Tuesday, 20 December 2005 00:00

Complications Common With Post-Mastectomy Breast Implants

MONDAY, Dec. 19 (HealthDay News) -- Almost one third of women who have reconstructive breast implant surgery after a mastectomy will face short-term complications, a new study finds.

One in five women will require additional surgery, although complete failure (loss of the implant) is rare, Danish researchers report in the December issue of Archives of Surgery.

"This doesn't surprise me at all. Everyone thinks that this is a simple surgery. It's really not," said Dr. Jay Brooks, chairman of hematology/oncology at the Ochsner Clinic Foundation in Baton Rouge, La.

Breast cancer is the most common cancer among women in most parts of the developed world.

According to an accompanying editorial, about 15 percent of mastectomies done in the United States today are followed by breast reconstruction -- a 147 percent increase from 1992.

Breast reconstruction can be done with an implant, with tissue taken from another part of the woman's body, or a combination of the two. Implantation is the most frequent, the study authors said. It is also the simplest procedure and requires the least amount of time.

Many more women today can choose between a mastectomy, which involves removal of the entire breast, and lumpectomy, in which only a portion of the breast is removed. Unlike a mastectomy, however, a lumpectomy usually needs to be followed by radiation treatment. Mastectomy may also provide women with more peace of mind.

"Survival rates for lumpectomy may even be better than for mastectomy," Brooks said. "The problem is breast irradiation. A lot of women have the concept in their mind that if it's in their breast and we remove it, everything's OK."

The current study looked at information collected by the Danish Registry for Plastic Surgery of the Breast. In all, 574 women who underwent post-mastectomy reconstruction with breast implants were tracked. The women were aged 21 to 78 years.

This study was funded by the International Epidemiology Institute, which received unrestricted funding from the Dow Corning Corp., a maker of breast implants.

Almost one third (31 percent) of the women who underwent breast implantation developed at least one adverse event, the researchers found. Almost half (49 percent) of these events occurred within three months of the initial surgery, and 67 percent occurred within six months. Sixteen percent developed two complications, and 8 percent had at least three. The most common problems were infection, blood clotting, seroma (build-up of fluid in the tissue) and skin perforation.

Twenty-one percent of the original women needed additional surgery, most frequently because of capsular contracture (when scar tissue tightens and hardens), asymmetry or displacement of the implant. That number, the editorial noted, is "alarmingly high and arguably unacceptable."

Among 302 women who underwent subsequent implantation, 36 percent experienced at least one adverse event, and 21 percent had more surgery.

Patients need to be given detailed information on the risks and benefits of procedures involving breast implants, the authors stated.

Brooks himself is not a proponent of reconstructive surgery after a mastectomy, at least not at the same time as the mastectomy.

"We do not know the extent of the cancer, and having a reconstruction can cause problems for the oncologist treating the person for their cancer," he said. "Many of these things become infected, they break. They have all sorts of problems and I'm left with postponing treatment which will determine whether they will live or die, basically for a cosmetic implant."

And the longer a woman goes without reconstructive surgery, the less likely she is to want one, Brooks said.

This is what Brooks tells his patients: "Before you make a decision about your body, talk to oth