Surviving Starts With An Assumption

Natasha Singer's New York Times article on the long-term maintenance issues related to breast implants, Do My Breast Implants Have a Warranty? was a smart and insightful look at the aftermath of breast implant surgery. Singer raised questions about what happens to implants five, ten and fifteen years down the road - not only in terms of the safety issues of silicone, but in terms of how the breasts look, how they feel, how many additional surgeries may be required to keep them up to snuff, and what maintenance procedures healthcare insurance may or may not cover.

As a breast cancer survivor who had a mastectomy in 1999, I was absolutely stunned at the notion that there are doctors, patients and entire segments of the healthcare industry who would proceed with surgeries without considering their long-term impact. Singer's piece quoted Stephen Li, the president of a medical device testing company in Sarasota, Florida and a man who has served on three of the F.D.A.'s panels that reviewed implant safety. "The short answer," Li said, "is, we don't know specifically how long implants last." And yet Li voted to approve them.

We talk a lot in this country about breast cancer survivors. We produce, market, and sell a lot of pink products and pink events that are designed to celebrate survivors and work toward a cure - and thank goodness that we do. But shouldn't the very first step on the road to being a survivor be an assumption that survival is going to happen? Shouldn't every breast cancer survivor who is considering choosing an implant know, specifically, how long it is going to last so that she can decide how many maintenance issues she wants to take on over the course of her life?

I was 35 years old when I lost my breast, and in every decision I weighed - from whether or not to take Tamoxifen to whether or not to have a mastectomy to whether or not to reconstruct - I had the notion of survival at the forefront of my thoughts. I intended to live a long a time. I was, in fact, banking on living a long time - and I didn't want a solution that would require me to go back to the surgeon four or five times. The fact is, however, that I was able to make that calculation because I was surrounded by doctors and experts who assumed, along with me, that I might live eighty years. People die of cancer, of course -- and I know that one of the most difficult parts of the process is that at some point, you have to stop the struggle to live, cross over a line, and prepare to die. But until someone is actively dying, they are still living. They have that key ingredient: the assumption of survivorship.

Some of my cancer-endangered friends chose implants with their eyes wide open, knowing perfectly well that they will have to perform routine maintenance throughout their lives. That is their right. But in order for women to have their eyes open, surgeons doing breast implants need to trumpet the need for maintenance; medical device companies selling implants need to shout out from the rooftops that breast implants are temporary devices that will require additional surgeries, additional financial input, and possible healthcare complications; and healthcare companies need to make it a priority to educate their patients about the long-term, specific maintenance issues related to implants. Surviving starts with an assumption.

Comments

[Zeje]

I had a mastectomy last summer. I opted for NO reconstruction and was annoyed by the doctors who seemed to be pushing (too much) for reconstruction. I'm fine with a prosthetic in my bra. After a while I was able to take off my shirt in front of my husband. I didn't want any extra surgery and he agreed. I feel perfectly fine without the breast.

[Robert59]

Married to a woman who underwent a bilateral mastectomy at 43 followed by reconstructive surgery she had a choice between saline and silicone. In my mind she opted for the smart choice, saline. They may not be as realistic looking, but who's kidding who?

A reconstructed breast doesn't and never will feel or respond like a real one. They do provide psychological comfort. When she looks in the mirror she's not reminded each time of her loss.

All implants require maintenance. The beauty of water is if they leak, no big deal. If they burst, no big deal. Silicone leaks however a big deal. They can affect your health.

Someone criticized you for calling it maintenance, but that's what it is. And if you're like most people you go to the repair shop after it's broken, not before, meaning when it's leaking and in the case of silicone you've just signficantly compromised your health.

I hope you continue to do well.

[derik]

In our case (I was the spouse without the breasts), we went thru similar thoughts and (hopefully) figured (with the decision coming from my spouse) reconstruction with her stomach tissue. The surgery (and recovery) was, brutal (I was just an observer). But I believe the optimum choice. Heck, her stomach is totally flat. We did wonder why people get the optional tummy tuck and breast augmentation in real life. What was somewhat profound was the system thought she should go on Tamoxifen (for preventing problems with the healthy breast) and "maybe" radiation (just in case the sentinel lymph node coming clean was a head fake. In general, I think we are somewhat intellectually minded. On the flip side, we think there are lots of blind followers of what the doc says is what they do. Which means, there are probably some needless treatments going on. ahh, the piper could come back to all of us (even the "I think" we know people). Either way, I think more disclosure would be a good thing, at least for the masses.

[drdigipol]

A friend of mine read this piece and asked me to post this response (she was a bit offended by calling it maintenance... the term minimizes the seriousness of the risks and the seriousness of actions required to minimize those risks):

Jennie,

Following all the safety recommendations is not "maintenance." It is trying to lower the chances of complications, which would be much more severe than, say, breaking a nail. Please see the comments on the Beauty and the Breast Blog:
http://tinyurl.com/32k88a