Dear Dr. Roach: I鈥檓 73 and had silicone implants put in when I was 29. Other than the fact they have gotten firm, I鈥檝e never had a problem with them. I have had a mammogram every year since I was 45 and all has been well except for this year, when the right implant showed up as ruptured. This was five months ago. I鈥檝e had three opinions, two from plastic surgeons and one from my primary doctor, that I should replace.
Please convince me that I need to do this when I have no pain and they are so encapsulated that the silicone is going nowhere. Also, it鈥檚 expensive, I鈥檓 a senior and I don鈥檛 want to go through all that it would entail for me to do so.
V.C.
As your doctors have told you, removal is the standard recommendation for a woman with a ruptured silicone implant. There are three major reasons why: cosmetic result, symptoms and possibility of developing medical problems from the ruptured silicone.
If you are satisfied with the cosmetic result and have no symptoms, then your concern should be about development of medical illness, and this is a controversial area. Some studies have shown an increase in risk of problems, while others have not. One concern is anaplastic large cell lymphoma, a rare cancer (approximately 10 people per year), for which breast implants are a risk factor, particularly when the breast implant is 鈥渢extured.鈥� The risk for this cancer is low, thought to be between one person in 1,000 to one person in 30,000 with an implant. Several sources I found recommended removal of a ruptured textured implant due to possible increased risk, though I can鈥檛 find out how much more risk there may be.
Another concern has been the development of autoimmune diseases, such as Sjogren syndrome, scleroderma and rheumatoid arthritis, all of which have been reported after breast implants. However, a Danish study showed no increase in risk of any connective tissue or rheumatic disease in women with ruptured silicone implants. There is a risk of capsular contraction (a kind of scar tissue), which affects the appearance of the breast.
In my opinion, the risk of developing a medical complication due to the implant rupture is low, especially since the leak is encapsulated by the breast. There are risks associated with the surgery as well as expense. It is certainly your decision, and close follow-up is a reasonable alternative to surgery.
Dear Dr. Roach: I accidently was injected with 1 cc of 80% alcohol into my deltoid muscle, and developed strong burning. Are there any long-term consequences? I am worried about developing neurological problems.
R.V.
That sort of accident, if by a medical professional, is hard for me to understand or forgive. Alcohol is not stored in any kind of container that would make it seem like it should be injected in normal circumstances. I should also note that I am assuming you are talking about ethanol: methanol and isopropyl alcohol are much more toxic. An urgent call to poison control should be your first action in an accidental injection or ingestion (1-800-222-1222 in the U.S.; 1-855-776-4766 in Ontario or your local Provincial Poison Centre).
Ethyl alcohol hasbeen used for intramuscular injections. Before botulinum toxin (Botox and others) became available, alcohol was used to temporarily reduce tone in muscles with severe spasm. The studies I read on this older technique noticed no long-term effects. Your symptoms should go away in time.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
