Beautify Me !

The Stress of Cancer: Seeking Support


Learning that you have a diagnosis of cancer is usually a traumatic experience. And following the shock of diagnosis, people have to face treatment decisions and side effects, changing personal relationships and uncertainty about their future.

"Stress can appear at every stage of the disease, at diagnosis, during treatment and after treatment," says Josée Savard, PhD, a professor of psychiatry at Université Laval in Quebec, Canada. While some stress is expected to accompany a diagnosis of cancer, Dr. Savard and other experts say that people with cancer should monitor their stress levels to make sure they are not crossing the line into depression and anxiety, which are conditions that can interfere with someone's quality of life and even their health status.



Stress vs. Anxiety and Depression
Most of the research on the psychological impact of cancer has been conducted in women with breast cancer. It's estimated that between 22 and 50 percent of women with breast cancer are depressed, while 33 percent have acute stress disorder and 3 to 19 percent have post-traumatic stress disorder (PTSD), a condition seen in people who have experienced traumatic events such as natural disasters or military combat.

A Canadian study published June 14th in the British Journal of Cancer found that almost 38 percent of its 3,095 participants—who included people with breast, prostate, colorectal and lung cancer—met the criteria for distress levels that should be treated. But almost half of these patients had not sought psychosocial support, primarily because they weren't aware of support services or because they didn't think they needed them.

According to study author Linda Carlson, PhD, a clinical psychiatrist with the University of Calgary/Tom Baker Cancer Centre in Alberta, Canada, not getting help can have major repercussions. "If people don't feel like they can talk to anyone, their distress just snowballs over time," she says, adding that people with untreated depression and anxiety often end up visiting doctors more often.

That snowball effect may be one of several reasons patients find the post-treatment period stressful. "Some patients find it most difficult when treatments end because they feel they're not fighting anymore and they don't have the support of their medical team," Dr. Savard says.






Getting Support
Sometimes people with cancer find that the friends and family they thought they could rely on aren't offering them the support they need. In fact, cancer can sometimes expose existing cracks in relationships, particularly in couples. "For couples who were functioning well before cancer, the cancer will usually have a minimal impact on their relationship, or even improve it. In couples who had difficulties before cancer, it will generally create more problems," Dr. Savard explains.

Other times, Dr. Carlson says, people don't want to overburden their friends and family with their worries and may feel pressure to stay upbeat. And those friends and family members don't always know what to say or how to be helpful, especially if they haven't faced a life-threatening illness themselves.

Many people with cancer find the support they need in psychotherapy. Depending upon someone's personality and preferences, they may choose one-on-one psychotherapy or a support group of their peers that is led by a mental health professional, such as an oncology social worker. A study published in May 2001 in The Archives of General Psychiatry found that support groups helped reduce distress in people with metastatic cancer, primarily by helping them face their advanced disease on an emotional level. (Because the concerns of people with early stage and advanced cancer are so different, separate support groups are often found to be helpful for participants.)

"Supportive treatment, whether it's individual or group therapy, allows people to express their concerns and fears," Dr. Carlson says. "There's this myth that you have to be positive all the time when what's really important is that people are able to express their feelings, whatever they are."

Support groups and psychotherapy are also available to the family and friends of people with cancer. People with cancer and their families can find psychosocial support though their hospital or cancer center, or though support and advocacy organizations such as the American Cancer Society and The Wellness Community and CancerCare, which offer online support groups led by health professionals.

Other options available to people with cancer include hypnosis and guided imagery, where you relax by focusing on a positive mental image. Biofeedback, a technique that helps people learn how to relax, works with bodily functions such as breathing and muscle tension. If it's feasible, mild aerobic exercise can also provide energy and a mood lift. Some people, especially those who have had anxiety disorder or depression in the past, may need antidepressants or anti-anxiety medications to help them cope.

Cancer is an isolating experience, Dr. Carlson says, but reaching out for support can help people living with the discomfort and uncertainties of cancer gain reassurance and a better quality of life.

National Cancer Institute's Symptoms of Depression Having a depressed mood for most of the day and on most days:

Loss of pleasure and interest in most activities
Changes in eating and sleeping habits
Nervousness or sluggishness
Tiredness
Feeling of worthlessness or inappropriate guilt
Poor concentration
Thoughts of death or suicide

More Than Mood Swings: Bipolar Disorder in Teens


Parents are often exasperated by their moody teenage children. After all, teenagers are known to be irritable, to sleep a lot and to resist authority figures. So how can a concerned parent determine when a teenager is just being a typical teenager and when their child has a mental illness such as bipolar disorder?

