Talk:Breast implant/Archive 3

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String Implants

Why is there no information on her about String breast implants? I know it was here before, but where did it go? (unsigned)

It was removed, but I restored it. The non-English links were also removed, so I restored those, too. I recommend that editors be more careful to avoid removing valuable text. Al 15:28, 22 May 2006 (UTC)

Alienus, this article has been contentious and other admins and users have requested that additional links be discussed here first.

String implants were banned a long time ago, and are NOT among the primary types of breast implants. They are unlikely to be reintroduced to the market anytime soon. Also banned were hydrogel implants in the UK, and those are not included in the BI article. That is one thing we all had agreed on. The string implants, however, have a certain 'appeal' to some because they are what adult entertainers used and create cartoonishly large breasts. However, they were also dangerous. There is still debate about the safety of silicone gel implants, but at least they are allowed on the market, so should be included..MollyBloom 17:39, 22 May 2006 (UTC)

I added two other implants, if the consensus is to include those. However, I added a reference and put them in context. The string implants are rarely used anywhere, and were banned in the US completely. I also added 'tissue engineered' implants which are in development.MollyBloom 18:45, 22 May 2006 (UTC)

Ok. There's also a procedure in which saline is injected directly to give a temporary boost in size and perhaps firmness. This is probably a type of implant, however temporary, so I think we should briefly mention it here. Al 20:52, 22 May 2006 (UTC)

Are you not talking about injection into an already-implanted double-lumen or saline implant? I can't imagine the value of injecting saline directly into breast tissue.

We can't possibly mention all the implants ever used or banned - there are many. I still dont' think string implants should be included for that reason, but I have no major objection.MollyBloom 00:08, 23 May 2006 (UTC)

No, I'm definitely talking about directly injecting saline into the breasts, as per this link. It's not popular and I couldn't quickly find a more reliable source.

As for how many types to mention, while I certainly don't want rare and unavailable types to dominate the article, a line or two max should be fine. Comprehensiveness is worth the small cost in space, I'd say. Al 02:45, 23 May 2006 (UTC)

Other languages

Sorry I deleted that - that was inadvertant. I meant only to delete the Inamed promotion on Inamed's 'bouncy breast implants' that had initially been added. MollyBloom 17:43, 22 May 2006 (UTC)

Images

I just wandered into this article and noticed something rather surprising: the images of ruptured and damaged implants are duplicated, while there are exactly zero images of female breasts, containing implants, from the outside - as in, the way they are intended to appear with functioning implants.

I don't personally have any way of acquiring copy-free images to upload in order to fix the second problem, but would anyone disagree with my removing the redundant copies of the implant-rupture images? Also, any editor who does have access to copy-free images of breasts containing implants, please upload them! Cheers, Kasreyn 05:19, 25 May 2006 (UTC)

That's a good point. If we could get some decent images that we are free to use, I would support using them. Considering what's on vulva and circumcision, I can't see any objection on the basis of content. Al 05:44, 25 May 2006 (UTC)

What about culling the dupe images? Kasreyn 06:06, 25 May 2006 (UTC)

If we have those, then yes, they should be removed. Al 06:10, 25 May 2006 (UTC)

The article will be split. That is why there is duplication. Please read the history, and also edit on the offline pages, after discussion. MollyBloom 01:09, 31 May 2006 (UTC)

Some additional problems.

Why is information on ruptures and other problems scattered around amongst "Local Complications" and "Risks and Controversies" sections? Aren't "complications" just a kind of "risk"? All these should be relocated under the "Risks and Controversies" section. There also appears to be redundant material in several areas. The article seems to spend a great deal of time focusing on the effects of the failures and complications of these devices, and very little time focusing on the motivations of the women who chose to undergo such a procedure. If a Martian were to read this article, he would be left wondering, "why do Earthling women do this? It never said!" The continued popularity of the procedure surely indicates that there is something motivating women to do this. It would definitely be notable to cover it in this article, whatever it is. Other possible details which are not covered are customer satisfaction rates (can surveys be found?), information on effects on breastfeeding (if any?), and more detail on the history of the procedure (which skips past everything between 1865 and the 1940's!)

