In a recent publication at the FDA, we find that after all the subjective airing of opinion by many doctors, in fact there is some risk associated with capsules in breast implants, yet, this is not mentioned, here or many other places online, it is interesting to see how this topic is treated. Are doctors really objective about this issue, or are they more subjective about this issue? There seems to be this mentality that doctors cannot be wrong, I submit that they are wrong.
Breast Implant Safety - How Subjective Are Doctors?
Doctor Answers (8)
Most plastic surgeons are honest and very critical of the literature and their results.
There are creeps in all professions. Almost all plastic surgeons are very critical of their results (as well as the results of others). True scientific research has very little subjectivity. Clinical outcomes have more subjectivity. But all my plastic surgery friends are aware of this and practice accordingly. I do think that your plastic surgeon is much more reliable source of accurate and documented information than the media or the internet.
Risk of ALCL in breast implant patients is very low
This is an extremely rare form of lymphoma- about 40-50 cases in over 5 million augmentations - these odds are similar to being struck by lightning. We have always emphasized the 'known' and 'unknown' risks of breast implants to our patients. Now that the FDA has pointed out this rare association, it will be part of the informed consent discussion for all breast augmentation patients in our practice.
There is risk in any surgery: elective or otherwise
The recent FDA report showing a possible connection between breast implants and ALCL in capsules is evidence that will be presented to patients in my practice in the same manner as that with other known possible complications with breast augmentation: in an honest and objective manner. Any new data or risks that apply to the procedures I perform is always discussed openly and honestly with prospective or established patients, as is the case with most colleagues I know. This is a rare occurrence and I will present it with the appropriate context. No matter how minimal or brief, there is no surgery that is free of risk. For that matter, there is rarely a day where we don't assume some risk in living our lives (driving cars, walking across streets, boarding airplanes). Processing the risks versus the benefit of elective surgery is up to our patients. Presenting those risks in realistic context is the job of the surgeon.
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The mentatlity that doctors cannot be wrong: the case of ALCL and breast implants: "Too err is human, to forgive is divine"
I think doctors are human. "To err is human, to forgive is divine." Have it in your heart to be less critical and look at this with open eyes. The data you mention was actually reported by several plastic surgeons and it was their due diligence that prompted them to pursue unusual findings, perform biopsies and evaluate their patients on a case by case basis. With 60 cases out of 10 million, that means there is an incidence of less than 1 out of 150,000 patients. It is unlikely that even the busiest plastic surgeons will perform this many breast augmentations in their lifetime. So to each one of us, it is an extremely rare possibility. Now that we have been made aware via the reports by plastic surgeons to the FDA, we will be even more alert to this rare possibility.
Opinions vs evidence on breast implant safety
Plastic surgeons are doctors bound to look after the safety of their patients, like any other specialty. To do this we rely on evidence-based practice, based on science. The FDA's recent call for monitoring of a possible association of an extremely rare condition that looks like cancer but doesn't bechave like it has brought out all of the fear mongering and junk science that provoked the implant debate in the 1990's. The good thang that came out of that was a substantial amount of objective research proving that implants are not associated with disease conditions. There is definitely more to learn on the subject of this new question but what you are hearing from plastic surgeons is not subjective opinion. To put it into perspective, here are some additional facts: the ALCL-like condition appears to occur in about one or two cases for every year since breast implants have been on the market, while each year 400 people are hit by lightning.
Breast Implant Safety - How Subjective Are Doctors?
Dr Aldea's extremely accurate posting says it ALL. The rarity of this form of lymphoma in the numbers of implants between 5 to 10 million speaks to how the media sensationalizes things. Especially anything that might cause more interest and a response. Studies will be done but as long as the prospective implant users now are informed, it is their decision based upon the #'s not the press releases. From MIAMI Dr. Darryl j. Blinski
Breast Implant Safety
Regarding: "Breast Implant Safety - How Subjective Are Doctors?
In a recent publication at the FDA, we find that after all the subjective airing of opinion by many doctors, in fact there is some risk associated with capsules in breast implants, yet, this is not mentioned, here or many other places online, it is interesting to see how this topic is treated. Are doctors really objective about this issue, or are they more subjective about this issue? There seems to be this mentality that doctors cannot be wrong, I submit that they are wrong."
You SEEM to be resentful of doctors. I know none of my colleagues who go around saying or feeling that we "cannot be wrong". Of course we CAN be wrong. Those of us who have been doctors for more than 10 years realized years ago that many of yesterday's firmly held practices have often been discarded in favor of better ways to solve problems.
But this does not make us "wrong". Doctors base their practice based on the scientific information available AT THE TIME. As a young general surgeon in the 1980's I routinely removed gallbladders through a long incision (Kocher) under the right rib edge? Was that wrong because today we can take out most gall bladders through 3 small incisions and send the patient home the same day? Of course not. Similarly, removing a large part of the stomach for bad ulcers was a commonly done operation well into the early 1990's. Was that "wrong"? Of course not. As drugs like Cimetidine and others came out and improved acid secretion and finally we learned that many ulcers were caused by a tiny bacteria which can be treated with antibiotics. Science moves on.
There are millionS of women with breast implants throughout the world. It is probably the most common cosmetic operation across the globe. Of these 10 plus million women, 34 (0.0000034) were identified with a very rare form of lymphoma in the scar tissue around the implant. If implants were THAT injurious, wouldn't you think that a at least a 5 to 10% involvement would be more indicative of an adverse correlation? Just for comparison, the odds of being hit by a lightning is 1 in 750,000 (0.0000013333). If we follow these odds, you have just 2.5 times the risk of getting this rare lymphomas as you are to be hit by lightning. Shall we ban all lightning as well?
Obviously, we need to study this topic thoroughly. The ultimate truth is never reachable because we constantly learn and improve.
Dr. Peter Aldea
Opinions of doctors
I think doctors respond accordingly to most things based upon facts. The recent FDA report regarding an extremely rare form of lymphoma and its possible association with breast implants in an extremely low number of paitients( 30-60 case in 5-10 million) still needs to be studied more.
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.