In teenagers, symptoms of bipolar disorder can include dramatic mood changes within a single day and may have different symptoms than adults. Below, Barbara Geller, MD, a professor of psychiatry at Washington University in St. Louis, discusses how to recognize and treat bipolar disorder in adolescents.



What is bipolar disorder?
It's defined like other psychiatric disorders across the age span in a manual called the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The specific definition for what we now call bipolar disorder, but used to be called "manic-depressive" illness includes certain symptoms that patients must have to make a diagnosis.

People have to experience both depressed and manic episodes. For example, to fit the depressed part, they would need to be sad, to lose enjoyment in usual activities, to have trouble sleeping and eating, to be guilt-ridden, suicidal. To fit the manic part, they'd have to have elation: a mood of being happy as if the most wonderful thing in your life is happening except it's on a day that's like any other day. Families often describe it as Jim Carrey—like behaviors: silly, giddy, joking without an apparent reason.

People with bipolar disorder also get very grandiose. In adults, it may be developing business schemes that are unlikely to work so they wind up maxing-out credit cards. They have very active personal lives and may have multiple marriages. They seem to be able to go without sleep and are very social.



When does bipolar disorder usually first appear?
It's really only been in the last decade that people have started to pay attention to diagnosing bipolar disorder in young children and early adolescents. So many adults looking back can describe that they had the illness, but it may not have been recognized at that time. It's estimated from current studies that maybe as many as half of adults who have bipolar disorder had their onset before age 17.



How is the bipolar disorder different in younger children?
In adults, what people are used to thinking is that there will be a discrete episode with a clear onset and a clear offset. You generally have mostly a high or a low, and people function somewhat better between episodes.

What we see in the younger population is they have continuous illness for years, but on a daily basis, they can be both high and low. So they may spend four hours of the day high and giddy and silly, and it's very infectious and amusing, and maybe another four hours of the day morose, gloomy, not wanting to be with friends and thinking of hurting themselves. You see these very rapid cycles shifting from extreme high to extreme low on a daily basis, day in and day out, year after year.

And in children, the high manifests a little differently because children are not likely to max-out credit cards or have had four marriages by the time they're seven or eight. So what we look for in children is being super happy, as if it were Christmas morning or the day you're going to Disneyland, except it's the average day in school.



What are some of the risk factors for bipolar disorder?
The biggest factor is that it seems to run in some families. Bipolar symptoms also can occur with use of certain prescription medications such as steroids, with some illicit drugs such as cocaine and with various brain diseases such as stroke, tumors and trauma.



What are some of the warning signs in teenagers?
What families may notice is an exaggeration of all the stereotypes of what we say teenagers do. So we think of teenagers as being irresponsible and being irritable, but the child with bipolar disorder may suddenly decide, "I'm not going to school. They're not teaching me anything. I'm going to be President of the United States anyway, why do I have to go to school?" They have very grandiose behaviors that are out of keeping with reality.

They can also get very hypersexual. We think of adolescents getting very interested in the opposite sex, but bipolar adolescents will feel an urgent need to have multiple partners. They'll begin using very sexy language in inappropriate places. At school, they may write it on the blackboard.

How can parents distinguish between a moody teenager and someone who might have a mood disorder?

It's extremely important for parents to get a professional evaluation if they have any suspicion. The worst that will happen, if it's unfounded, is they will have spent a little time and money. But if it is not evaluated, and you let it go on, it can devastate a child's life. There will be multiple suspensions from school. They can get sexually transmitted diseases because they have unsafe sex. They can very rapidly go into a depression and get very suicidal and act on it. So it's very important, especially in families where a family member has bipolar disorder or has depression, for parents to get consultations at the first sign of any suspicion.



Are teenagers with bipolar disorder more likely to have drug and alcohol problems?
There is a very high rate among people with bipolar disorder of using alcohol and drugs across the age span. Parents have to be very suspicious because a child who's using drugs may seem like they're just having "the normal moodiness of adolescence."

There are some common things to look for. For example, drugs cost money and the family may find that items are disappearing from the house. A child may ask to borrow Mom's jewelry, and it somehow gets lost. Or they borrow electronic equipment, and what they're doing is selling it so they can afford their drugs.



