The truth about Silicone implants

Jack Nicholson was in a "bust-up" last week, say the tabloids. An unnamed "Hollywood socialite" claimed that the ageing hell-raiser had burst her silicone breast implants during a fight over dinner. Definitely embarrassing for the woman - but is leaking silicone also a health risk?

In the UK, 100,000 women have breasts which are not entirely their own. Of these, 60,000 elected to have extra bits put in - a la Paula Yates - to swell their figures, while 40,000 have had implants as part of reconstructive surgery after operations for breast cancer. And about 15,000 are currently trying to sue the company that made them.

Most breast implants are made of a silicone envelope with a liquid or gel-like silicone filling. A compound derived from sand, siliconewas assumed to be totally inert until the late Eighties when evidence started to emerge in America to suggest that it could "bleed" from its proper site and provoke skin and joint inflammation, and auto-immune diseases such as rheumatoid arthritis. Suddenly there were thousands of women claiming that their implants had caused everything from ME to cancer.

The bandwagon got a huge shove from litigation-hungry American lawyers and it has been rolling ever since. Silicone-filled implants were banned in the US, while over here every woman who has one inserted is registered by the Department of Health so that they can easily be traced. Thousands have had old implants removed.

Meanwhile, US lawyers are pursuing a huge action against Dow Corning, the major implant manufacturer. British women are being encouraged to join in, and so far nearly 15,000 have come forward.

Most of these women say they have suffered recurrent ill health for years, and that the symptoms began when they had implants and ended when they were removed. However, this testimony is not reflected in the scientific literature. In the past four years there have been 18 studies of possible links between silicone and auto-immune disease, and none has found a connection. One of the biggest, by researchers at Harvard Medical School, examined 87,500 nurses, of whom 1,200 had breast implants. It found no greater incidence of illness among women who had implants than among those who had not. However, the lawyers argue that this (and every other study) had methodological flaws.

On balance it looks as though the risk of auto-immune disease - if any - from leaking silicone is very small. Many plastic surgeons are playing safe, anyway, by using other substances. One, called Trilucent, is made from soya-derived triglycerides. Unlike silicone, it allows X-rays to pass through unimpeded, so mammography is more effective. And if it does leak, the makers claim it is well tolerated by the body.

Even discounting silicone reactions, breast implant surgery carries risks. It can cause blood clots that need to be removed, and occasionally the implants cause irritation, an allergic reaction, or chronic breast pain. Some women are left lopsided. Implants are not entirely safe to remove, either - in September a woman in Cheshire died after a removal operation went wrong. The good news is that they do not normally affect the ability to breastfeed.If your heart is set on breast implants, make sure you go to a surgeon who specialises in them, rather than a general surgeonn

Further information: the British Association of Cosmetic Surgeons (0171- 323 5728), or the British Association of Aesthetic Plastic Surgeons, 35 Lincoln's Inn Fields, London WC1 (enclose large SAE).