I don't really know who did what and I'm going to assume good faith on the part of every individual, but on the whole, the article seems to take a very one-sided approach to the issue. It goes into great detail on every negative aspect of implants, but scarcely breathes a word elsewhere. Kasreyn 06:32, 25 May 2006 (UTC)

If you were reading the discussion above, you would see that we need knowledgeable (and NPOV) editors to help with a balanced view, on the 'offline' pages. Rupture is a local complication; the photos should stay there. Also, if you read the discussion , you will see that the article will be split, after it is worked out. Thus, the 'rupture' in the local section will be short - but with actual photos of rupture, while the 'risks and controversy' section will be more detailed. Please read the discussion and edit on the off-line pages. The adverse effects of implants often do not occur for years - that was my situation, and that of many women like me. The 'main' article should not go into the risks or controversy, but be factual, without discussion on the controversial risks. MollyBloom 14:02, 25 May 2006 (UTC)

As to 'why do earthlings do this' question, my answer would be because many plastic surgeons tell women implants are completely safe, and Dow has spent millions on studies insisting these are safe. Thousands of women who have had to have multiple surgeries, been disfigured and become ill know full well why women do this, and wish they never had.MollyBloom 14:06, 25 May 2006 (UTC)

Well, I can certainly see that a lack of information can make for poor decisions. But underlying all this is still the question of "why do women want these things inside their bodies?" I could trot out several possible answers that come to mind, but being a guy and not personally knowing any women who've had implants, I don't have anything better than guesses based on popular conceptions. Issues such as fashion, social conformity, and possibly even professional careers may be involved (women who work as actresses, or in the "adult" industry, seem to predominantly pursue plastic surgery of all kinds, from what I've seen). These motivations, I'm sure, could be expressed in a neutral manner without being insulting to women who have chosen to have implants.

As to the offline version, sorry! Can you direct me to it so I can have a look at how it's coming along?  :) Kasreyn 21:10, 25 May 2006 (UTC)

Kasreyn, you wrote "but on the whole, the article seems to take a very one-sided approach to the issue. It goes into great detail on every negative aspect of implants, but scarcely breathes a word elsewhere". You are 100% spot on. There is one editor who has taken it upon herself to highjack this topic to the point where it's irrelevent as a source of information. There is a tremendous amount of information about the safety, efficacy, and patient satisfaction available, much of which is politically inconvienent to said editor.Droliver 03:07, 26 May 2006 (UTC)

He's talking about me, of course, Kas. I don't quite care what Rob thinks, because he has shown himself to be every bit as one-sided as he claims me to be. Only in his case, his bias is dangerous for his customers. The article as he had written it looked like an advertisement for breast implants - which, of course, is his business. By the way, I did not 'freeze' the article. Other editors chose to do that, and suggested we discuss any further changes on the off-line pages.

