Implant patients see problems 20 years later

May 19, 2009 1:56:52 PM PDT
Breast implants have become one of the most common cosmetic surgeries in the country and though the surgery is considered safe, some surgeons says many women are encountering problems from procedures performed years ago, when patients had less understanding of the commitment they were taking on.

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Danielle Marinovich still keeps a photograph of her late sister on the shelf of her shop in Berkeley. But the memories of her death from breast cancer came rushing back recently, as Danielle was giving herself a breast exam.

"During a breast exam in the shower I felt a lump on my right breast, it felt abnormal, and of course I was scared and thought it was cancerous," said Marinovich.

A series of follow-up tests revealed that the hardening in her breast wasn't cancer, but the result of a decision Danielle had made decades ago.

"I wanted to look a little sexier, feel sexier. I thought I'd be sexier if I had larger breasts," said patient Danielle Marinovich.

Like thousands of other women, Danielle had received silicone breast implants while she was in her early 20's.

"To me I thought it was going to be a onetime deal," said Marinovich.

"She's a classic example of someone who had implants 20 years ago. No one really told her what might have to be done in terms of maintenance or what to look for," said San Francisco surgeon Carolyn Chang, M.D.

Dr. Chang says Marinovich's condition is a relatively common side effect that typically emerges decades after implant surgery -- when friction from the implant causes the interior wall of the breast to harden.

"When it goes in its [a normal shape]. Then scar tissue forms around it. If there's a little space between the scar tissue and the implant, then it's soft and it sits nice in the body. If the scar tissue contracts it looks [like a tight ball]," said Dr. Chang.

The condition, known as encapsulation can also cause severe pain. So Marinovich ultimately opted to have her implants replaced.

ABC7 got to witness how Dr. Chang performed the procedure on another patient suffering similar side effects. While silicone implants were pulled from the market in the 1990's after allegations of leakage, they were reintroduced three years ago, and are now considered to be safe. But Dr. Chang says issues are still surfacing from surgeries performed decades ago.

"I think the basic problem was that we as physicians were not educating patient that these implants potentially need to be replaced over the lifetime. And so what I was seeing 20 years later was implants that were frankly ruptured and were not taken care of," said Dr. Carolyn Chang, M.D.

Implant patients are now taught to recognize potential trouble signs: breast pain, deformities of the breast, and encapsulation. They are also are warned that the implants will probably need to be replaced once or even twice in a lifetime.

In Marinovich's case, Dr. Chang placed new implants -- this time saline -- beneath the muscle under her breast, to allow for easier use of cancer screening tools like mammograms. However, Danielle is still uncertain about any future replacements.

"Because of history and what I know now, that's a really hard question for me to answer if I would or not. As I get older, I may not care as much. I may opt not to put them back in," said Marinovich.

Dr. Chang says that screening procedures to detect problems such as potential leakage have also improved significantly. Patients are now given an MRI scan, three years after surgery, and are advised to have follow up scans every two years after that.

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