What treatment is recommended to teenagers with bipolar disorder?
There are three classes of medication that are used for bipolar illness across the age span. The antimania drug lithium is the mainstay, and lithium is especially good if somebody else in the family with bipolar disorder has responded to it. The second class of drugs is called anticonvulsants because they were originally developed to treat epilepsy. And the third class of drugs is called neuroleptics.

It's very important to educate the family about the illness and to let them grieve. The last thing they want is for one of their children to have the illness. Then you can help them adapt and take part in the child's treatment. You also have to educate personnel at the school so that the expectation about the amount of work that the child can do is geared toward what the child can manage.



How well does medication control the disease?
Some kids do very well and become indistinguishable from other children as long as they take their medication regularly. The medication essentially has to be taken indefinitely, as it is in adults. Most who take it regularly will have fewer hospitalizations and suicide attempts, and they will be able to hold jobs better and have more stable personal relationships. For others, bipolar disorder is very difficult to treat, and it can be months of trying to find the right combination of treatments.



Are there strategies for helping teenagers stay on their medication?
Strategies have really not been formally researched and developed. This is a very important area for future research. For example, will there be Web-based programs the patients can go to? One thing that we find very helpful to do with adolescents is to grieve with them. The way parents have to mourn the loss of a child who's well, the children themselves have to mourn the loss of their former well self.

But grief hurts a millimeter less every day, so we usually can tell them that six months from now, it'll be more automatic just to take the medication and go about your other business.

More Than Mood Swings: Bipolar Disorder in Teens


Parents are often exasperated by their moody teenage children. After all, teenagers are known to be irritable, to sleep a lot and to resist authority figures. So how can a concerned parent determine when a teenager is just being a typical teenager and when their child has a mental illness such as bipolar disorder?

In teenagers, symptoms of bipolar disorder can include dramatic mood changes within a single day and may have different symptoms than adults. Below, Barbara Geller, MD, a professor of psychiatry at Washington University in St. Louis, discusses how to recognize and treat bipolar disorder in adolescents.



What is bipolar disorder?
It's defined like other psychiatric disorders across the age span in a manual called the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The specific definition for what we now call bipolar disorder, but used to be called "manic-depressive" illness includes certain symptoms that patients must have to make a diagnosis.

People have to experience both depressed and manic episodes. For example, to fit the depressed part, they would need to be sad, to lose enjoyment in usual activities, to have trouble sleeping and eating, to be guilt-ridden, suicidal. To fit the manic part, they'd have to have elation: a mood of being happy as if the most wonderful thing in your life is happening except it's on a day that's like any other day. Families often describe it as Jim Carrey—like behaviors: silly, giddy, joking without an apparent reason.

People with bipolar disorder also get very grandiose. In adults, it may be developing business schemes that are unlikely to work so they wind up maxing-out credit cards. They have very active personal lives and may have multiple marriages. They seem to be able to go without sleep and are very social.



When does bipolar disorder usually first appear?
It's really only been in the last decade that people have started to pay attention to diagnosing bipolar disorder in young children and early adolescents. So many adults looking back can describe that they had the illness, but it may not have been recognized at that time. It's estimated from current studies that maybe as many as half of adults who have bipolar disorder had their onset before age 17.



How is the bipolar disorder different in younger children?
In adults, what people are used to thinking is that there will be a discrete episode with a clear onset and a clear offset. You generally have mostly a high or a low, and people function somewhat better between episodes.

What we see in the younger population is they have continuous illness for years, but on a daily basis, they can be both high and low. So they may spend four hours of the day high and giddy and silly, and it's very infectious and amusing, and maybe another four hours of the day morose, gloomy, not wanting to be with friends and thinking of hurting themselves. You see these very rapid cycles shifting from extreme high to extreme low on a daily basis, day in and day out, year after year.

And in children, the high manifests a little differently because children are not likely to max-out credit cards or have had four marriages by the time they're seven or eight. So what we look for in children is being super happy, as if it were Christmas morning or the day you're going to Disneyland, except it's the average day in school.





What are some of the risk factors for bipolar disorder?
The biggest factor is that it seems to run in some families. Bipolar symptoms also can occur with use of certain prescription medications such as steroids, with some illicit drugs such as cocaine and with various brain diseases such as stroke, tumors and trauma.



What are some of the warning signs in teenagers?
What families may notice is an exaggeration of all the stereotypes of what we say teenagers do. So we think of teenagers as being irresponsible and being irritable, but the child with bipolar disorder may suddenly decide, "I'm not going to school. They're not teaching me anything. I'm going to be President of the United States anyway, why do I have to go to school?" They have very grandiose behaviors that are out of keeping with reality.

