Silicone implants: what's all the fuss about, asks Jo Sedley

Making mountains out of mole hills

An estimated two million women in the UK and the USA have undergone breast augmentation surgery. Many do it to feel more confident about and satisfied with their appearance. For some, breast enlargement can also be an astute financial move. There is gold in them there hills, and it is more than likely that once somebody like Pandora Peaks has made her mega bucks revealing her mega bust she will have the implants removed.

For the first time it is possible to get bigger, reasonably lifelike breasts. The operation costs around £4000, you can be back at home on the same day, the bruising goes after a few weeks and in the majority of cases all you are left with is a hairline scar under the breast. For women not altogether content with 'what God gave them', it all seems too good to be true.

But all is not well in silicone valley. As the popularity of breast augmentation grows, so do the fears of possible medical problems. For every picture of a smiling Melinda Messenger there seems to be a story of a woman whose health has been ruined by silicone implants. Elaine Coomber, from the Breast Implant Support Group, told me that she started suffering serious side effects just three years after she received her implants in 1976. Her health problems include crippling pain and swelling in the arms and joints, partial blindness, dizziness and fatigue.

Silicone implants have been accused of causing a wide range of health dis-orders: cancer, urinary problems, swallowing difficulties and even smaller children at birth. The most widely publicised health risk to date links silicone to connective tissue diseases (CTD) including rheumatoid arthritis, systemic lupus erythematosus, and also auto-immune diseases. These pathological problems are reported to occur when the silicone gel contents leak into the surrounding tissue and into the bloodstream and lymph nodes. Leaking occurs due to small amounts seeping through the silicone shell (bleeding) or to a larger extent due to a rupture.

A recent review in the Lancet medical journal about the prevalence of ruptures claimed that 'the proportion of patients who could expect to have both implants intact was 89 per cent after eight years and 51 per cent by 12 years, but only five per cent after 20 years'. (Lori Brown et al, 22 November 1997). The review described how silicone is thought to migrate to various parts of the body including the chest, ribs, upper arm, biceps, elbow and hand. This would back up Elaine Coomber's story of having lumps of silicone removed from her neck and arm.

As a result of the growing concern about the side effects of breast implants, some women who have already had the op are beginning to panic. The extent of these fears is summed up by Jenny Jones, an American TV chat show host with breast implants: 'Not a day goes by that I don't wonder how my exposure to silicone is affecting my health. With every ache, every pain, the question arises: Is it the silicone?'

In the USA, silicone survivors' support groups successfully lobbied the US government Food and Drug Administration for a ban on silicone gel implants for breast augmentation operations, which came into force in April 1992. They have also successfully sued the silicone implant manufacturers for compensation, obtaining over $4.25 billion in pay-outs. In the UK, New Labour health minister Baroness Jay is leading an inquiry into the safety of silicone, with special emphasis on the feelings and stories of the silicone support groups.

Silicone's days, it seems, are numbered and for the small-chested women who desperately want a larger bosom, the future looks bleak. But how scientific is the basis for a ban on silicone implants?

For all the furore about silicone, thorough and extensive scientific research - 23 studies to date - have, on the whole, found no proof that breast implants lead to illness. A report of the largest study to date in the Journal of the American Medical Association stated that: 'The major contribution of this and other observational analytical studies has been to exclude large risks of connective tissue diseases following breast implants.' (Hennekens et al, 28 February 1996). This study did find a small risk, but the authors admitted that this finding was dubious due to the high chance of the overemphasis of symptoms and over reporting by affected women.

The high rupture rates of breast implants that were quoted in the Lancet review last year have been questioned by other experts who point out that these figures were taken from a highly selective sample - women who wanted their implants removed. Other studies have found much lower rupture rates of five per cent (letters, New England Journal of Medicine, 10 October 1996).

In fact, the weight of scientific and medical evidence has been ignored, especially in America. As Dr Deborah Del De Junco puts it, 'despite the remarkable agreement showing little to no increased risk of the established CTDs the breast implant controversy has gained its own inexorable momentum' (Journal of the American Medical Association, 28 May 1997). Marcia Angell, editor of the New England Journal of Medicine argues that 'there are many individual stories of CTD developing after the placement of breast implants but these reports alone are not enough. Anecdotes do not constitute evidence that the implants caused the disease' (Science on Trial: The Clash of Medical Evidence and the Law in the Breast Implant Case, 1996).

