Journal of Obstetric, Gynecologic, & Neonatal Nursing

Objective: The safety of silicone breast implants recently has been questioned. Increasing numbers of women have reported a variety of health problems that they attribute to their implants. The purpose of this descriptive study was to explicate the phenomenon of silicone-related illness as reported by women who have had breast implants.

Design: A qualitative design was grounded in the theoretical framework proposed by McBride and McBride (1981), the core of which is the first-person, lived experiences of women as interpreted and explained by the women themselves.

Participants: Participants were recruited through Command Trust Network, an international support group for women with breast implant problems. The sample consisted of 55 women from 19 states and Canada who experienced health problems they attributed to their implants. Eighteen percent labeled themselves as disabled.

Results: Themes emerging from responses to 10 questions are discussed in terms of circumstances leading to initial implantation, understanding risks and benefits, health problems and symptoms, physician response, choices made about implant removal, and psychosocial and emotional consequences.

Conclusions: Findings included dissatisfaction with implants, similarity of health problems, and recurrent surgical and nonsurgical procedures. Dominant themes included lack of informed consent, physician denial of health problems, and the decision to remove implants. Further research should be directed at recipients of implants who report silicone-related illness to determine the number of women affected and the nature of their problems.

Accepted; October 1994

 

During the past several years, silicone gel breast implants have come under intense scrutiny. Although the devices have been used widely for more than 30 years, reports of silicone-related illness recently have generated a great deal of publicity. In 1988, consumer activist groups voiced concerns related to long-term health risks and informed consent issues (Goldrich, 1988; Wolfe, 1988). In December 1990, a segment of Face to Face With Connie Chung featured women's reports of health problems. Media attention intensified in November 1991, when testimony before the Food and Drug Administration (FDA) General and Plastic Surgical Devices Advisory Panel raised questions about links between silicone implants and reports of cancer and autoimmune disease. Based on information released from protective order in a San Francisco court case (Smart, 1991), FDA Commissioner David Kessler requested on January 6, 1992 a moratorium on the use of silicone implants. Headlines heightened the anxieties of women with implants and revealed cover-ups by manufacturers (Pollitt, 1992; Rigdon, 1992). After recommendations by the advisory panel, Kessler announced his decision on April l6, 1992: Silicone breast implants would be used only within tightly controlled FDA protocols restricted mainly to reconstruction (Kessler, 1992). Clinical trials aimed at establishing statistically reliable data to answer basic safety questions began that fall after FDA approval of Mentor Corporation protocols ("Breast Implants Available," 1992). The medical community labeled the FDA policy paternalistic (Angell, 1992), and its professional organization took the position that women's anxieties were needless and that they should have the right to choose silicone implants after being fully informed of the risks and benefits (Council on Scientific Affairs, American Medical Association, 1993).

 

An estimated 1 million women in the United States (Segal, 1992) and 150,000 to 200,000 women in Canada

(Berkel, 1992) have silicone breast implants. Although the majority of these women are satisfied and do not regret implantation (Handel, Wellisch, Silverstein, Jensen, & Waisman, 1993; Iverson, 1991), increasing numbers have reported a variety of chronic health problems they attribute to their implants. Exact percentages of women who experience problems are unavailable. McCarthy, Merkatz, and Bagley (1993) conducted a descriptive analysis of three FDA sources for reporting problems with silicone breast implants: women's letters describing problems they attributed to their implants, manufacturers' reports from the mandatory Medical Device Reporting program, and consumers' reports from the voluntary Product and Reporting Program. They concluded that the significant increase in complaints from women and the unfavorable reports from the Medical Device Reporting and Product and Reporting programs received in the first 6 months of 1992 raised questions about safety and indicated that more women than previously recognized have reported problems.

 

Purpose and Theoretical Framework

 

The purpose of this descriptive study was to explore women's problems with breast implants. Despite the extensive media attention, little is known about the specific nature of silicone-related illness reported by women; thus, a qualitative, interpretive approach was the design chosen. The theoretical context for the study was a framework proposed by McBride and McBride (1981), the core of which is attention to the first-person, lived experiences of women as interpreted and explained by the women themselves.

