Contents
Foreword....................xi
Preface to the Third Edition....................xiv
Acknowledgments....................xviii
Introduction....................1
1: The Story Unfolds....................5
The History of Silicone....................6
The FDA Enters the Scene....................7
A Range of Reactions....................13
What Went Wrong?....................16
Where Are We Now?....................20
2: The Benefits of Implants: Who Wants Them and Why?....................26
Breast Implants after Cancer ...: Reconstruction....................27
Breast Implants as Cosmetic Surgery: Augmentation....................31
So Where Are We Now?....................38
3: Types of Breast Implants and Surgical Procedures....................39
Types of Implants....................39
Implant Surgery....................43
Related Techniques and Surgeries for Reconstruction....................46
Tissue-Flap Surgeries....................50
Which Reconstruction Technique Is Best?....................58
4: Effects of Implants on Nearby Tissue (Local Complications)....................64
Capsular Contracture....................67
Rupture and Deflation....................71
Gel Bleed and Shedding....................78
Unsatisfactory Appearance....................78
Infection....................79
Pain and Other Changes in Breast Sensation....................80
Calcium Deposits....................81
Interference with Mammography and Cancer Detection....................82
Other Local Complications....................87
5: Effects of Implants on the Whole Body (SystemicDisease)....................89
Interactions Between Silicone and the Immune System....................90
A Spectrum of Symptoms and Opinions....................96
What Do the Studies Say?....................98
The Role of Infection....................107
A Continuum of Symptoms?....................109
Immune or Autoimmune?....................111
Are You Feeling Lucky?....................113
Cancer....................114
Effects During Pregnancy and Breast-Feeding....................117
6: What Should You Do if You Have an Implant?....................120
General Steps....................121
Guidelines for Self-Monitoring....................123
Guidelines for Professional Monitoring....................126
Capsulotomy....................134
Should You Remove or Replace Your Implants?....................135
Capsulectomy....................143
Risks of Implant Removal and Capsulectomy....................146
Making the Explantation Decision....................147
Making the Decision about Replacement, Tissue Transfer, Uplift, or Further Diagnosis....................152
Systemic Treatments....................157
7: Alternatives to Implants....................161
Replacing a Breast after Mastectomy....................161
Alternatives to Augmentation....................169
8: Should You Have Implants?....................173
Steps Toward Making Your Decision....................174
Reducing Risks....................179
Timing for Reconstruction....................187
Timing for Augmentation....................190
Who Pays?....................191
9: The Future of Implants: Where Do We Go from Here?....................192
A Better Silicone-or Something Else?....................192
Silicone Tests....................195
Improving the FDA's Role and Responsibility....................197
Corporate Trust and Accountability....................200
Our Implants, Ourselves....................201
Appendix A: Five Important Issues to Explore When Considering Implantation-or Explantation....................203
Appendix B: Breast-Implant Facts and Figures....................207
References....................208
Bibliography....................217
Books....................217
Miscellaneous....................218
Resources....................220
Food and Drug Administration....................220
Other Federal-Government Resources....................220
Women's Health....................221
Plastic, Cosmetic, and Reconstructive Surgeons....................222
Breast Cancer, and Cancer Generally....................222
Breast Self-Exam Reminder....................224
Silicone-Implant Organizations....................224
Disease-Specific Organizations....................226
Children's Issues....................227
Treatment Clinics....................227
Manufacturers of Implants....................227
Manufacturers of Prostheses....................228
Index....................229
