breast
implants, I was left with no breasts at all and the deformity is
simliar to having breast cancer.I did have a nipple reconstruction
because silicone had to be scraped out from behind them, leaving them
folded over and sunkin into my chest. My health has gradually returned
to almost normal except now my lungs are turning fibrosis causing
difficulty in breathing and a heavy feeling in my chest. I have never
smoked cigarettes. I am 53 years old now and at a new place in my
life, older and wise enough to know that breast size really doesn't
matter. Having bigger breasts are not really important in life, good
health and loving relationships are what really matters. I just wish I
would have realized that when I was 29.
Sincerely,
Diana Reynolds
Competing interests: Personal experience of a woman that had
silicone breast implants for 15 years.
Cosmetic breast implants 13 March 2003
Carolyn R Wolf,
Retired
22152
Send response to journal:
Re: Cosmetic breast implants
Email Carolyn R Wolf:
Perhaps these good doctors will take the word of those women who have
had breast implants for more than 20 years; most of the studies done
in the US have been bought and paid for by manufacturers and plastic
surgeons -- those who profit monetarily from trumped up studies
covering only those women who had the implants for less than 8
years..Had they included women who had the implants for 15 years or
more, AND had they told the truth, the published story would be a
totally different one. As one who has recently been diagnosed with
"silicone induced multiple sclerosis", and one who has had these
symptoms for several years, and been told by doctors that everything
is "okay" - and when I finally was allowed to have an MRI, was
untruthfully told that there were some lesions on the brain, but a
normal amount for someone my age (72 years -- 28 years with implants);
another doctor (looking at the same film) has now told me there are
more than 20 lesions, far more than a "normal amount".Is this cause
for depression??
Lets stop the cover up and lies! Those are the reasons there are so
many suicides -- because doctors seem to be afraid to tell the truth;
we are constantly being lied to -- or offered tranquilizers..Will
making us tranquilized zombies solve the problem?? I think not - they
only deepen the depression and cause more suicides.
Competing interests: I am a silicone survivor
Breast Implants: Promoting Good Mental Health 13 March 2003
Kathleen VF Nye,
PSY. student
Reading Area Community College
Send response to journal:
Re: Breast Implants: Promoting Good Mental Health
Email Kathleen VF Nye:
I could not help but be interested in the article about suicide and
breast implants.
As a psychology student I am interested in all areas of clinical
depression. The article associate breast implants and suicide,
suggesting a connections. I agree on this point, but I think the
suicides come after the disappointing results and repeated surgeries
and the frustration of not being taken seriously when giving symptoms
to the physicians. After and not before the implantation, does the
depression set in.
I also write as a silicone survivor, implanted in 1968 after a
bilateral mastectomy(age 22). With 14 implants in 18 years behind me,
I speak from experience. The depression came after the promise of
"newer, better implants" and the "won't get hard" line.
The high suicide rate does not surprise me. What does surprise me is
that the medical community still thinks that stuffing sacks of
silicone into women's chest is a procedure that will promote good
mental health.
Competing interests: None declared
Authors miss most important clue 14 March 2003
Ilena Rosenthal,
Director, Non Profit foundation
San Diego, CA 92109
Send response to journal:
Re: Authors miss most important clue
Email Ilena Rosenthal:
This study's authors miss the most important clue to the reasons a
disproportionately large number of women with breast implants choose
suicide.
Most breast implants fail over time, even though for decades they were
sold as a "lifetime" device.
With this extremely high rupture rate comes additional surgeries,
infections, and frequently the ultimate loss of the implant along with
breast tissue. Commonly, women suffer from the very painful
fibromyalgia and other often undefined diseases.
The denial of the medical profession as to their illnesses as well as
families experiencing their once healthy and vibrant mother, wife,
sister, or daughter now in chronic pain with no medical solution in
sight, leaves the women feeling more isolated and desperate.
She often then loses her job, her insurance, and the downward spiral
continues.
To ignore the enormous physical harm from ruptured implants and
drawing the fuzzy psychological conclusions the authors have, makes me
wonder about their open minded scientific approach to this growing
medical tragedy.
Ilena Rosenthal
Director, Humantics Foundation for Women
http://www.BreastImplantAwareness.org
FDA Rupture Studies
http://www.fda.gov/cdrh/breastimpla...racapstudy.html
http://www.fda.gov/cdrh/breastimpla...iinterview.html
Competing interests: Author: Breast Implants: The Myths, The Facts,
The Women Founder of Support group: Breast Implants: Recovery &
Discovery
Re: Breast Implants: hype and realities. 14 March 2003
Carolyn R. Wolf,
Retired
22152
Send response to journal:
Re: Re: Breast Implants: hype and realities.
Email Carolyn R. Wolf:
Perhaps one of the reasons for low self esteem might be a plastic
surgeon inorming you (after double mastectomies!) that "you don't have
to go through life looking like THIS". Those of us with no problems
with our self esteem started thinking something horrible was wrong
with us; then to be assured, and reassured, that the implants were/are
safe, and "no, you are not being used as a guinea pig." Which is
exactly what we were/are being used for.
When I found one breast collapsed (both implants were ruptured, but
only one scar tissue capsule had collapsed), three plastic surgeons
tried to "sell" me on replacements with saline filled implants-- only
they did not use the correct designation: silicone implants with
saline filling, rather than with silicone gel filling!!
This world needs a few doctors willing to emulate Raoul Westenberg
(remember him from World War II?)-- to try to find some answers to
this chemical poisoning that we have been subjected to..Worldwide,
there are millions of us..
Competing interests: Silicone implant survivor
Body Dysmorphic Disorder? 25 March 2003
Jordan Klesmer,
Assistant Professor of Psychiatry, NYU School of Medicine
North Shore university Hospital, 400 Community Drive, Manhasset, New
York 11030
Send response to journal:
Re: Body Dysmorphic Disorder?
Email Jordan Klesmer:
To Whom It May Concern,
Koot et. al. recently reported an increased risk of suicide amongst
patients who received cosmetic breast implants (1). The Somatoform
Disorder known as Body Dysmorphic Disorder involves a preoccupation
with a defect in appearance and the defect is either imagined, or, if
a slight physical defect is present, the patient's concern is markedly
excessive with subsequent impairment of social or occupational
functioning (2). The patient's distress may lead to suicidal ideation,
suicide attempts, and completed suicide (2,3). It has been estimated
that between 6% to 15% of cosmetic surgery and dermatology patients
suffer from this disorder (2).
Consequently, it behooves cosmetic surgeons to seek psychiatric
consultations preoperatively for the purpose of ruling out Body
Dysmorphic Disorder and have it treated if present. Perhaps only then
can the elevated suicide rate associated with breast implants be
diminished.
References
1.Koot VCM, Peters PHM, Granath F, Grobbee DE, and Nyren O. Total and
cause specific mortality among Swedish women with cosmetic breast
implants: prospective study. British Medical Journal. 326:527-528.
2.Diagnostic and Statistical Manual of Mental Disorders, Fourth
edition, Text Revision. American Psychiatric Association. American
Psychiatric Press. Washington, D.C. 2000
3.Phillips KA, McElroy SL, Keck PE, Pope HG, Hudson JI. Body
Dysmorphic Disorder: 30 Cases of Imagined Ugliness. American Journal
of Psychiatry. 150:2 302-308.
Competing interests: None declared
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