I am in my 50's and my breasts are "sagging". I do not want the scarring associated with a lift. Is there a problem with getting either a saline or silicone implants with regards to an increased breast cancer risk? Is it better in this case to go under the muscle? My mother developed breast cancer in her 70's. Is that a reason I should not get implants?
Should I Avoid Getting Breast Implants Due to my Family History of Breast Cancer?
Doctor Answers 26
Breast Implants for Someone With Cancer Risk
You are right to be asking the question.
Breast Implants do not increase cancer risk, and should not interfere with monitoring, either by self exam or imaging (mammograms). Mammographers tell us they prefer the submuscular (under the muscle) positioning of implants.
Please understand that implants add volume and help to shape the breast, but do not lift a sagging breast! If your nipple and much of your breast has drooped below the height of the breast crease, you are probably a candidate for a breast lift (with or without implants).
A thorough discussion with your plastic surgeon about your objectives should clarify these options.
Breast implants and cancer risks
Thanks for your question.
I am not aware of any CURRENT data the unregistered poster marlene sorma is referencing that supports her position; the NCI data from the 80s did find a statistically insignificant finding that masses might be detected later but this has been countered by more recent studies.
Every current study I know of actually supports the fact that women with submuscular implants (90% of the implants done today) actually detect palpable breast masses EARLIER than women without breast implants.
The reason for this has been debated (do women with breast implants pay more attention to their breasts? Do breast implants make the mass easier to palpate?).
In addition - since this is an important topic - let's review the data... from NCI (the NCI data still remains one of the largest studies regarding this topic) -
In 1992, researchers at the National Cancer Institute (NCI) initiated a study on the long-term health effects associated with breast implants. It is estimated that between 1.5 million and 2 million women in this country have had breast implants since they first appeared on the market in 1962.
One of the longest and largest studies to date on the health effects of implants, the NCI report involves 13,500 women with an average follow-up time of 13 years.
*Most previous investigations have looked at the health effects over a shorter time period, typically less than 10 years, and have been too small to evaluate uncommon diseases.*
The purpose of the study is to evaluate the effect of implants on the risk of:
* Developing breast cancer;
* Developing cancers other than breast;
* Dying from all causes of mortality; and
* Developing connective tissue disorders.
Before we get to the results let's debunk some of the conspiracy theory arguments before we even hear them...
Because of the highly controversial and political nature of the study, maintaining objectivity was a particularly important issue. The following steps were taken to ensure scientific objectivity:
* The study was funded entirely by the government, not by plastic surgeons, implant manufacturers, or other special interest groups.
* Government scientists, not manufacturers of implants or plastic surgeons, designed and provided scientific oversight for the study.
* To participate in the study, plastic surgeons had to agree to allow investigators to see all of their records, not just records for selected patients. The investigators obtained detailed information on factors which could affect health status.
* The NCI researchers found no association between breast implants and the subsequent risk of breast cancer.
In addition, they found no link between breast cancer risk and number of years of follow-up, nor with any particular type of implant. There was no significant difference in breast cancer mortality between the implant and comparison patients.
Reference: Brinton LA, Lubin JH, Burich MC, et al. Breast Cancer Following Augmentation Mammoplasty (United States). Cancer Causes & Control 2000; 11(9):819–827.
* Women with breast implants were not at an increased risk for connective tissue disorders when their records were reviewed by two independent rheumatologists who did not know if the women had an implant or not.
According to initial reporting by an implant patient questionnaire, there appeared to be a two fold increased risk for developing rheumatoid arthritis, scleroderma, systemic lupus erythematosus, and Sjogren's syndrome in this population. NCI researchers were able to access only 34–40% of these patients' records who reported being diagnosed with a connective tissue disorder. When these records were reviewed by two independent, board-certified rheumatologists who did not know if the patient had an implant or not, the rheumatologists found between 17–30% of the diagnoses likely. As a result, the risk for developing a connective tissue disorder due to breast implants, while still somewhat elevated, became statistically non-significant. Further research including records linkage, standardized diagnostic criteria for rheumatoid disorders, and clinical exams, is needed to understand if a relationship exists.