They can also get very hypersexual. We think of adolescents getting very interested in the opposite sex, but bipolar adolescents will feel an urgent need to have multiple partners. They'll begin using very sexy language in inappropriate places. At school, they may write it on the blackboard.

How can parents distinguish between a moody teenager and someone who might have a mood disorder?

It's extremely important for parents to get a professional evaluation if they have any suspicion. The worst that will happen, if it's unfounded, is they will have spent a little time and money. But if it is not evaluated, and you let it go on, it can devastate a child's life. There will be multiple suspensions from school. They can get sexually transmitted diseases because they have unsafe sex. They can very rapidly go into a depression and get very suicidal and act on it. So it's very important, especially in families where a family member has bipolar disorder or has depression, for parents to get consultations at the first sign of any suspicion.



Are teenagers with bipolar disorder more likely to have drug and alcohol problems?
There is a very high rate among people with bipolar disorder of using alcohol and drugs across the age span. Parents have to be very suspicious because a child who's using drugs may seem like they're just having "the normal moodiness of adolescence."

There are some common things to look for. For example, drugs cost money and the family may find that items are disappearing from the house. A child may ask to borrow Mom's jewelry, and it somehow gets lost. Or they borrow electronic equipment, and what they're doing is selling it so they can afford their drugs.



What treatment is recommended to teenagers with bipolar disorder?
There are three classes of medication that are used for bipolar illness across the age span. The antimania drug lithium is the mainstay, and lithium is especially good if somebody else in the family with bipolar disorder has responded to it. The second class of drugs is called anticonvulsants because they were originally developed to treat epilepsy. And the third class of drugs is called neuroleptics.

It's very important to educate the family about the illness and to let them grieve. The last thing they want is for one of their children to have the illness. Then you can help them adapt and take part in the child's treatment. You also have to educate personnel at the school so that the expectation about the amount of work that the child can do is geared toward what the child can manage.



How well does medication control the disease?
Some kids do very well and become indistinguishable from other children as long as they take their medication regularly. The medication essentially has to be taken indefinitely, as it is in adults. Most who take it regularly will have fewer hospitalizations and suicide attempts, and they will be able to hold jobs better and have more stable personal relationships. For others, bipolar disorder is very difficult to treat, and it can be months of trying to find the right combination of treatments.



Are there strategies for helping teenagers stay on their medication?
Strategies have really not been formally researched and developed. This is a very important area for future research. For example, will there be Web-based programs the patients can go to? One thing that we find very helpful to do with adolescents is to grieve with them. The way parents have to mourn the loss of a child who's well, the children themselves have to mourn the loss of their former well self.

But grief hurts a millimeter less every day, so we usually can tell them that six months from now, it'll be more automatic just to take the medication and go about your other business.

What The Most Dangerous Job In The World Taught Me About Coping With Stress
By: Kevin Thompson



I just got through reading some troubling news in the New York Times this morning.

62% of employees now say that work-related stress leaves them overwhelmed and overtired.

And for many of us, who bring work home from the office, the problem is even worse.

So what’s going on?

Why are most of us so stressed?

I’ll tell you what a major part of the problem is… lack of job security.

I remember as I was growing up, my father only had two jobs. He was a high school teacher for the earlier part of his life, and later on he went into the real estate profession.

Two jobs, and they spanned his entire lifetime!

And the one career change he made was something he wanted to do. He didn’t make the change because he was losing his job as a teacher. In fact, the school district wanted him to stay.

But that’s a far cry from the way things are today. In fact, the days of job stability, and working for a single employer for your entire working career are long gone.

You’ll probably change jobs at least 11 times before you retire.

Downsizing, rapid business expansion and outsourcing are terms that we’re all too familiar with.

Before I got involved in the health industry and started my own indoor air quality business back in 1996, I’d already held 5 jobs in 5 completely different industries.

I worked as a telecommunications technician (in the Army), as a framer, on the green chain at 2 separate lumber mills, as a farm hand and finally as an Alaska fisherman for seven years (which was the hardest and most stressful job I ever had).

Now, you may be thinking to yourself, “You must’ve been a problem employee”.

But the fact is, nothing could be further from the truth.

I was in fact a model employee for every company I worked for, and never left a single employer on bad terms.





For example…

I began working as an Alaska fisherman in 1988. My main motivation for doing this was the money. Quite honestly, that’s the only reason I took the job.