 

Method

 

Sample

 

Purposive sampling was used to target women with health problems they attributed to their implants. Fifty- five women from 19 states and Canada were recruited through Command Trust Network, an international information and support group for women with breast implant problems. The sample included well-educated women from a variety of occupations, 18% of whom labeled themselves as disabled. Participants ranged in age from 26 to 72 years, with a mean age of 44 years.

 

Approximately 70% of the women had augmentation mammoplasty, and the remainder had reconstruction after mastectomy, roughly approximating the 80% augmentation and 20% reconstruction estimates in the general population of implant recipients (Segal, 1992). The number of years since their implant procedure ranged from 1 to 25, with a mean of 11.27 years. The women's combined experiences totaled 620 years of living with breast implants.

 

Procedure

 

After the institutional review board approved the study, women were recruited at a November 1992 national conference devoted exclusively to breast implant issues. Command Trust Network leaders who sponsored the event announced the purpose of the study during conference proceedings and provided space at a registration table to distribute information. Implant recipients interested in participating received a packet of materials that included a cover letter with further details and human rights assurances, an instrument including implant history questions and a list of 10 questions directed at exploring health-related implant problems (see Table 1), and a business reply envelope for return mail. Consent to participate in the study was indicated by return of the completed instrument.

 

Table 1. Questions to Explore Women's Problems With Breast Implants 

What circumstances led to your breast implant surgery?   What did you believe to be the benefits and risks of your implant surgery?   What health problems have you had that you attribute to your breast implants?   How did your physician/s respond to your implant problems?   How did your husband/significant other respond?   Have you considered implant removal? Why or why not?   Have you considered reconstruction, such as the flap surgery that uses your own tissue? Why or why not?   What personal feelings and/or emotions have your experiences with implants aroused in you?

 

Data were analyzed using a phenomenologic approach (Oiler-Boyd, 1993). Each woman's responses were read with the goal of capturing the lived meaning of her experience of breast implant problems. These responses were examined for recurrent words and phrases to identify essential structures and meanings. Similar and repetitive patterns of expression were clustered together and labeled to constitute themes that explicate the phenomenon of silicone-related illness. To produce as faithful a description as possible, this identified core of common elements was then checked against the women's original words to assure their meanings had not been taken out of context or distorted. Table 2 presents one example of similar expressions and a related theme for the women's thoughts about reconstruction after implant removal.

 

Results

 

The Initial Implantation

 

The dominant theme in responses about the initial implantation decision was body image concern, which was equally strong in women who had breast reconstruction and augmentation. Women who had one or two mastectomies experienced a body image alteration. Women who had augmentation procedures experienced a body image disturbance related to dissatisfaction with their small breasts.

 

Women choosing breast reconstruction. About half the group choosing reconstruction had undergone mastectomy after a diagnosis of cancer. A frequently expressed theme was the need to restore a sense of wholeness, characterized by statements such as “To feel whole and feminine again... I hated being lopsided after the mastectomy.”

 

Table 2. Similar Expressions and Related Theme

Theme: Newfound acceptance of body Similar Expressions: I will be me.         I'm fine the way I am and always was, just never knew it till now. I will respect my old self. It's time to live with myself. I am very pleased to have my small breasts right back the way they were... I missed them! I now have a small bust line again and am quite content with the results. I will like me for me after the explant. I want to be as natural as possible.

The remainder of the women in this group had undergone subcutaneous mastectomy for fibrocystic disease. The procedure has a high rate of complication and has been challenged for some time; because unknown amounts of breast tissue remain, the rationale supporting it as a prophylaxis against the development of breast cancer remains unproved (Slade, 1984). Most of these women reported a history of recurrent aspirations of cysts and biopsies of lumps that resulted in ongoing anxiety. One woman recalled, "After multiple breast biopsies, I was frightened about the risk of breast cancer. Breast self-exam had become a form of Russian roulette—was this the lump that would be cancer? or the next one?" Another woman expressed regret that "problems I've had with implants were not worth it. I would have rather had the cancer."

Women choosing augmention. More than half the women choosing augmentation spoke of feeling inadequate and inferior as a woman, self-conscious, or embarrassed by their small breasts. Representative comments included "I was in my early 20s, had an athletic figure, and my first love. I wanted my sexuality and femininity," and "I felt that I could not attract a male as easily with a flat chest. I wanted to be voluptuous, and the surgery seemed an easy way to do it." Another woman explained her augmentation decision as ". . . wanting to be society's perfect Barbie." Several women's images of normal breasts had been shaped by the media. One woman revealed, "My breasts were near perfect and had only a slight sag which I did not know was normal. The only breasts I had seen were in Playboy magazine and stuck straight out."

