Women should not have their breasts enlarged thinking it won't cost them anything beyond money and that it will make their lives better -- it may, and it may not, says Dr. Melvin J. Silverstein, medical director of the Breast Center in Los Angeles.
"The one thing that we know is that you cannot do as good a mammogram in an augmented patient as you can in a woman who doesn't have silicone gel-filled implants in her breasts," Silverstein, a nationally recognized authority on breast cancer, said yesterday.
"The average woman probably loses 25 percent to 30 percent visualizable tissue. You just don't see it on the breast X-ray. So, a woman has to decide for herself: Is it worth it?"
If a woman is concerned about finding cancer as early as it can be found, she won't have her breasts enlarged, said Silverstein.
Silverstein is one of about 25 experts in the field of breast cancer and breast health, rheumatology, plastic surgery, radiology and ophthalmology who are to be in Baltimore today and tomorrow to share research and clinical experiences involving silicone.
The conference has been called by the U.S. Food and Drug Administration, which will take its first detailed look at the safety of silicone, a controversial form of plastic used in breast implants and other medical devices.
About 2 million women have had silicone gel breast implants since 1964, when the devices were first introduced -- half of them since 1983. That is more than 1 percent of all the women in the United States. And, women continue to be implanted at the rate of 130,000 a year.
The conference is the outgrowth of a continuing outcry by consumer groups, women who have had unpleasant experiences, scientists and researchers.
The risk of breast cancer in American women had been rated at one chance in 10. Two weeks ago, the American Cancer Society changed that to one in nine.
"If a woman is not considered high-risk and she wants to have her breasts enlarged, that's her decision," Silverstein said. "But, a woman whose mother and sister both had breast cancer when they were 45 years old has a 50 percent chance of getting cancer.
"I think it would be very silly for that woman to have augmentation."
Silverstein also recommends that a woman who has had a breast biopsy that shows premalignant changes and needs to be followed closely should not have her breasts enlarged.
Formerly, when a woman had a mastectomy and then reconstruction to replace the removed malignant breast, plastic surgeons in Silverstein's center would augment the other breast to make it look better.
"But, now, we are recommending against that," he said. "We already know the opposite breast is at much higher risk for cancer. So, why put something there that interferes with what we can see?"
About 80 percent of the implants are obtained by women who simply want bigger breasts because they believe nature has cheated them. The rest are performed after breast surgery.
Health experts say there are side effects or complications in about 40 percent of women who have implants, and that some of them are serious. Aside from the masking of breast cancer, the possible risks include:
* Immune reactions, leading to serious illnesses such as rheumatoid arthritis, lupus and scleroderma, a life-threatening condition in which the tissues and the internal organs of the body harden.
* Hardening of surrounding breast tissue.
* Silicone leaks.
* A greater chance of getting cancer.