Health:
Women Find It Difficult to
Get Breast Implants Removed
By Joan E. Rigdon03/20/1992
The Wall Street Journal
PAGE B1
(Copyright (c) 1992, Dow Jones & Co., Inc.)
When Cynthia K. Buford decided to enlarge her breasts with silicone-gel
implants in 1983, her doctor quickly scheduled surgery and billed her
insurance.But when she decided to get the implants removed after black goo began
leaking from her nipples recently, Ms. Buford got a rude shock. Plastic
surgeons, demanding cash up front, issued stern warnings about potential
disfigurement. One doctor told her to imagine "a very huge fat lady and
look at the skin under her arms. That would give" her an idea of what her
breasts would look like if she didn't replace the implants after removing
them, Ms. Buford recalls. "I came home and cried for three weeks."In the end, she sought help at a county hospital, which demanded a down
payment of $525 on a charge card. The total bill: more than $4,000. (A
spokeswoman says the hospital normally asks for the whole fee up front
because the surgery is considered cosmetic and shouldn't be funded with
taxpayer money.)Women are finding that it was much easier to get implants than it is to get
rid of them. While Esther Rome, a member of the Boston Women's
Health Book Collective, says "it's impossible to document" the scarcity of
doctors willing to remove implants, she adds that "it seems fairly
widespread."Getting the procedure performed is also emotionally draining. Many
plastic surgeons predict deformity or encourage women to get
replacement implants even if they don't want them. Most also say the
procedure isn't medically necessary, so insurance companies are refusing
to pay for it. (Some women have persuaded their insurers to pay by
bypassing their surgeons and obtaining letters from family doctors and
rheumatologists instead.)Under fire from angry women, one implant manufacturer is offering
financial aid to those who want implants that it made removed. Dow
Corning Corp., which is getting out of the silicone implant business,
increased its financial aid offer this week to $1,200 a patient from $1,000
offered in February. Dow Corning is a joint venture of Dow Chemical
Co. and Corning Inc. Other breast-implant makers declined to comment
on the issue of financial assistance or said they haven't decided whether to
offer it.But financial aid is small consolation to women who can't find doctors
willing to perform the procedure. Many plastic surgeons are reluctant
because they fear lawsuits from other patients: Removing implants is
tantamount to admitting they're not safe. Critics charge that the implants
can cause or trigger a variety of diseases, ranging from muscle pain to
chronic immune disorders.Even doctors who are willing to extract implants say they are being
discouraged from doing so by insurers. One plastic surgeon says his
insurance company, Doctor's Co. of Sonoma, Calif., advised him against
performing a large number of removals. "They didn't want me to be a
potentially higher risk person . . . because it's such a lethal issue right
now," the surgeon says. Dr. Mark Gorney, medical director of Doctor's
Co., says that's "utter nonsense" and that removing implants isn't
considered riskier than putting them in.Removing implants can require more surgery than putting them in,
because if the implants have ruptured, stray silicone must be scooped out.
Polyurethane-covered implants can be especially difficult to remove if the
polyurethane has mingled with scar tissue or surrounding muscle tissue.Women's health groups have been steering women toward a few
surgeons who also remove and study scar tissue to see if it has reacted
with the silicone. One such surgeon, Dr. Lu-Jean Feng of Cleveland, has
performed almost 100 implant removals on women from all over the U.S.
But Ms. Rome of the Women's Health Book Collective says that so far
she has searched unsuccessfully for a plastic surgeon in the Boston area
who will remove and study scar tissue along with implants or send the
tissue and implants to other researchers.Some surgeons may be reluctant to remove implants for fear they will
anger their colleagues or hurt their practices. One Texas woman, who
traveled to Florida to have her implants removed in 1990, says her plastic
surgeon told her he didn't want to remove too many implants in too short
a time because "that would imply there was something wrong with them."
The woman, a medical records worker, declines to be named.Dr. Charles Plows, a member of the American Medical Association's
Council on Ethical and Judicial Affairs, says there's no policy on how
quickly surgery should be performed on women who want to remove
their implants. In general, "valid concerns by patients should be
investigated," he says.The American Society of Plastic and Reconstructive Surgeons says it
"applauds" Dow Corning's decision to offer financial aid to women
seeking implant removal and encourages members to "further minimize"
costs for patients who don't have insurance. It says it will help to arrange
doctor visits for women who have lost touch with their plastic surgeons.Nonetheless, for many women, the quest for removal has become an
odyssey. Ms. Buford, whose gel implants were covered with
polyurethane foam, says she decided to have them removed after she
developed knots in her breasts and "black stuff" began leaking from her
nipples. The first plastic surgeon she consulted encouraged her to get
replacements.A second surgeon, Dr. Richard Burkett of Dallas, "told me I would want
another set because I was going to look so disfigured" without implants.
After comparing the likely result to a fat lady's arms, Dr. Burkett called
her at home to repeat his warning that "I would not look right" without
implants, Ms. Buford says. Dr. Burkett declined to return several phone
calls seeking comment.Devastated, Ms. Buford waited weeks before consulting another plastic
surgeon, Dr. Diane Gibby of Dallas, who told her that surgery would
make her flat-chested, not disfigured. "She's the one who started making
me feel good about myself again," Ms. Buford says.But there was another obstacle: Dr. Gibby required $5,000 in cash up
front, Ms. Buford says. Unable to pay and no longer covered by
insurance, she sought treatment at Parkland Memorial Hospital, a county
hospital in Dallas. Her doctor required $1,500 up front but later settled
for a $525 down payment made with her American Express card.Other women say they had to travel long distances for treatment. Patti
Scher, a former nursing director who lives in Charlotte, N.C., flew with
her husband to Cleveland so she could be operated on by Dr. Feng.Ms. Scher says that before her implants were removed, she suffered
fatigue, blurred vision and night sweats that made her so weak she had to
quit her job. Normal errands became Sisyphean tasks. "My family would
have to be fed off of whatever I was able to get in the grocery cart in the
first two aisles, because I couldn't master the rest," she says. Now,
several months after surgery, she says she is feeling healthier.-30-