Reference: Brinton LA, Buckley LM, Dvorkina O, et al. Risk of Connective Tissue Disorders among Breast Implant Patients. American Journal of Epidemiology; 2004;160; 619–627.
The NCI study reviewed patients implanted BEFORE 1989. Subsequent studies have supported the NCI findings as well as amplified on other issues (such as palpable breast masses being easier to detect with subpectoral implants @marlene sorma) - in addition, these are complicated scientific questions... even if you (wrongly from the literature I've reviewed) assume that you detect a palpable mass later - there's no change in mortality or morbidity associated meaning that the consequence of that later finding may not matter at all (again from the literature I've reviewed).
In our San Francisco area office we consistently stay current with the literature and take the time to discuss these issues with our patients. Be sure your plastic surgeon does the same for you! Like anything in medicine - these are complicated issues because human beings are complicated!
I hope this helps.
It's a lot of data and this is just the tip of it but hopefully it gives you a place to start...
Remember that implants don't lift the breast and they don't cause cancer
To correct your sagging breasts, the best procedures involve lifting the nipple and areola and tightening the lax lower pole tissues. This causes scars but can dramatically improve the shape and youthfulness of the breasts. Mammograms are not affected by this procedure alone.
Implants will not correct sagging, they will just make you bigger. So, if your breasts don't need to be larger, it may be that a lift alone is the best procedure for you. Evaluation by an expert plastic surgeon will help you sort out these issues once you have been examined.
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Breast implants don't cause breast cancer
Depending on the amount of "sagging" you have, you may not be a candidate for implant surgery alone. That being said, implants do NOT increase your risk of developing breast cancer. You need to be aware of the fact that implants do cause compression of your breast tissue, which makes the tissue more dense and possibly more difficult to image with mammography. Placing the implants under the muscle does make the breast tissue easier to xray, but also makes it more difficult to correct the sagging. A consultation with a board certified Plastic Surgeon will help to identify all of your possible options and guide you in your decision making process. Good luck.
Issues with implants and risk of breast cancer
The correction of sagging breasts with implants has little to do with the choice between saline and silicone implants. Howver, the issues with implants and breast cancer has to do with causation and detection.
The causation risks have pretty much been put to rest although there are certain groups who might argue differently. You should speak to a breast cancer specialist, not as regards risks of implants, but your specific increased risk of developing cancer with a first degree relative with post-menopausal cancer.
The main concern with silicone implants has to do with detection and complications from leakage. The softer the implants, the better the mammagram and this would tend to favor a submuscular placement, although a submuscular position generally does not correct mild sagging as well as subglandlular placement so you might be faced with a compromise. This is true even for saline implants. Ultrasound and MRI are also available to assist in screening and monitoring the breast tissue and implants.
Microscopic leakage can cause silicone granulomas that while easily diagnosed by mammogram or MRI might cause considerable concern and on-going expense to detect and monitor. This is not the case with saline implants. Continued vigilence is the order of the day, even in women without a family history of breast cancer. Individualization of the choice you make keeping in mind the various risks and desired goal will allow you to come to a reasonable decision.
Saline or silicone implants do not cause breast cancer
Breast implants have never been shown to have a correlation to an increased incidence risk of breast cancer. Which implant you chose (saline or silicone) with the help of your plastic surgeon is a purely personal choice once you have been properly educated about the differences between them.
Every woman who has a breast augmentation with or without a lift needs to remain as vigilant as other women regards screening for breast cancer (self breast exams and annual screening mammograms following the American Cancer Society guidelines). The more family exposure you have in terms of direct relatives (Sisters, Mother, Aunts, etc.) your risk is elevated. You should enterain having your implants placed partially under the chest muscle to aid the mammographer in being able to view your breast tissue with the mammogram.