Other women described their humiliation from teasing and cruel remarks that came from loved ones as well as heartless strangers. One woman said, "My older sister made repeated comments to me about my aa chest and had called me a 't*tless bitch'." A woman who first described how her former husband used to tell her, "You'd be perfect if you had t*ts," then added, "So what did I do but rush out and get me a pair." Another woman recalled the hurt, saying, "All my life I was flat chested and was the object of much 'fun'—director of the itty bitty t*tty club, et cetera. Many years I appeared to laugh it off on the outside but my insides were ripped apart."

Body image dissatisfaction also involved a desire to restore shape after childbearing. One woman said that after having children she "just wanted the air put back."

Implant Problems

 

The women experienced recurrent surgical and nonsurgical procedures, a capsular contracture rate of 43.6%, and a rupture rate of 34.5%. Many women reported multiple experiences of open capsulotomy, a surgical procedure to loosen the contracted scar capsule surrounding the implant and correct a complication known as capsular contracture. Fibrous scar tissue formation is the body's natural response, walling off a foreign material by surrounding it with a capsule. The capsule may contract and tighten, causing varying degrees of hardness, pain, distortion, coldness, and lack of sensation (Rudolph, l99l). The women described the discomfort of capsular contracture with words and phrases such as "cement hard and uncomfortable," "unmovable, cold, rock hard breasts," "painful on compression or stomach sleeping," and "like someone continually squeezing my breast."

Eleven women (20%) had experienced closed capsulotomies, another attempt to deal with capsular contracture. In this nonsurgical procedure, the physician forcefully squeezes the hardened breast to compress and displace the implant, which tears the surrounding scar capsule and relieves the tightness (Baker, Bartels, & Douglas, 1976). One woman depicted the procedure as "some kind of medieval torture " that was "over in an instant, but caused a brief searing, burning pain." In addition to causing pain and discomfort, closed capsulotomy is now discouraged because it can lead to implant rupture (Dow Corning Wright, l99l).

Symptoms

 

 

There were strong commonalities in the health problems the women attributed to their implants. The most prominent symptom, experienced by 48 women (87%), was muscle and joint aches and pains. The next most frequently reported symptoms were fatigue, experienced by 33 women (60%), and decreased cognitive ability, experienced by 22 women (40%). In more than one third of the sample, these complaints clustered together in a triad.

The myalgias and arthralgias were described as "transient achey-bone feelings," "arthritis aches," "deep flu-like symptoms," "migrating, burning pain in muscles," ''stiffness," and such "tightness" that led one woman to say, "It feels like my skin doesn't fit me anymore," Descriptors for fatigue included "chronic," "extreme," "severe," and "profound." Decreased cognition most frequently involved complaints of "short-term memory loss," with some women complaining of "concentration problems" and "word loss." One woman said she fell "dim-witted sometimes." Another said she was "having difficulty expressing myself as fluently as I am accustomed to."

        Other symptom clusters were also apparent in the data. Complaints of local breast and chest wall pain were described as "burning," "hot," or "pressure." Diverse neurologic symptoms commonly were reported, including "numbness," or "tingly," "prickly," or "electric sensations" in some pan of the body, sometimes involving tremors or lack of control. Reports of various types of emotional distress included depression, panic attacks, anxiety attacks, and mood swings. Gynecologic problems were experienced, such as menstrual irregularities, endometriosis, hysterectomy, and infertility. Many women reported mysterious rashes over a variety of body areas and hair loss.

       A central question concerning the long-term safety of breast implants is whether a cause and effect relationship exists between silicone and autoimmune disease. The issue is debated in the medical literature; some physicians acknowledge an association between silicone and the variety of connective tissue disorders reported (Brautbar, Vojdani, & Campbell, 1994; Bridges, Conley, Wang, Burns, & Vasey, 1993; Spiera & Kerr, 1993), and others assert that such reports are simply anecdotal (Brody  et al., 1992; Gabriel et al., 1994; Sanchez-Guerrero, Schur, Sergent, & Liang, 1994). Although data from this study cannot resolve this question, it is worth noting that more than one third of the subjects responded to questions about their health problems using the following medical diagnostic terminology: Raynaud's disease (1), Sjogren's syndrome (3), lupus erythematosis (l), fibromyalgia (9), myositis (2), fibromyositis (2), mixed connective tissue disease (4), human adjuvant disease (2), rheumatoid arthritis (5), chronic fatigue syndrome (3), and multiple sclerosis (l).

