Medical scanners help find leaks in implants, Hopkins, L.A. studies show

December 04, 1992|By Jonathan Bor | Jonathan Bor,Staff Writer

Recent studies in Baltimore and Los Angeles offer hope that medical scanning devices can give accurate pictures of breast implants that have ruptured and leaked silicone gel into surrounding tissue.

Two techniques, magnetic resonance imaging (MRI) and ultrasound, appear to do a good job detecting the most serious )) leaks: those in which gel has seeped outside the capsule of scar tissue that naturally forms around an implant once it is placed inside the breast.

They appear less effective in detecting leaks that are contained by the scar-tissue envelope.

Technologies capable of finding silicone leaks would help women who want to find out if their implants should be surgically removed. Physicians warn, however, that even if the encouraging findings by Johns Hopkins Hospital and the University of California Los Angeles are supported by further research, the techniques are too expensive to warrant use in routine screening of the estimated 1.5 million American women with the implants.

Magnetic resonance imaging costs as high as $1,200 per scan, while ultrasound runs around $400. Until less expensive methods are found, physicians at Johns Hopkins Hospital recommend MRI or ultrasound for women with sudden breast pain, suspicious masses in their breasts or arms, or breasts that have absorbed shocks in accidents.

"For the rest who are just concerned because of all the attention around implants, it's kind of hard to know what to recommend because of the cost involved," said Dr. Wendie Berg, a Hopkins )) radiologist who discussed her study this week at a national meeting of the American Society of Radiology in Chicago.

Dr. Berg and her colleagues studied a sample group of 32 women with leakages that were later confirmed in surgery. In that group, ultrasound and MRI each detected close to 60 percent of the ruptures.

In the UCLA study, MRI detected 94 percent of the ruptures. That California group had a technological edge: a magnetic coil that sits directly atop the breast. It is used in conjunction with conventional MRI -- a hulking device with a large coil that envelops the entire body.

Although the magnetic coil is not widely available, Dr. Berg said Hopkins expects to purchase one soon, and the device ought to be in much wider circulation in the coming year.

While scientists continue their search for the best method, the demand for effective scanning will be strong. At the Johns Hopkins Hospital, Dr. Berg and Dr. Norman D. Anderson, a well-known authority on implant problems, have seen 134 patients with silicone leaks since just last February.

"Many of these women have been shuffled around from doctor to doctor before anyone would address their complaints," Dr. Berg said.

"I think there is a much broader population that was told not to worry about it. A number of women said they had chest pain for years but thought it was normal." Dr. Anderson said the most common complaints were chronic pain inside the breast and in )) the surrounding chest area. Many patients also had "triggerpoints" -- spots that were extremely painful to the touch.

But problems were not confined to the chest area.

"Some of the women could not even turn their head because the neck was so painful and stiff," Dr. Anderson said. Some women had globs in the armpit, elbow or abdominal wall, said Dr. Berg.

Almost 10 percent of the women were dependent on narcotics, hypnotics or tranquilizers -- drugs prescribed by previous physicians for pain control, Dr. Anderson said.

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