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Weighing up the risks of breast implants

Women deciding to get breast implants weigh up risks of two kinds: possible health risks of having the implants, and perceived social risks of not having them. This is a key finding of a study by researchers at Victoria University’s Health Services Research Centre.

Researchers Bridget Rowsell, Pauline Norris, Kath Ryan and Melissa Weenink wanted to understand how people cope when they are not sure, or become unsure, about the safety of a medical device that they are using or have used. Their interest was in how women think about the risks of breast implants, and how they make sense of conflicting information both before and/or after they decide to go ahead.

The researchers interviewed 23 women and found they mostly fell into two groups.

The first group comprised women who had opted for breast implants because they were dissatisfied with the size or shape of their own breasts. These women wanted to meet social and cultural expectations, and to feel "more like other women".

The women in the other group had had mastectomies, and for them getting breast implants tended to be an assumed part of the recovery process which meant they did not have a daily reminder of their illness.

What the groups had in common was that the women perceived risks in not having breast implants - risks to their identity - and these had to be weighed against their appreciation of the risks associated with implants in order to understand how they coped with risk.

Not surprisingly, the women relied heavily on the information their doctors or surgeons gave them about the risks of breast implants. The research team found that the women in the study had somewhat conflicting expectations of their doctors. They wanted to be fully informed, treated with respect and seen as competent to receive all the information -- yet they also had a need for the doctor to be an expert authority who would provide reassurance and relieve uncertainty. The issue of breast implants, where there is disagreement about safety, may have highlighted this conflict of expectations.

Some women were not aware of any risks when they decided to have implants and only heard about the possibility of problems later. Others had problems that required replacement implants but this did not necessarily change the way they felt about the benefits of implants.

In general, the researchers deduced from the women's descriptions of the risks they had been informed about, that these risks had often been downplayed; and that the women had strategies, such as choosing the "best" surgeon and "being positive", for distancing themselves from the risks.

For many of the women in the study the benefits of breast implants seemed to be very powerful and to outweigh the possible risks. Having breast implants made them feel more "womanly" or "whole" again and enabled them to feel more at ease and confident about themselves.

Information about the dangers of silicone leakage became known only after some of these women had had their implants fitted. Other problems that can result include pain, discomfort and deformity in the region around the implant, while more systemic disease -- largely connective tissue diseases-- have been related to implants by some researchers.

The benefits and the problems related to the implants seemed to be viewed quite separately, and most women were prepared to tolerate some discomfort or even pain without that impacting on the benefits. A few women did have ongoing and severe problems which clearly outweighed the benefits and led to the removal of the implants.

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