 

Response by Physicians

 

Eighty-one percent of the women's responses indicated physician denial. Descriptions of their experiences with physicians included comments such as "I was at the mercy of plastic doctors with plastic hearts" and "The treatment I received from some of my doctors is almost as horrible as the pain itself."

 

     In most cases, the denial concerned symptom etiology. Many women reported that their physicians attributed symptoms to coincidence; for example, "Every doctor I saw said I was grabbing at straws thinking my implants might be the problem" and "No one would believe me. Even when my implant's shape changed and I suspected rupture, doctors all said everything looks fine." Other women said their symptoms were blamed on their own emotionality and reported being told "You muse be depressed," "It's all in your head," or "It must be change of life." One woman believed she was treated "like an overreactive housewife with nothing better to do." In some cases, the denial was expressed as paternalism, represented by one woman's comment, "I've seen four different specialists who think I'm anxiety ridden over the media hype. One patted me on the head and said everything was going to be fine."

 

     Some women reported being refused treatment; others reported having to travel many miles to find physicians willing to treat them. One example was a woman who said, “The physicians in this area are totally and completely unsupportive and unwilling to recognize and treat us. Most of us in our support group are seeing doctors in another part of the state.” One woman called it "patient dumping." Another woman concluded, "I've learned that if I want medical care, I have to never mention the word silicone if I am to get it." Another woman summarized the feelings these experiences had aroused in her:

 

Not being taken seriously by these medical people adds to the victimization and isolation of the women. You come from those physician visits feeling more discouraged and hopeless than when you went in, and you usually leave in tears. It feels like a bad dream that just keeps replaying.

 

Informed Consent Issues

 

All the women charged that they were denied adequate disclosure of information on which to base competent decisions about their bodies, claiming breast implants were promoted as safe and indestructible devices that would last forever. The three themes emerging from the information the women reported having been given by their physicians were inconsistent with evidence about risks that had been known for some time (Conyers, 1993).

 

Implants are biologically safe. More than half the women said they were led to believe that implants were biologically safe products. Examples of this theme included "I was not told of risks—was assured implants were safe—safer than my own tissue" and "I had no clue of the risks. I was told silicone was inert and naturally occurring, that gave me the belief it was safe and tested. Done in a doctor's office, I believed the surgery to be minor."

     More than 40% said risks, when mentioned at all, were downplayed or minimized. For example, one woman recalled being told that there were "a few risks 'as with anything,' but were so minute. The risk fact sheet claimed less than 0.5% to 1% of reported problems. Benefits clearly outweighed risks." Another woman declared, “I still have the list of questions about the risks that I brought with me to the doctor.  I was assured this was safe and I would have no problems. Now I feel like I have a time bomb in my chest just waiting co explode!"

Approximately one fourth of the sample indicated that the only risks discussed were those of surgery itself, such as anesthesia, infection, and bleeding. Approximately one third reported that the only risk mentioned was capsular contracture, saying, for example, "I was not informed of risks other than 'tightening,' which could 'be easily broken loose'."

Implants are indestructible. Forty percent of the women reported being told that breast implants would not bleed, leak, or rupture. Responses from two women are examples of the assurances the women were given about the durability of implants. The first woman said, "I was told there were no risks. My plastic surgeon jumped up and down (literally) telling me they were indestructible." The second woman recalled, "When 1 decided to have reconstruction I really felt I was doing the right thing. My surgeon tossed the implant in the air and even stomped on it, assuring me of its safety."

