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.