Why on earth would implant safety (if indeed a fact) be 'politically inconvenient' to me, Rob? That is simply ludicrous, or crazy. Unlike Rob, I have no personal financial or political stake in this. I do know what implants can do, because I experienced it, as have hundreds of women I know. Every bit of information that is on the article right now is accurate. I challenge Rob to point to anything that is not. I have referenced every single statement that I added there. That is politically inconvenient for Rob (who does not know how to use legaleze, btw). And, of course, I was not the only editor. You can find the off-line pages at the top of the article. You can't miss them. I hope that some neutral observers and scientists will help edit. I also think it is important to discuss the studies that say there is a lack of evidence to show implants are dangerous (they do NOT say implants are safe, by the way). Also, I suspect that we should discuss the shortcomings of the studies. In fact, another plastic surgeon, and professor of medicine, had written that he also thinks silicone implants are unsafe, and that it will eventually be proven. I don't share his optimism, unless and until the conspiracy theorists are exposed for what they are -- those who claim all the women's problems are merely a platintiff lawyer's greed. Good God. Talk about ludicrous. I didn't file a lawsuit. I didn't even register for the class action settlement. I did, however, become sick from implants, to the point I was disabled. Thank God I had them removed, and my health has improved: not just subjectively but objectively (my lab tests are now normal, where they had been very abnormal for 5 years before explant). This is consistent with peer-reviewed studies that show women do improve after explant. But that is politically inconvenient for Rob, who makes his living putting implants in women. Alleged doctors like this harm women. Had I listened to an ignorant (or blind) plastic surgeon who told me removing my ruptured implants would not improve my health, I believe I would be dead now. Fortunately, I had a friend who is a medical doctor who convinced me to get them removed. Also, my internist and rheumatologist advised that I remove the implants. Just two days ago my internist called me at home, to tell me that a repeat of my blood tests was normal! She still is in awe, because I had been so sick just two years before (when I had surgery to remove ruptured, sticky, yellow-black remains of what used to be implants. She said she has absolutely no doubt that removing my implants made the difference. There is no other explanation. So, going back to political' motive, I suppose I do have a motive. My motive is to warn other women before they become as sick as I, and many many other women, have become from implants. My motive is to see women healthy, and not disabled or dead. As to this article, I hope that someone - NOT Rob here - will start some of the edits. MollyBloom 03:38, 26 May 2006 (UTC)

Molly, you've explained why your POV is so hostile to breast implants. Unfortunately, it is this very bias that is the problem. In reality, the vast majority of breast implant procedures are uneventful, if perhaps a bit tacky. If you want to make sure the article includes reliable sources that recommend removing ruptured implants, that's fine. However, if you want this article to make breast implants sound uniformly deadly, that's simply not acceptable. Al 04:10, 26 May 2006 (UTC)

NO NO NO Alienus. Everyone has a POV. The WRITING is what needs to be NPOV. There is nothing wrong with the information that I and others have added to this article. All work is cited, with accurate references. Do you object to that? The vast majority of implantations are NOT uneventful. Statistics show that. Where do you get this information, anyway? My point was that Oliver has every bit as much bias, if not more so, than I do. I said I would be willing to include other information. But NOT to make it look like an advertisement for breast implants. And I do object to your comment that breast implants are tacky. They are not tacky, as there are many reasons why women want implants - not all are adult entertainers. However, the fact is that the FDA has NOT yet approved silicone breast implants. More than half rupture by 10 years. How on earth do you suggest that the 'vast majority' are uneventful? That simply is untrue. We are splitting this article into the main article and "Risk and Controversy" because there IS controversy as to the safety. And we most certainly will say more than just the advisability of women removing ruptured implants (although I doubt Rob would even agree to that, since he has ridiculed the FDA on other issues, as well. MollyBloom 00:15, 27 May 2006 (UTC)

I see now that you were talking about saline implants. The main issue of contention is silicone, not saline.MollyBloom 02:43, 27 May 2006 (UTC)

Just thought I'd add another voice to the "why do earthlings do that" debate, and I better declare my industry affiliation at the start. I am a plastic surgeon (in Australia, if that becomes important.) It is pretty clear that augmentation is a popular procedure and it is untrue that keeping patients poorly informed is necessary to maintain that demand. Most women requesting implants are really well informed. Most feel much happier about their appearance afterwards, many feel better proportioned and balanced, and often women comment on their confidence improving. The proportion who end up having implants removed and not replaced is very small (like 2%.) Women, in general, like their augmented body better. Will Blake 04:49, 29 May 2006 (UTC)

Welcome aboard. I know this article is controversial, but don't let that scare you away. While you may well have a bias due to your profession, you also have some relevant medical knowledge, so I'm sure you can contribute in a positive way. Al 05:41, 29 May 2006 (UTC)