Implants last a lifetime. The majority of the sample said they were assured the implantation procedure was a once in a lifetime event. "Last a lifetime" and "last forever" were recurrent phrases. Representative comments included "I didn't believe there were any risks. I was led to believe they would look and feel completely natural and would last forever" and "I did not make an informed decision. I was simply told that implants were the way to go—they would last until I was 100." One woman recalled she had negotiated for saline implants during the preoperative consultation and later discovered her surgeon had substituted silicone during surgery. She explained, "At the second surgery I had been hearing about the problems with implants. I said I wanted saline. Two months after the surgery I found out that the doctor made a decision to use silicone."

The Decision to Remove Implants

 

The choice made by almost 90% of this sample was to have the implants removed. At the time of data collection. 40 women had already completed the procedure and nine others had scheduled it.

No reconstruction after removal. Almost three fourths of the women refused any reconstruction of their breasts after implant removal. Two themes emerged from their responses. The most dominant one was a belief that, after what they had already experienced, any further procedures were simply too much to put themselves through and might compromise their already fragile health. One woman explained, "I have not considered any reconstruction. I just want to someday get my health back—and  I don't want to further tax my system with any additional surgeries or procedures." Another woman said, "Enough of an onslaught on my body!" Some women found the thought of going through more surgery intolerable. One said, "I no longer care if I have breasts. I have developed such a hatred, a fear of surgery, that I cannot make myself go through any type of surgery." Others developed a deep distrust of surgeons, as revealed by the remark, "No reconstruction considered. Don't want a surgeon to come near me."

 

The choice made by almost 90% of this sample of women was to have the implants removed.

 

 

The second theme from those women deciding against reconstruction was the expression of a newfound acceptance of their bodies, best expressed by this woman's comment, "I don't want reconstruction. I'm fine the way I am and always was—just never knew it till now." Another woman said simply, "I think it's time to live with myself."

Reconstruction after removal. Two options existed for the remaining one fourth of the sample choosing reconstruction after their implants were removed—one to replace their silicone implants with saline implants, the other to have reconstruction using their own tissue. Each option has trade-offs. Saline implants also are subject to capsular contracture, deflate readily and require additional surgery for replacement, and do not completely eliminate exposure to silicone because the saline is encased in a silicone shell (Segal, 1992). Tissue transfer procedures, known as "flap" surgery, involve moving muscle, fat, and skin from another body area to the chest, where the tissue is then sculptured into a natural-feeling, permanent breast. Flap surgeries are technically demanding to perform, much more extensive to go through, and result in further scarring (Kroll & Baldwin, 1992).

The women were evenly divided in their selection of these two options. Those choosing saline implants did not regard flap surgery as a viable option primarily because of the extensiveness of the procedure, explaining, for example, "The flap is a little drastic for me. I will have saline or some safer material put in." Conversely, women who opted for flap surgery did not regard saline implants as a viable option. Two of them pointed out that switching from silicone to saline would not completely eliminate all the complications of implantation. The first woman said, "I chose a very difficult procedure as an 'investment' for my future since it offered me the only hope to be finally done with repeated capsulotomies." The second woman affirmed, "I am at peace knowing I am made of me."

 

Improvement after implant removal. Eleven women who had their implants removed (28%) reported partial or total improvement in their symptoms and comfort level. The number experiencing improvement may be higher; this information was included in their responses regarding implant removal decisions and was not directly requested. The women's descriptions of their improvement varied; for example, "I immediately noticed reduction in the chest wall pain which was continual since 1973," and "I had two hard baseballs that did not move or shift when I laid down. I went through a lot (flap reconstruction) to have soft breasts that move naturally, and I am much more comfortable."

Emotional Responses

The problem experienced by this sample of women aroused their strong feelings. Although their responses covered the full gamut of human emotions, the four strongest themes included anger-rage, fear-anxiety, sorrow-grief, and betrayal-distrust.

 

Anger-Rage. The dominant theme was the women's anger and rage, present in almost three fourths of their responses. One woman said, "I have a lot of anger because of my suffering and because no one wants to take responsibility; neither the manufacturers, the doctors, nor the FDA." Another woman emphasized, "I am enraged. I feel like I have paid to kill myself."

Much of the outrage the women expressed was directed at their sense of being used as a means to an end.
They contended that without adequate information to make an autonomous decision, they were forced to par-
ticipate in an uncontrolled experiment, charging that "We victims have been guinea pigs" and "We were used as nothing more than laboratory animals." One woman noted, "The only difference between women and mice is we can talk, but no one seems to be listening."