If your breasts are sagging then most likely an implant alone will not improve them other than to make the upper part of your breast larger only to leave the lower breast still saggy. It is omportant to visit a board-certified plastic surgeon for their opinion because what you percieve as saggy may be minor enough to not require a lift.
I hope this has been helpful
Michael C. Edwards, MD, FACS
Should I avoid getting breast implants due to my family history of breast cancer?
It is known that women are more in tune with their breasts and more diligent with examination and feeling/knowing the contour of her breasts, thus able to identify any abnormality sooner. Imaging studies of the breasts are similar to imaging without breast implants and cancers are not hidden either by the presence of breast implants. You should remain proactive with your monthly self examination, annual clinical examination, and mammograms beginning at age 40 (unless family history, as directed by the Radiological Society). You may consider obtaining a preoperative mammogram as a baseline prior to consideration of a breast procedure. Best wishes! Hope that this helps!
Breast Cancer and Breast Augmentation
There are several things that are useful to know if you are considering breast augmentation and are concerned about the implants either causing cancer or preventing its detection with mammography.Research studies have shown that breast implants will make the detection of breast cancer more difficult.Although in some cases the detection of breast cancer was delayed, it did not result in a change in the prognosis for the patients.Research studies have shown that women with implants were diagnosed with cancers of similar size and stage as women without implants.
The research has suggested several possible reasons for finding little difference in tumor
characteristics among women with implants and women without implants despite the fact that implants may interfere with mammography.
1.It may be that women with implants detect cancer more easily than other women because they have less of their own breast tissue or because the implant itself pushes the breast tissue to the surface making the detection of a tumor easier.
2.Women with breast implants are usually told to check their breasts often for any problems so they may be more likely to find lumps on their own.
3.Women with implants may be more body conscious and seek advice more readily than women without implants.
Other important information to know if you are concerned about cancer detection with implants are:
1.Patients with breast implants are at no greater risk for developing breast cancer as compared to patients without implants.
2.Early detection of cancer is possible in patients with breast implants.It is very important to tell the personnel performing your mammogram that you have breast implants.With this knowledge, a different technique will be utilized.Speciality views referred to as Eklund Views or displacement techniques are utilized.In this situation, the implant is pushed backward and the breast tissue itself is drawn together over the top of the implant.Very likely additional views will be taken to optimally examine the breasts.
3.Submuscular placement allows for greater visualization of the breast tissue.Submuscular placement is also associated with a lower rate of capsular contracture.Breasts with capsular contractures are much more difficult to image due to the fact that the breast becomes hard and is not as compressible between the mammogram plates.Both silicone and saline implants create the same difficulties with visualization.One is not worse than the other.
Implants and Cancer
There is no evidence of any relationship between breast implants and cancer in humans. Opponents of breast implants often refer to studies which show a form of rare cancer can develop when silicone is implanted in rats. It is well known in the scientific community that any smooth surfaced object implanted in laboratory rodents has initiated tumor growth. In the opinion of an ad hoc advisory group of scientists representing the FDA and the National Institute of Health (NIH), it is unlikely that this finding is relevant to humans.
Having breast augmentation will not change your personal breast cancer risk
Many women seek cosmetic breast augmentation, and some of these women will also have a history of breast cancer in their families.
I counsel ALL women to know their family history of both breast cancer and ovarian cancer prior to considering any surgery on their breasts.
When appropriate, I refer women with a significant family history of these types of cancer (particularly before menopause) to a breast cancer specialist or a genetic counselor for further workup.
If women are older than age 40, I recommend they have a screening mammogram prior to any breast surgery - just for future reference.
However, having breast implants placed will NOT change the risk of developing breast cancer. In fact, two studies in the literature found that women with breast implants who developed a breast lump, found it slightly earlier than those who did not have breast implants. This is not to say that breast implants protect against breast cancer - they merely perhaps enabled the lump to be felt earlier.
Implant placement above or below the muscle also makes no difference.
Be sure to visit a Board Certified Plastic Surgeon with experience in breast augmentation for the most informative consultation!
Karen M. Horton, MD, MSc, FRCSC
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.