Media Hype: Exploding Implants
October 15th, 2009
Most normal physical activities do not break breast implants. However, extreme high speed sporting accidents can exert excess pressure, resulting in implant failure. This is a very rare occurence. More commonly the accident just breaks the scar tissue around the implant. The recent report of a woman breaking her implant while doing a stunt for reality TV proves this point. Warning – this video clip contains harsh language. I think she just broke the scar tissue as it is impossible to tell immediately if the implant broke. Her response is to the change in her breast which was hard before the fall and became softer after the impact. Breaking the scar tissue from the outside is called closed capsulotomy.
I know I have mentioned it before, but all breast implants break or fail eventually. This is no surprise, as all man made implant eventually fail. Why? Because stresses are repeatedly placed on the materials which lead to stress fatigue. Take a piece of wire and bend it back and forth many times. You will first notice the wire becomes warm in the area that it is bending. Keep bending it back and forth and it will eventually break. This is the same process which goes on in the body. Whether it is a heart valve, hip implant, pace maker or breast implant, this process continually goes on within the body and it eventually fails.
Of course, the length of time that it takes for an implant failure to occur is variable. The length of time that an implant lasts, is inversely related to the focus of the stress. In the specific case of breast implants, they can develop a crease or fold once they are implanted. This crease (like the wire) if it persists will result in implant failure. Obviously localized stresses decrease the life expectancy of an implant. I generally tell patients breast implant failure is rare within ten years, but starts to increase between ten to twenty years after surgery.
The implications of various types of broken implant does varies. Heart valves and pace maker failures can lead to serious or fatal consequences. Joint replacement failures usually result in pain and a decreased ability to use the involved limb until corrective surgery is done. Fortunately, breast implant failure does not lead to any immediate functional problems. Saline implants, to their advantage, result only in possible embarrassment when they deflate. They also might interfere with mammograms more than when they are fully inflated. Implants filled with silicone gel will eventually lead to changes in the natural scar tissue around the implant when they break. These changes show up as firmness, tightness, tenderness, swelling, changes in breast shape or hard lump adjacent to the implant. Silicone gel can become extravasated into the surrounding breast tissue in the extreme cases. For these reasons, the FDA recommends patients with silicone gel implants undergo MRI studies every other year after surgery, in an effort to detect silicone gel implant failure early. Early detection allows corrective surgery to be carried out before these clinical changes occur.
One other caveat needs to be mentioned. I hope it is obvious to everyone that when the breast is penetrated with a needle or scalpel during surgery, the implant can be damaged or broken. I have seen this on two occasions. Fortunately both implants were saline implants. Simply replacing the implants in these cases was all that was necessary. Silicone gel implants damaged in this way might have required more surgery and they may have left the patient with mammogram changes.
Finally, mammograms should never be avoided for fear of breaking a breast implant. Even though considerable pressure seems to be applied to the breast implant, it is very, very difficult to actually break an implant in this way. It happens only very rarely.
Too Much of a Good Thing – Making Money
September 29th, 2009
Joan Rivers has had a lot of cosmetic surgery by her own admission. In her book, Men Are Stupid…And They Like Big Boobs, she presents her opinions, impressions and attitudes regarding cosmetic surgery and what it has done for her. Clearly she believes in having cosmetic surgery and considers it to be an important option available for women today.
Some say she has had too much done. Certainly, in my opinion, her appearance does not look natural. If this is the definition of having too much done, then I would have to agree. Yet there are many women and men which have had as many facelifts, eyelid surgeries, injections, and facial implants as Joan Rivers which look completely natural and refreshed. People have different opinions in judging an attractive aesthetic, which often varies regionally or culturally. What people want to look like in Los Angeles, may not be the ideal benchmark in New York or Paris.
I believe the reason for Joan River’s love of plastic surgery is not as pathologic as perhaps Michael Jackson. I suggest that the reason for her obsession might be related to her income. Her ability to work as a personality is perhaps shored up by her extensive cosmetic surgery. First her physical appearance of not looking age 75 or of having a peculiar cosmetic processed facial appearance creates Hollywood buzz. Secondly, her confidence in presenting herself may be stronger because she feels that she looks her best after all this cosmetic surgery. This phenomenon is actually more closely related to Lizardman, who has pushed the limits of physical appearance through body modification. Surgery serves as a vehicle for attention. He has had so much done to himself that he now makes personal appearances for a fee. It has become his job. Pure and simple, it is my theory that these individuals have done this for fame and fortune. Controversy sells!
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