If there is one subject that has given women who have had breast augmentation the jitters, it is the PIP (Poly Implant Prothese) implant scare.

Reports of the French-made implants’ increased risk of rupturing and allegations of their being filled with industrial grade silicone, combined with a rumpus in several countries about whether they should be removed and who would pay for the removal, have alarmed women worldwide.

According to Dr Chris Snijman, a plastic surgeon and national secretary of the Association of Plastic and Reconstructive Surgeons of South Africa (Aprssa), the organisation had had “a flood of calls” from concerned women.

Snijman says the organisation has identified a possible 11 surgeons in SA who might have used PIP implants.

“There is no cause for alarm, however, as the PIP implants that were used were put in prior to 2006, which is when all of the trouble started, so patients can be reassured that they are safe,” he says.

He says the major suppliers to South Africa are Eurosilicone, Allergan and Mentor, all of which “supply implants of the highest quality”.

However, patients should ask their surgeons what they are using and why.

Durban plastic surgeon Dr Paul McGarr said he had never used PIP implants, but he had removed a ruptured PIP implant from a patient about a year ago.

He said women who had implants should check where their implants were manufactured and if they were PIP, they should contact a plastic surgeon for advice.

“The problem with low grade silicone is that it is impure,” he said.

“It will not cause a systemic disease, but it can cause localised irritation in the breast tissue.

“The silicone implants that are used today are vastly superior to those of 20 or 30 years ago, thanks to improved technology. There is a 100-point check during the manufacture of the implant and the outer capsule of the implant actually consists of five to seven layers.

“The silicone molecules are specially linked so that they form a gel and are not liquid.”

Umhlanga plastic surgeon Dr Mahendra Daya said he had not used PIP implants. The company whose implants he used had issued statements that their safety and quality of their implants had never been compromised.

“Fortunately, the use of PIP implants in South Africa was uncommon,” he said. “Patients who are concerned and do not know the make of their implants should contact their plastic surgeons.”

While the celebrity culture and endless nip and tuck television programmes may have made breast augmentation surgery seem almost routine, like any surgery, it is not without risks.

If you are considering breast implants (breast augmentation surgery), here’s what you should know:

How is it done?

A breast implant is inserted either behind the breast tissue or under the chest muscles.

Incisions are made to keep scars as inconspicuous as possible, usually under the breast, around the lower part of the aureola, or in the armpit. Breast implants are manufactured in a variety of shapes, sizes and with either smooth or textured surfaces.

The method of implant selection and size, along with surgical approach for inserting and positioning breast implants, will depend on your preferences, your anatomy and your surgeon’s recommendation.

What size?

The shape and size of the breasts prior to surgery will influence the recommended treatment and the final results.

If the breasts are not the same size or shape before surgery, it is unlikely that they will be completely symmetrical afterward.

Changes to the breasts after augmentation or reconstruction with implants are not reversible.

There may be an unacceptable appearance to the breast if you later choose to have breast implants removed.

Contraindications?

Breast implant surgery is contraindicated in women with untreated breast cancer or pre-malignant breast disorders, active infection anywhere in the body, or who are pregnant or nursing.

Women with a weakened immune system (currently receiving chemotherapy or drugs to suppress the immune system), conditions that interfere with blood clotting or wound healing, or have reduced blood supply to the breast tissue from prior surgery or radiation therapy treatments may be at greater risk for complications and poor surgical outcome.

How long does it take?

One hour, one night in hospital and a one-to-two-week recovery period.

Alternatives to surgery?

The use of external breast prostheses or padding, or the transfer of other body tissues to enlarge breast size.

What are the risks?

Every surgical procedure involves a certain amount of risk. Although most patients do not experience the following complications, patients should understand all possible consequences of the surgery.

l Implants: breast implants, similar to other medical devices, can fail. They can break or leak. Rupture can occur as a result of an injury, from no apparent cause, or during mammography. It is possible to damage an implant at the time of surgery. Damaged or broken implants cannot be repaired and ruptured or deflated implants require replacement or removal.

l Capsular contracture: scar tissue, which forms internally around the breast implant as a foreign body reaction to seal off the implant, can tighten and make the breast round, firm and possibly painful. Excessive firmness of the breasts can occur soon after surgery or years later. Treatment for capsular contracture may require surgery, implant replacement, or implant removal.

l Skin wrinkling and rippling: visible and palpable wrinkling of implants can occur. Some wrinkling is normal and expected and may be more pronounced in patients who have thin breast tissue. An implant may become visible at the surface of the breast as a result of the device pushing through layers of skin.

l Change in nipple and skin sensation: some change in nipple sensation is not unusual right after surgery. After several months, most patients have normal sensation. Partial or permanent loss of nipple and skin sensation may occur occasionally.

l Calcification: calcium deposits can form in the scar tissue surrounding the implant and may cause pain, firmness and is visible on mammography. Surgery may be necessary to remove and examine calcifications.

l Implant displacement: displacement, rotation, or migration of a breast implant may occur and may cause discomfort and/or distortion in breast shape. Additional surgery may be necessary.

Can I breastfeed?

Yes. It is not known if there are increased risks in nursing for a woman with breast implants. A study measuring elemental silicon (a component of silicone) in human breast milk did not indicate higher levels from women with silicone-filled gel implants when compared to women without implants.

Can I have mammograms?

Breast implants may make mammography more difficult and may obscure the detection of breast cancer. Implant rupture can occur.

Immune system diseases and unknown risks:

A small number of women with breast implants have reported symptoms similar to those of known diseases of the immune system, such as systemic lupus erythematosis, rheumatoid arthritis, scleroderma and other arthritis-like conditions. After several large epidemiological studies of women with and without implants, there is no scientific evidence that women with either silicone gel-filled or saline-filled breast implants have an increased risk of these diseases.

What does it cost?

The average cost of an augmentation is approximately R34 000 inclusive. Most medical aids exclude coverage of cosmetic surgery or any complications from the surgery. - Daily News

See: www.plasticsurgeons.co.z

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