THE BREAST IMPLANT DEBATE The dispute has led to a drop in operations, but a rise in awareness to seek information

Mary Romano loves her breast implants -- they're wonderful, she says. When Jackie Clark talks about hers, though, she talks about "silicone nightmares."

"Seeing how beautiful these silicone implants can be, I say to other women, 'If you can afford it, go ahead and do it,' " said Ms. Romano, 30. Two years ago, the Arnold woman had one implant inserted after a mastectomy and a second put in the other side -- "saggy and stretched after two children" -- so that it would match.


But Ms. Clark, 38, an Alexandria, Va., woman who had her breasts enhanced for cosmetic reasons, later had the implants removed because she was convinced they were causing her serious health problems.

"For some women the whole thing becomes a horror story," said Ms. Clark, who will not talk about the personal details of her case because she is suing her plastic surgeon and the manufacturer of the implants.


The wide range of feelings women have about breast implants was dramatically demonstrated last week as a Food and Drug Administration advisory panel held three days of hearings about their safety. The panel recommended keeping silicone gel breast implants on the market despite concerns that their safety has not been proved. But it also called for more research to be done to answer safety questions.

Dr. David Kessler, FDA commissioner, has until Jan. 6 to decide whether to ban implants, limit their use, or allow their continued general use.

Some women who testified at the hearings spoke of health problems that they attribute to implants, particularly autoimmune disorders such as lupus, which causes joint pain, and scleroderma, which causes a painful and disfiguring tightening of the skin.

Others spoke about how their lives have improved since having had breast implants, either as cancer patients who had their breasts reconstructed after surgery, or as women who were unhappy with their bodies and had the cosmetic surgery to increase their self-esteem.

Surgical breast implants have been available for 30 years, and it is estimated that more than 2 million American women have them. About 80 percent of those women chose to have their breasts enlarged or filled out for cosmetic reasons. The other 20 percent are women who have had a breast removed because of cancer.

According to one survey, positive feelings about implants, such as Mary Romano's, are more common than Jackie Clark's complaints. Conducted last year by the American Society of Plastic and Reconstructive Surgeons, it found that 93 percent of those responding said they were satisfied with the results of their implant surgery and 96 percent said they would definitely or probably choose to have the surgery again.

"It's one of those operations that plastic surgeons love to do because there's immediate gratification," said William Gilbert Armiger, an Anne Arundel County plastic surgeon who estimated that breast implants account for about 18 percent of the surgery he does.

However, for the patient, that gratification can be costly. Breast implant surgery usually costs more than $3,000 -- and often the only procedures covered by health insurance are reconstructions after mastectomies.


Many say the results are worth the price. One satisfied patient is Carol, a 29-year-old medical supply saleswoman who asked that her real name not be used. "I'm tall, I have long legs and I never, ever had breasts," she said. "It's not that I have a bad feeling about my body, but I never felt feminine. It's just something I wanted."

In fact, Carol had the procedure -- which cost her $4,000 -- done twice. "I couldn't get any cleavage before," she explained.

Molly, 24, said her decision to have breast implants had a lot to do with prevalent cultural attitudes.

"Breasts are all over the media, on TV, in magazines, and I'm not just talking about Playboy," she said. "You see girls in bikini contests at bars, in outside public things, at the beach. It can all add up to make a woman feel she's not good enough, even if she's attractive. I was really tired of telling myself that I didn't have something that made other women so attractive to men."

Kathleen Anneken, a 45-year-old artist from Fort Mitchell, Ky., had breast implants nearly 20 years ago because she "thought it was a marvelously practical idea" and was tired of the trouble she had finding clothes that fit in both the top and bottom. But her story is one of those that eventually deteriorated into a silicone nightmare.

Ms. Anneken's troubles began when she replaced her implants in 1986 because "I had never felt they were right for me; they were too high, too firm, too big." One of the replacements migrated under her arm and the other ruptured. When they were removed and replaced, she experienced internal bleeding and then started feeling joint pain, sun sensitivity, bad headaches and other lupus-like symptoms.


Two years ago Ms. Anneken had the implants removed and not replaced and, she said, "most of the symptoms were gone within 13 months. That convinced me that there must be a link between my symptoms and the implants."

Her problems prompted Ms. Anneken and a California woman, Sybil Goldrich, to start the Command-Trust Network, a national clearinghouse for women who have had problems with breast implants. "We have now heard from 8,000 women, about 85 percent of them reporting problems," Ms. Anneken said. And though she does not believe breast implants necessarily cause problems for all women who get them, she thinks preliminary findings of the few medical researchers who are working on the issue indicate that at least 1 percent of women can expect difficulties.

Closer to home, Jackie Clark formed the Silicone Connection, a support group for women in Maryland and Virginia who have had trouble with breast implants. "Every day it's growing," said Ms. Clark, who estimated she has heard from about 35 women in the area. The group meets periodically for lunch and Ms. Clark said she also does "a lot of one-on-one counseling."

With all the recent publicity, the calls and letters are increasing for Ms. Anneken and Ms. Clark, even as a number of local plastic surgeons are finding that business in breast implants is dropping off because women have been frightened by the negative attention the FDA hearings have generated. "The numbers are definitely off this year," said plastic surgeon Charles Converse.

But he sees a positive side to the controversy. "It's good that patients will demand information," Dr. Converse said, noting that Maryland is the only state that requires that implant patients sign informed consent agreements after reading a pamphlet the state health department has published about the procedure. "One of the major criticisms is that had people known of certain post-operative problems, they never would have done it. Because of this coming up in public, people considering it will demand that they be informed of all the potential problems."

Still another concern occurs to Dr. Bernard McGiven, chief of plastic surgery at Greater Baltimore Medical Centers and president of the Maryland Medical Breast Society, who has been performing implant surgery for 20 years, he said, has "never come across anyone with serious or life-threatening problems."


Because a "vocal minority" is exaggerating the dangers of implants, he is afraid, he said, "that a woman who had a lump in her breast would hesitate to report it for fear of having an unreconstructable deformity. And that could be a truly deadly hesitation."

For more information...

Women experiencing difficulty with breast implants can contact the Silicone Connection, a support group for women in Maryland and Virginia. Call (703) 532-1654 after 6 p.m.

To find out more about what resources are available for implant problems, write the Command-Trust Network, P.O. Box 17082, Covington, Ky.., 41017, include $1 for handling charges and a double-stamped self-addressed envelope.

Women interested in getting breast implants can call the Medical and Chirurgical Faculty of Maryland, 539-0872, for referral to a plastic surgeon.