Questions about breast implant safety and the validity of cosmetic surgery itself have been the source of a great deal of discussion and argument over the last 50 years. Implants are becoming more and more widely used with hundreds of thousands of women seeking breast augmentation each year in the U.S. alone. However, this does not mean that the controversy is going to end any time soon.

What are some of the top concerns about breast implants? Is there any reason to be worried about implants? Should women be able to choose breast augmentation for cosmetic reasons regardless of the risks? There aren’t clear cut answers to all of these questions – especially those that don’t deal with areas that lend themselves to scientific inquiry. But you can learn what the medical community has discovered so far to help you make a decision about breast implants for yourself.

Surgical and Device Complications
Although breast implants and surgical techniques have improved substantially over the past 40 years, breast augmentation is still associated with a wide range of complications. The rates of revision surgery are quite high compared to other types of cosmetic procedures. This is partly because no implants have yet been designed that can be considered permanent. There are also a variety of adverse effects that can occur which require revision.

According to data collected by Allergan, 25-30% of cosmetic breast augmentation patients require reoperation in the first 5-7 years after receiving implants. The most common reasons for reoperation are:

• Requests for replacement with a different implant size or shape
• Severe capsular contracture
• Rupture, leakage, and/or deflation of the implant

Improper positioning of the implant, sagging, and asymmetry are also common breast implant problems that lead to re-operation. Some people feel that a cosmetic device that requires so much maintenance should not be on the market. However, others believe that patients should simply be informed of all possible complications. If they have access to the actual data showing the recorded rates of each adverse side effect, they can reach their own conclusion about breast implant safety.

Silicone Safety Debate
Consumer advocacy groups have been very vocal about their concerns that silicone gel leaked from ruptured implants might cause a wide range of diseases – most notably connective tissue disorders and cancer. Some people also feared that silicone could leach into breast milk and be ingested by infants with unknown consequences. The FDA severely restricted the use of silicone implants from 1992-2006 to provide ample time to evaluate these potential breast implant problems.
However, the results of carefully controlled safety trials and evidence analyzed by the Institute of Medicine simply did not bear out these concerns. Despite these findings and the fact that silicone is regularly introduced into patients bodies via many other implanted devices, medical implements, and everyday consumer goods without incident, the controversy over silicone breast implant safety continues.

Psychological and Emotional Wellbeing
Some of the most troubling studies having to do with breast implant problems are those showing a correlation between breast augmentation and higher than average suicide rates. Data compiled from patient records beginning in the early seventies has consistently shown that approximately .4% of women who get breast implants later commit suicide (usually more than 10 years after their surgery). This is a significantly elevated percentage (2-3 times higher than expected) compared to the general population.

The data is sometimes presented as meaning that getting breast implants increases the risk of a woman committing suicide. However, this does not take into account the fact that women with certain mental health issues including body image disorders and depression may seek breast implant surgery in an attempt to alleviate these symptoms. In a widely published but fairly small Danish study, 50% of the patients who committed suicide had previously been hospitalized for psychiatric disorders.

Data on psychiatric history of breast implant recipients is not available for the largest study from Canada including over 24,500 patients. That study also did not track complication rates, so there’s no way to know if women who have more complications from breast implant surgery are at increased risk for suicide as critics suggest. Without more information, it isn’t possible to say whether getting breast implants is a causative factor in suicide or if women who are prone to suicide are also more likely to seek breast augmentation.

These studies do highlight the importance of appropriate mental health evaluation as part of the consultation process for all women seeking breast implant surgery. A basic evaluation is often done using a body self-esteem or self-concept scale. Plastic surgeons should watch for potential warning signs of psychological distress and make referrals to a mental health professional if needed for at-risk patients.

Emotional Wellbeing
Some groups are concerned that getting breast implants is emotionally damaging and that most women regret their decision to pursue augmentation. This is a fairly difficult factor to gauge, and the information collected from patients varies depending on which study you look at. On average, most patients seem to show little change in their overall level of self esteem or body image after receiving implants – with the exception of a marked increase in feeling sexually attractive. Since breast augmentation is intended for women who have a moderately healthy overall body image to start with, this result is not surprising.