I think Will does , not mean 'fork' but rather another article. That is the difference. I will not debate his comments here, but to say I doubt that he follows women years down the road. MollyBloom

Fork silicone

There's a tag alterting editors to the fact that the article has gotten a bit large and needs branching. I was thinking that we could separate out the section on silicone implants into a fork. My rationale is that it's well-defined and represents a topic that is considerably more controversial and (due to recent actions to restore the legality of such implants) less stable. What do you think? Al 01:46, 28 May 2006 (UTC)

DO NOT FORK SILICONE - This is what another editor and administrator (Encephalon) explained, and why NOT to fork this section, but make it a separate article:

Now, there is no doubt that the specific subject, silicone breast implant controversy, can be written about at great length: it has a long and involved history, and thousands of pages have been written devoted to it—books, journal reports, court documents, company reports, news reports. It would be inappropriate, however, to reproduce a voluminous account on a general article about breast (including saline) implants, especially at the expense of the other important aspects an article on breast implants should contain as mentioned in 2.

On the other hand, the controversy and its history are important, and it is desirable for an encyclopedia to have a good account of it. So what do we do? On Wikipedia this type of problem is resolved by using something known as the Summary style. I urge those of you who haven't read this document to do so. (This should not be confused with a POV fork. A POV fork is a second article on a given subject with an opposing POV; i.e., instead of collaborating to write a single balanced, neutral, article, editors of opposing points-of-view create two biased accounts of the same topic.) The impetus to create silicone breast implant controversy however is that this subtopic is sufficiently noteworthy, important and complex that it requires an individual page, itself conforming to NPOV, which the main article breast implant will summarise in a neutral fashion in the relevant subsection).MollyBloom 03:45, 28 May 2006 (UTC)

I agree but for a different reason: I don't think breast implants are notable enough to merit multiple articles. If this one's getting too long, some of the fat should be trimmed. Kasreyn 16:28, 28 May 2006 (UTC)

I should clarify. On a rereading, my comment was too ambiguous. I am against a fork. Kasreyn 20:43, 28 May 2006 (UTC)

No fork - I agree with Molly - Silicone needs be kept within main topic, but the article is long and so a split half-way down ((a) what they are and (b) the possible risks which has generated noteworthy public controversy for both types) is sensible encyclopedia article writing. Whilst I don't think breast imlants are as important as perhaps heart surgery or hip replacements (by numbers undertaken or significance to myself as a General Practitioner), they are notable and the controversy over whether there is or is not chronic side-effects has been well aired in public. It is one of a number of topics in which general medical consensus, research evidence, vocal patient groups and regulatory authorities are not in accord and the article does need to observe on these issues (although of course WP is not the place to actually argue out debates).David Ruben ^Talk 17:02, 28 May 2006 (UTC)

With as many implantations as there are, I'd say the controversy is a notable subject. The main article should be fairly concise. The 'Risks and Controversy" could and should discuss the issues.MollyBloom 20:26, 28 May 2006 (UTC)

Fork it I reckon the Silicone Implant Controversy forms a very natural self-contained topic which could form a seperate topic refered to in the main breast implant article. There are many people interested in implants but not much in the silicone controversy (because they live in areas where saline is used exclusively) and there are many of us who use silicone who feel the debate has been largely settled in the negative by quality evidence and is essentially ended. Will Blake 04:48, 29 May 2006 (UTC)

I wonder how many plastic surgeons who feel the debate has been 'largely' settled follow women for 5, 10, 15 or 20 years. I doubt many. I use my experience as an example only, because I am only one of many thousands of women who have had problems with implants.... I was very happy with my implants for 15 years, which is approximately when they ruptured. I did not know it at the time, and for the next several years became increasingly ill. This has happened to many many many women.