And if you’ve ever seen that movie “The Perfect Storm” or watched those shows on the discovery channel, you have an idea of what it’s like to fish in Alaska.

My own story isn’t much different and it taught me why being an Alaska Fisherman is know as “The Most Dangerous Job In The World”.

The winter of 1995 had been an especially bad winter in Alaska. Fishing boats and fishermen's lives were being claimed by the Bering Sea almost weekly.

I was working on the outside deck after dark and we were in an unbelievable storm. It was the worst I'd seen in my 7 years of fishing. The kind of thing you only see in the movies.

I was scared to death!

But I had my own way of dealing with my fears. I'd never look out at the horizon when we were in a storm like this because I didn't want to see the big picture. I didn't want to know how high the waves really were. So I'd just concentrate on my job, which was to get all the fish onto the boat. As long as I did my job, and didn't look up, I could almost convince myself that the storm wasn't that bad.

While this certainly wasn’t the best way to deal with stress, at the time, it was the only way I knew how.

As always, the captain was in the wheelhouse driving the boat. His job was to keep an eye on me and watch for the dangerous rogue waves that would come out of nowhere and slam into us broadside. He'd tell me if I was in any real danger.

And then it happened!

I heard the captain's thundering voice over the intercom system.

Kevin! Hit the deck!

Before I could react, I was buried under a wall of water that hurled me all the way across the deck of the boat, face first into the railing on the other side.

When the water settled, and I realized what had happened, my immediate thought was, "Thank God I'm still on the boat" The impact had knocked out my front teeth and caused serious facial damage, but at least I was still alive, and on the boat.

If that wave would have lifted me just a few inches higher, I would have been thrown right over the top of the railing into the freezing waters of the Bering Sea. And there's one thing I knew for sure. In a storm like that, there's no way in hell the captain would have got that boat turned around in time to save me. I would have died right then and there.

It was at that moment I decided my life as an Alaska Fisherman was over.

While it was a great experience, I’ve never regretted my decision to leave the fishing industry. I just didn’t want to deal with that much stress in my life.

Decades of research has linked stress to everything from heart attacks and stroke to diabetes and a weakened immune systems, and none of us want to deal with that.

I’ve since found much better ways to deal with stress, and you can too by using the resources on this site.

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Kevin Thompson is a national authority on indoor air quality and health issues. His free Health Articles & News Update service gives you instant access to the world's most respected and sought after health experts in 70 categories, including Men’s Health, Women’s Health and Children’s Health just to name a few. Find out how this free service is changing people's lives and how you too can live a longer, healthier and more prosperous lifestyle... beginning today!

How To Destress Your Life Naturally
By: DAVE WOYNAROWSKI, M.D.
The World's Top Anti-Aging Specialist


What would you say if I told you that a lot of today's stresses are not environmental!

You'd probably say, "What are you talking about! If so and so wasn't doing this and my boss wasn't doing that and he kids listened better I would be a lot calmer!"

Well that is probably true, but your ancestors had to deal with disease starvation and wild animals which had to be very stressful!

I don't think A.D.D. and Chronic Fatigue and Fibromyalgia were survival advantages!

My point is this: As I've said before Food is the most powerful drug ever invented. And the biggest missing in our diets if Omega 3 fatty acids.

With the proper amount of fish Oil Omega 3 fatty acids in your body you will notice you are a lot calmer and much more able to handle stress creatively!

A while back I talked about the effects of stress on longevity and health. All of it was bad!

Well, I have recently uncovered some additional evidence that Omega 3 fatty acids are needed for us to respond properly to stress.

And I mean serious stress, like the kind our ancestors faced, AND the version of it we face today!

Undoubtedly this is how our ancestors survived the tremendous stresses in their lives.





In all of the cardiac studies with fish oil it shows there is an inverse relationship between fish oil intake and death and development of heart attack in humans.

We have talked in the past about all kinds of reasons for this: the blood thinning effect of fish oil via platelets, the direct anti-inflammatory effect of fish oil on the formation of clogged heart arteries.

The latest research suggests that Fish Oil has adaptogenic properties with regards to the human response to stress.

This includes a direct effect on a very primitive part of the human brain called the brain stem. It is from this area that nervous discharges happen.

One type of nervous discharge is called "sympathetic".

This funny name refers to the type of nervous discharge that causes blood vessels to tighten blood pressure to go up and people to get anxious and stressed out.

It also leads to increased cortisol which is the hormonal equivalent of suicide by stress!

Fish oil attenuates this type of discharge and allows the body to respond in a graded sensible manner instead of a ballistic blast.