Fear-Anxiety. Their unknown future and medical uncertainty fueled feelings of fear and anxiety. Representative comments included "Fear—that I am doomed to a future of silicone-induced problems for which there is no treatment" and "Fear that the quality and quantity of my life is over."

Sorrow-Grief. Other women felt deep sadness and a sense of loss, summarized by the comment, "I have lost everything dear to me—my health, my career, my marriage, and my mental abilities." Another woman reflected, "I will never know what kind of life that I should or could have had without silicone."

 

Betrayal-Distrust. Some women expressed feeling betrayed by a system they believed should have helped and protected them, one whose ulterior motives they now suspected. For example, one woman remarked, "I feel I have been betrayed by my physicians and the manufacturers. I also feel betrayed by the government, which has not done enough to investigate these and to help the victims." Another woman concluded, "Nothing is without danger if there is a profit to be had." Several women expressed feelings analogous to being raped; for example, "I feel raped a thousand times, and struggle to deal with the pain,"

Internalization of feelings. An inward projection of feelings was another strong pattern in almost one third of the women's responses. Many women blamed themselves in some way. One woman was angry at herself for "trying to improve on the beauty I had." Still another felt ashamed that she had "so little self-esteem that I cut open a perfectly healthy body to put a foreign material in that has now harmed me!"

 

Pain outside themselves. The theme of pain expressed by the women extended beyond their own symptoms and health concerns. Some women spoke of the toll their health problems had taken on family relationships, saying, for example, "My 7-year-old son can't hug or lean on mommy's left side" and "Our life has become centered around this illness as it dictates what we are able to do every day." Other women emphasized adverse effects on their sexual relationships with comments such as, "I am often in too much pain to feel sexual. This used to be a very rich part of our relationship"  and "My husband seldom touches me since I cannot feel him anyway." Still other women voiced concern for the children they had carried and breastfed within an environment of silicone, now known as second-generation effects (Levine & Ilowite, 1994; Teuber & Gershwin, 1994). One woman admitted she worries "every single day" about the long-term effects of her son's exposure to silicone.

Discussion

Women reporting problems with their silicone breast implants were specifically targeted for inclusion in this study to explicate women's experience of silicone-related illness. Thus, the multitude of health problems and high levels of dissatisfaction with implant experiences they report are understandably in sharp contrast to the conclusion in other studies that most women's implant experiences are gratifying and problem free (Handel et al., 1993; Iverson, 1991).

This study's sample may be part of a significantly different subset of implant recipients, one consistent with samples in two recent FDA reports (McCarthy et al., 1993; Merkatz, Bagley, & McCarthy, 1993). The themes derived from the small subset of dissatisfied women in those studies are similar to the themes reported in this sample: Women did not receive adequate information before surgery, were not taken seriously by their physicians when they verbalized health problems, had difficulty maintaining normal activities, and had concerns about the future (Merkatz et al., 1993). The most common complaints reported to the FDA were also similar to those of the women in this sample: breast pain, rupture, capsular contracture, joint pain, fatigue, arthritis, and other autoimmune disorders (McCarthy et al., 1993)- Findings from the current study lend support to the observation by McCarthy et al. (1993) that more women than previously recognized have reported problems.

 

 

     Further research should be directed at implant recipients who report silicone-related illness to determine how many women are affected and the nature of their problems. However, findings from such studies will be unavailable for some time. Until then, women with breast implants who report symptoms of immune-related connective tissue disorders, such as painful or swollen joints; swollen glands or lymph nodes, unusual fatigue; swollen hands and feet; redness, tightness or swelling of the skin; and unusual hair loss (Hirmand, Latrenta, & Hoffman, 1993), should be encouraged to seek medical attention from a rheumatologist.

     Nurses are often the first health care professionals from whom women seek advice. Nurses must be aware of recent FDA conclusions that conflict with the information given to the women in this study, namely that the biologic safety of implants has not been established (Kessler, 1992) and that implants are not indestructible and should not be expected to last a lifetime (Segal, 1992). Nurses also should recognize that it may be more difficult for their clients who have had problems with implants to place trust in the professional relationship.