When the evidence that silicone implants can be harmful is so scant, how has the campaign against silicone implants gathered enough momentum to bring about a ban? One important reason, it seems to me, is that the exaggerated medical fears about silicone provide a convenient means of support for those who really object to implants on moral grounds: they simply believe that it is ethically wrong for women to enlarge their breasts. Not everybody appreciates the 'man made' curves of a Pamela Anderson Lee or Melinda Messenger. Feminist campaigners in particular have led the way in condemning supermodels, fashion magazines and plastic surgeons for perpetuating an 'ideal' image of beautiful women, and have insisted that women should learn to be content with 'the way they are'. In opting for artificially bigger breasts, they argue, women are giving in to pressure and conforming to a stereotyped image of the big-boobed sex object, created by a male-dominated society.

In her influential book The Beauty Myth, Naomi Wolf compares the effects of boosting your boobs to the eighteenth century procedure of clitoridectomy. To her, women are not making autonomous choices about ways to improve their looks, they are being pres-surised into surgery: 'modern surgeons claim they make women feel better, and that, no doubt, is true; Victorian middle class women had so internalised the idea of their sexuality as diseased that the gynaecologists [removing the clitoris] were "answering their prayers.".' In other words, society forces women to mutilate themselves for the benefit of men, and plastic surgeons, far from responding to women's choices, are simply playing their role in perpetuating the 'beauty myth'.

There is now often an assumption that women are being manipulated into self-mutilation by the selfish will of men. Early last year, rumours that the bad boy of British football, Paul Gasgoigne, had insisted his wife have breast enlargements were met with outrage by women's health groups. This gave the campaigners an opportunity to get the entire Rangers team (not normally seen as a feminist stronghold) to sign footballs to raise money for the anti-silicone implants campaign. But can women's decisions to increase their cup size so easily be put down to the whims of bullying men? In 1996 alone, 5000 women in the UK had the breast augmentation operation - surely 5000 men were not responsible. Meanwhile, Sheryl Gasgoigne's part in the decision to go ahead with the operation was ignored. (Given her new media career, it seems unlikely she will be handing the implants back to Gazza as part of their divorce settlement.) It was more conven- ient to believe that this was another example of uncaring men forcing their partners to have their breasts cut open.

Other commentators offer different takes on the 'irrationality' of women who have breast implants. Jojo Moyes, a journalist on the Independent, interprets the whole thing as some sort of terrible leftover from the eighties philosophy of style over content. 'Women who have had implants don't want to hear about potential side effects in the future: they want to feel better about themselves now', she writes, condemning the 'terrible mistakes' made by women who have gone for the operation. 'They don't care if it feels a bit different; they just care that it should look perfect. If they lose a bit of sensation, have trouble breast feeding or suffer the odd sleepless night from fear, isn't that a small price to pay?' (16 September 1997) Moyes may not blame men for women's decisions, but she echoes the dim view of women's abilities to make reasonable life choices of their own.

In fact, there are many rational reasons why a woman might want silicone implants, just as there are many reasons why people feel inadequate: too fat, too thin, too small or too tall. Whatever your preference, real bosoms or bigger artificial ones, women should be allowed to have access to whatever technology is available. Some would rather have us settling for what we have been 'given'. But why should women have to settle for anything less than what they think is best for them?

There is no denying that there can be side effects to breast implants, like a hardening of the breast tissue. There are also women who are suffering from painful conditions. Whether these conditions are directly caused by silicone remains to be proven. Elaine Coomber has been recently diagnosed with multiple sclerosis. It is uncertain whether this alone has been the cause of her health problems, or whether the problems were also related to the breast implants. Further scientific research to find real evidence continues. A useful move by all those concerned about the medical side effects of silicone would be to present women thinking about having the 'op' with as much scientific fact and evidence as possible and let them decide after weighing up the pros and cons. This would at least credit them with the intelligence to make up their own minds about their own future.

What is not useful is having the discussion on silicone turned into an emotional and irrational panic. Nor is it positive to portray women like Sheryl Gasgoigne as poor, helpless victims dominated by their husbands. This can only encourage the authorities to treat women as fragile and naive little flowers, unable to choose for themselves whether to go ahead with breast enlargements or not. Governments can then take it upon themselves to decide for us, as they have done in the USA, Canada and Australia where the use of silicone gel implants is banned whether women want them or not. Such 'victories' only reinforce the view that women are vulnerable weaklings living in fear of male disapproval, and in need of protection by big brother of the breast implant police.

I have to admit that reports that Dolly Parton has decided to have six different implants, each one increasing in size, sound bizarre and ridiculous, and in some cases it has seemed that the bigger the enhanced cup size, the smaller the natural talent. But then again we can't all sing and dance.

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