Most of you are aware of fish Oil's effects on the brain as well. I've referenced many studies in the past on depression and behavioral modification with Fish Oil via serotonin and dopamine, brain chemicals.

Another very cool and very healthy thing happens when adequate fish oil is present in the system.

The body starts using fat preferentially as a fuel during times of mental and physical stress.

So there you have it! Improve your brain chemistry, buffer your body's ability to handle both mental and physical stress, burn more fat, reduce cortisol and the illness it is associated with including aging!

What more could you ask for! Make sure you go to the site and order as the winter flu season comes upon us and take advantage of the beneficial immune effects that fish Oil can also give you!

Breast Augmentation: A Public Health Perspective


By: Diana Zuckerman, PhD

More than 150,000 women had breast augmentation surgery last year; an all-time high. At the same time, the number of teenagers who choose breast implants has more than doubled in the last two years.

And yet, the controversy about breast implants still rages. As is often the case when the media covers medical issues, there are experts on all sides of this issue, and the consumer is left totally confused.

As a Congressional investigator in the early 1990s, I had access to all published and unpublished studies of breast implants, and was appalled to learn that almost one million women had breast implants, but they had never been objectively evaluated in either clinical trials or epidemiological research. That situation has changed. After the FDA started restricting access to silicone gel breast implants, the implant manufacturers started to fund research in an effort to prove that they were safe.

As a scientist trained in psychology and epidemiology, I have studied both the desire for implants and the possible physical risks. Despite all the controversy and media coverage about breast implants, there are surprisingly few studies on the psychological benefits of implants, the local complications caused by breast implants, or the long-term risks. Instead, there is a great deal of misinformation in the media, and many women make the decision to get breast implants with unrealistic expectations about how it will change their lives, little awareness of the financial consequences, and without the resources to cope if problems do occur.



Breast Implants and Self-Image
Plastic surgeons claim that breast implants have a very positive impact on a patient’s self-image. It would be easy to study this objectively, by evaluating women’s self-esteem and body image before, after, and several years after getting breast implants. No such study has ever been conducted.

Surveys indicate that when plastic surgeons ask their patients if they are satisfied, most say that they are. However, that is not an objective way to study the impact on breast implants. There is no doubt that some women are very satisfied with their breast implants, but any evaluation of patient satisfaction should be conducted by someone other than the plastic surgeons or their staff. If you want honest and accurate answers, it is important for patients to feel that their answers are anonymous. Since implants are a lifetime commitment, it is also important to study them several years later, since that is when problems become more likely.

From a psychological point of view, improving one’s appearance, with plastic surgery or other means, can help a person feel better about himself or herself. On the other hand, there are individuals who feel unattractive because of a particular physical shortcoming, who then “solve” that problem, and then focus on a different shortcoming. There are other potential problems specific to implants: a woman who changes her appearance by getting breast implants may find that men treat her so differently that she feels uncomfortable. If the implants seem obvious (for example, because of the swooshing sound of saline, hardness from capsular contracture, or because they don’t feel the same as natural breasts) she may become more self-conscious rather than self-confident.



Are Breast Implants Approved by the FDA?
It may surprise you to learn that there are almost no published studies of the safety of saline breast implants, and that no breast implants were ever approved by the FDA until a few months ago. In May 2000, for the first time, the FDA approved several styles of saline breast implants made by two manufacturers, Mentor and McGhan. The FDA decided to give women the choice of buying implants even though FDA advisors expressed a great deal of concern about the complications experienced by many women with implants. The FDA did not approve saline implants made by other manufacturers, and did not approve some of the styles of implants previously sold by either Mentor or McGhan. That means that many women are walking around today with implants that never were approved by the FDA and probably never will be.

Saline breast implants are made with silicone outer shells with saline inside. The implants, commonly called “silicone implants,” have the same kind of silicone outer shells, with silicone gel on the inside.

No type of silicone gel breast implant has ever been approved by the FDA. When the FDA reviewed the safety research in 1991, they determined that the studies did not prove that implants were safe. The sale of silicone gel breast implants was therefore restricted to mastectomy patients, patients with breast deformities, and any augmentation patient who had a broken silicone gel implant that she wanted to replace. All of those women are required to participate in a study of the health risks. A small number of first-time augmentation patients were recently included in these studies.



Saline Implants
FDA approval of some Mentor and McGhan saline breast implants is based on studies that are not published. For detailed information, check out the FDA Web site or the summary on the Web site of the National Center for Policy Research for Women and Families.