NOT FORK -- I think you mean a separate article - NOT a fork.MollyBloom 15:09, 29 May 2006 (UTC)

Input on types of Implants

String implants are banned in the US, for anyone. This is not true for silicone implants, for which there is an adjunct study. If string implants are available elsewhere, please post here. Otherwise it does not belong here. And, are string implants very common, if they are available anywhere?MollyBloom 00:46, 31 May 2006 (UTC)

We've been over this before. I'm not sure what's changed or why you decided to revert to the earlier version. Al 00:47, 31 May 2006 (UTC)

If we are going to have implants listed that are not available, then we should have all - including the one you did not add back that was deleted. Since there seems to be some controversy, it is worth discussing here. Let's ask others what they think. Also, let's add such changes to the off-line pages - that is what they are for. I don't have a problem adding other implants that are not in use, but we should be thorough. If one is in development, then it should be added, as in the tissue engineered implant. It is listed on an information webpage as one of the types of implants. I suspect it will become more important in the future, where string implants will become even less likely to ever be used.MollyBloom 00:50, 31 May 2006 (UTC)

Agreed. And it's not unreasonable to put saline implants in a prominent position, since they make up the overwhelming majority, followed by what's legal but less available, what's illegal and what's in development or related. Is that a reasonable order? Al 17:04, 1 June 2006 (UTC)

Actually saline implants are the overwhelming minority in the every market in the rest of the world and likely to be that way here by 2007Droliver 03:02, 2 June 2006 (UTC)

Saline implants should be first to be discussed, as they were in the original article. I agree with Al. Rob, there are numerous implants that have been marketed in Europe. And your perspective is, well, sufffice to say, limited. When I meant that I wanted to hear from MDs, I meant real MDS, who are not as biased as you are. MollyBloom 03:31, 2 June 2006 (UTC)

That's fine with me. That was the order it was in, I think, before someone started deleting.MollyBloom 18:04, 1 June 2006 (UTC)

Ok, so let's plan it out here.

Al, I would add these

Freely available: Saline -- Saline-filled implants are believed to be safer than silicone because rupture or leakage will only release salt water--not silicone gel--into the body. Consequently, FDA has allowed these implants to remain on the market without evidence of safety until 2000. On May 10, 2000, the FDA approved saline implants made by McGhan (now Inamed and soon to be Allerghan) and Mentor for augmentation in women 18 or older. They were approved for reconstructive use for women of all ages.

Limited availability: (This is from a plastic surgeon's website, and it is pretty neutral, which is refreshing)

• Silicone-filled (silicone elastomer shell) --- Very controversial, because of hundreds of thousands of women's complaints and concerns of local complications and systemic illness. Although there is no conclusive evidence that they cause systemic illness, there is still controversy about their safety. Certainly enough to cause alarm in even the most skeptical person. Even the studies which suggest no link advise further study be done to detemine if a subset of women are suseptible to silicone sensitivity. However, there is evidence of granuloma and macrophage accumulation with silicone injections and gel bleed (or rupture) from mammary prostheses. Lower molecular silicones do tend to migrate and cause granulomatous fibroses (nodules of inflamed tissue) as well. Capsular contracture (CC) and thicker capsules have been reported to occur more often with silicone filled implants than in saline-filled implants due to the permeation of lower molecular silicones, called "gel bleed", into the surrounding tissues. The body treats this like an irritant, comparable to a grain of sand in an oyster, and continues to surround it with fibrous collagen.

(We need to discuss availability in NEUTRAL terms. I welcome other's input, but I ask that any editors please identify themselves, and add to, not delete others' suggestions. This is, after all, a discussion page)

• Saline with polysaccharide (Hydrogel) --- Hydrogel mammary prosthesis has a filler which is a silicone elastomer shell filled with either a hyaluronic acid fluid, polysacharide gel or a hydrophilic polycrylamide gel.

• Poly Implant Prosthesis (PIP) Saline: a French-made prefilled saline implant with propietary elastomer coating.