     Most of the women in this sample elected to have their implants removed. They reported highly positive responses to removal, such as positive body image adjustments and relief of symptoms, in contrast to the more variable outcomes reported in the medical literature (Hirmand et al., 1993). Unfortunately, there is no way to identify which women will benefit from implant removal (Hirmand et al., 1993). Information about responses to removal should be provided to women considering the procedure. Implant recipients also should be aware that removal is recommended for those with symptoms (Hirmand et al., 1993; Vasey, Seleznick, & Germain, 1993). Access to information and support groups should be available to those women in the process of identifying their options and making implant-related health care decisions (see Table 3).

     Although the silicone breast implant issue has received much media attention, a full appreciation of its complexity will not occur until the voices of the women affected are heard and their personal experiences are shared. The words of 55 women have described the phenomenon of silicone-related illness as they interpret it. These findings will be useful for nurses to understand better the implications of silicone breast implants for women's physical and psychosocial health and to advise women who experience silicone-related illness.

Table 3. Information networks for Women With Implants

 

Command Trust Network no longer provides services to consumers, but their informational materials are available through:
Center for Medical Consumers 237 Thompson Street New York, NY 10012 212-674-7105	Coalition of Silicone Survivors P.O. Box 129 Broomfield, CO 80038-0129 303-469-8242
Silicone Scene, Inc. Carol Mancini P.O. Box 721630 San Diego, CA 92172-1630 619-484-8716	Positive Action, Love, & Support (PALS) Susan Boone, RN 18 Hollow Tree Court Hamilton, OH 45013
National Women's Health Network 1325 G Street N.W. Washington, DC 20005 202-347-1140	Public Citizen Health Research Group 2000 P Street N.W. Washington, DC 20036 202-833-3000
As Is (American Silicone Implant Survivors) Janet Van Winkle 1288 Cork Elm Drive Kirkwood, MO 63122 314-821-0115	Children Affected by Toxic Substances (CATS) Jama Roussano 60 Oser Avenue, Suite 1 Hauppaugue, NY 11788 1-800-CATS-199

 

References

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Baker, J., Bartels, R., & Douglas, W. (1976). Closed compression technique for rupturing a contracted capsule around a breast implant. Plastic and Reconstructive Surgery, 58, 137-141.

 

Berkel, H. (1992). Breast implants: Quo vadis? Canadian Medical Association Journal, 147, 1127-1129.

 

Brautbar, N., Vojdani, A., & Campbell, A. (1994). Silicone breast implants and autoimmunity: Causation or myth? Archives of Environmental Health, 49,151-152.

 

Breast implants available for reconstruction under clinical studies. (1992, September). FDA Medical Bulletin, p. 3.

 

Bridges, A., Conley, C., Wang, G., Burns, E., & Vasey, F. (1993). A clinical and immunologic evaluation of women with silicone breast implants and symptoms of rheumatic disease. Annals of Internal Medicine, 118, 929-936.

 

Brody, G., Conway, D., Deapen, D., Fisher, J., Hochberg, M., LeRoy, E., Medsger, T., Robson, M., Shons, A., & Weisman, M. (1992). Consensus statement on the relationship of breast implants to connective tissue disorders. Plastic and Reconstructive Surgery,90, 1102-1104.

 

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Gabriel, S., O'Fallon, W., Kurtland, L., Beard, C., Woods, J., & Melton, L. (1994). Risk of connective tissue diseases and other disorders after breast implantation. The New England Journal of Medicine, 330,1697-1702.

 

Goldrich, S. (1988, June). Restoration drama; A cautionary tale by a woman who had breast implants after mastectomy. Ms., p. 20.

 

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Hirmand, H., Latrenta, G., & Hoffman, L. (1993). Autoimmune disease and silicone breast implants, Oncology. 7(7), 17-24.

Iverson, R. (l99l). National survey shows overwhelming satisfaction with breast implants. Plastic and Reconstructive Surgery, 88, 546-547.

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Kroll, S., & Baldwin, B. (1992). A comparison of outcomes using three different methods of breast reconstruction. Plastic and Reconstructive Surgery, 90, 455-462.

 

Levine. J., & llowite, N. (1994). Sclerodermalike esophageal disease in children breast-fed by mothers with silicone breast implants. Journal of the American Medical Association, 271, 213-216.

 

McBride.A., & McBride, W. (1981). Theoretical underpinnings for women's health. Women & Health, 6(1/2), 37-55.

 

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