The manufacturers studied local complications such as pain, implant rupture, and the rate of subsequent surgery and implant removal. Mentor reported that 43 percent of the augmentation patients in their study experienced local complications within the first three years, including:

* asymmetry, scarring, or wrinkling (32 percent)
* needing additional surgery (13 percent)
* severe capsular contracture (10 percent)
* implant removal (8 percent)

Even more women (60 percent) with McGhan implants reported at least one serious complication in the almost four years of that study. In the first three years, McGhan patients experienced the following:

* asymmetry, scarring, or wrinkling (27 percent)
* needing additional surgery (21 percent)
* severe capsular contracture (9 percent)
* had at least one implant removed (8 percent)

The complication rates were even higher for patients who got new breast implants to replace previous implants, and higher still for women getting implants for reconstruction after a mastectomy.

If these complication rates sounds very high to you, you’re not alone. The FDA decision to approve saline implants has been questioned by members of Congress because one of the manufacturing companies is under a criminal investigation and because the FDA did not require long-term studies or studies of whether saline breast implants cause serious diseases. Long-term research is essential, because many of the implant patients who have had problems, complain of systemic diseases that developed years after getting their implants.

Instead, the FDA apparently relied on studies that had been reviewed by the Institute of Medicine, which did not find a significant increase in systemic diseases among implant patients. However, the Institute of Medicine only reviewed studies that had been conducted previously, and these studies were not conclusive.






Silicone Gel Implants
The Institute of Medicine report primarily focused on silicone gel breast implants, and found no statistically significant relationship to systemic disease in most of them. However, several studies found an increased risk of connective tissue diseases, although the risk was not always statistically significant. These trends can mean several things:

* Illness could occur by chance (in other words, whether or not the person has implants)

* The sample could be too small to detect a real risk (this is especially likely when rare diseases like scleroderma (connective tissue disorder) are studied)

* The study is not well designed—for example, most of the studies include women who had implants for a few months or years, which is probably too short a period of time to develop connective tissue disease or cancer.



Whether or not silicone gel implants cause systemic disease, a new FDA study shows that they break more quickly than has been acknowledged. The new FDA study, published in September, 2000, showed that many women with silicone gel implants walk around with broken and leaking implants without knowing it. Using magnetic resonance imaging (MRI), researchers determined that almost half (48 percent) of the women who had silicone gel-filled implants for only six to ten years had at least one ruptured implant, even though they didn’t know it. Even more of the women (79 percent) who had gel-filled implants for 11 to 15 years had at least one ruptured implant. What was surprising was that the women had not realized the implants were broken and had not sought any medical care. Since this study excluded any women who had already reported implant problems or removal, the actual breakage rate is even higher.

Even more worrisome is that more than one in five of women had silicone gel “migrating” away from the broken implant capsule. The long-term risks of migrating silicone are unknown, but there are studies documenting serious health risks and fatalities when liquid silicone migrates to vital organs. Since silicone gel can break down to liquid form, this is a serious concern, especially since these women were not aware of what was happening and only found out because they were randomly selected for a study.



What Are the Local Complications of All Implants?
There are some known risks of implants that are true for either saline-filled or silicone gel-filled implants:

All surgery for breast implants, whether silicone gel or saline, has risks. These include the risk of infection, hematoma (blood or tissue fluid collecting around an implant), the risk that one or both of the implants will have to be removed (requiring additional surgery), and the potential costs of repeated surgeries if the implants are replaced.

All breast surgery, including implants, can interfere with a woman’s ability to breast-feed a baby. Women with implants are less likely to be able to nurse than women who have not had breast surgery.

All breast implants will eventually break, but it is not known how many years the breast implants that are currently on the market will last. As shown in the recent FDA study, most implants last seven to 12 years, but some break during the first few months or years, and some last more than 15 years.

The most common complaint is capsular contracture, which occurs when a woman's body reacts to the “foreign body” by forming a capsule of scar tissue around the implants that can become too tight. If that happens, the breasts can become very hard, misshapen, and painful as a result, often requiring surgery or removal. The appearance is common among actresses and models, who sometimes look like they have two balls attached to their chests instead of natural breasts. The result is especially unattractive if one breast has contracture and the other doesn’t, or if the contracture causes the breast to feel very hard or to change in shape. View a photo of capsular contracture on the FDA Web site.

Although the epidemiological studies have not proved that systemic disease is caused by breast implants, several European studies have indicated that breast surgery (whether for breast implants or to reduce the size of breasts) may be associated with an increased risk of connective tissue disease or rheumatism. If these disorders, which include diseases such as scleroderma and fibromyalgia (a syndrome characterized by chronic fatigue and body aches and pains), are related to breast surgery, all women with implants would be at increased risk, regardless of whether the implants are filled with saline or silicone gel. Since women with implants often have multiple surgeries, the risks of systemic illness are potentially increased even further.

All breast implants interfere with mammography, because implants can obscure the view of a tumor. Implants, therefore, have the potential to delay the diagnosis of breast cancer. Although specially trained technicians can perform mammography in ways that minimize the interference of the implants, not all women have access to a mammography technician with this expertise. Unfortunately, even with expert technicians, about 30 percent of the breast will still be obscured. Experts estimate that 20,000 to 40,000 women who already have implants will have a delayed diagnosis of breast cancer because of their implants.

Although there are no long-term safety studies of saline implants, it is assumed that they are safer than silicone gel implants because if they break, they can be more easily removed. In contrast, silicone gel can be very difficult or even impossible to completely remove from the body once an implant has ruptured. In addition, it is not always obvious that a silicone gel implant has broken, and the gel can migrate slowly over time into various parts of the body. However, there is research evidence that bacteria and mold can grow in a saline-filled implant, and nobody has studied what happens when the implant breaks in a woman’s body. In addition, even saline implants can leak small amounts of silicone or platinum into the body, which come from the outer shell (the “bag” that holds the saline) of the implant. The long-term health risks of those leaks are unknown.



Financial and Insurance Concerns
Breast augmentation usually costs $5,000 to $7,000 and many physicians will sell the procedure on the installment plan. However, the initial cost is small compared to the lifetime costs, even for women who like their implants.

Since implants can break at any time, and are almost assured of breaking within seven to 12 years, a woman needs to consider the lifetime expense of additional surgery and replacement. Although unusual, some implants break within a few days, weeks, or months of surgery. Some implant manufacturers promise to replace the implants for free, but the expense of the implant may be a small percentage of the total cost of augmentation. Some doctors also promise to provide their replacement services for free, but that does not include the cost of the medical facility, anesthesiologist, and so on.

Augmentation is almost never paid for by health insurance, so the costs of additional surgery can be very expensive. Women with implant problems can have many surgeries within a few years.

An even greater problem is that breast implants can make a woman uninsurable. While many insurance policies will merely exclude the implants, or the entire breast area from coverage (a terrible problem if the woman later gets breast cancer), some major insurance companies have decided to totally exclude any woman with breast augmentation from their policies.

The costs of removing a broken silicone gel implant are substantial. If the implant breaks and the silicone gel spills out, it can mix with the breast tissue and other tissue and be almost impossible to remove. Surgical efforts to remove broken gel implants can take hours and cost tens of thousands of dollars. In addition, a mastectomy may be necessary to remove the silicone in an otherwise healthy breast.



What Have I Got to Lose?
Many cosmetic changes are easy to undo. Breast implants are not. Once the skin and natural breast tissue have been stretched by breast implants, they will never look the same as they did before the implant surgery. Most plastic surgeons try to persuade their patients to replace a problem implant, warning them that they will be depressed by their appearance if they are taken out and not replaced. This should be of particular concern to parents who are considering implants for their daughters. If a 17-year-old dyes her hair, she can dye it back or grow it out. If she decides to get breast implants, it is a decision that will permanently change her body. If she wasn’t satisfied with the size of her breasts before implants, imagine how she will feel to have breasts that are just as small and also sagging.



Why Weren’t Implants Studied Before They Were Sold to Women?
With all the problems and unanswered questions about breast implants, the obvious question is “Why weren’t implants studied first and improved before selling them to women across the country?”

The FDA did not have the authority to regulate any kinds of implants or medical devices until 1976. Implants had been sold since the 1960s, so they were allowed to stay on the market until the FDA reviewed them. Meanwhile, there was a substantial backlog of products that the FDA needed to review, and cosmetic products like breast implants were not a priority. Unfortunately, the manufacturers did not conduct long-term studies until the FDA required them.



Conclusion
The more than one million women who have breast implants are, without their realizing it, part of a natural “study” to learn what the risks are. Women deserve to be told what is known, and what is not known, before they make this decision. And, if a woman with implants complains of symptoms, she needs to find a plastic surgeon who has a reputation for helping women with implant problems.