Unavailable:

• Polypropylene (PPP) Strings --- Also known as polypropylene implants, are not currently approved by the US FDA. Intended for individuals wishing to obtain extreme breast sizes, string breast implants continue to grow after they are implanted, and can result in abnormally large breasts; string breast implants have resulted in the largest recorded increases in breast size due to surgical augmentation. The string breast implants were only available for a short time. They are made of a synthetic material called polypropylene, which causes the string breast implants to absorb fluids and expand.

• Poly Implant Prosthesis (PIP) Hydrogel -- Manufactured in France and distributed by Clover Leaf Products Ltd. The PIP is prefilled with a hydroxypropyl cellulose hydrogel (polysaccharide) gel filler. The MDA (The UK Medical Device Agency) requested a recall, for more studies "due to the lack of long-term toxicity data or clinical follow-up, together with methodological flaws in some of the pre-clinical tests." For more information regarding their safety concerns see - Medical Devices Agency - MDA Safety Warnings on PIP Implants. http://www.medical-devices.gov.uk

• Soy or Soya-filled (silicone elastomer shell - Approximately 5,000 women were implanted with the Trilucent™ Soya Implant. This implant was manufactured by Lipomatrix Inc./AEI Inc. (formerly Collagen Aesthetics International, Inc.). The shell is as the above - silicone elastomer - but filled with soya bean oil. Although the manufacturers insist they are safe, concerns about toxicity induced by a possible rupture of rancid soya oil into the body cavity led to them being removed from the market.

Pending: tissue

=

Please do not change what I have written here. This is my suggestion. We can get input from other editors, Rob. Your changing this on the DISCUSSION page is not honest. Write your own suggestion, but do not alter mine. This, by the way, mostly came from the website of BOARD CERTIFIED plastic surgeons. MollyBloom 23:38, 2 June 2006 (UTC)

I don't know about the direct saline injection. Perhaps we can get input from some MDs on this? I think that would be good. The rest sounds fine. I know there were some other implants like Hydrogel in the UK that were banned, but I don't know much about them. Do you think the whole section on silicone implants should be shortened - eg the 'generations'?MollyBloom 21:42, 1 June 2006 (UTC)

string implants, hydrogel, and saline injections are so peripheral as to not worth even being mentioned. Autologous tissue cultures are also more theory then reality at this point as well.Droliver 02:59, 2 June 2006 (UTC)

Al, that sounds fine. Your thoughts on this are very good. It gives a broader perspective on breast implants, that an encyclopedic article should have. WE don't have to write more than a sentence or two on the ones that are not widely used, or are in development. But after thinking about it, I agree that it is important to include.MollyBloom 05:40, 2 June 2006 (UTC)

I don't actually know anything about hydrogel, above what I can infer from the name. Are these currently available? Saline injections are worth linking to, but not worth more than one sentence of coverage. Tissue cultures are, to the best of my knowledge, more an idea than anything available, so I'd also limit it to a sentence. Al 04:32, 2 June 2006 (UTC)

As I said above, I agree with you, Al. This article is too US-centric. It is useful to at least mention the various implants that have been introduced in other countries (not just the US market). The Hydrogel were first introduced into the European market. Also, there is a pattern of putting implants on the market without long term safety studies, which all of these show.

A sentence or two should suffice. There still seems to be controversy on the Hydrogel, too, like silicone. The problem with hydrogel was lack of long term follow up; which ironically, is still the problem with silicone implants - the two US manufacturers only provided the FDA 2 and 3 years of 'core' data. The FDA acknowledged the adjunct studies were fatally flawed. Here are a couple links on Hydrogel. A 2002 plastic surgery article published in PubMed said they were fine (surprise surprise). http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11832859&dopt=Abstract As with silicone implants, women began having serious problems with the Hydrogel, as this article mentions: http://www.timesonline.co.uk/article/0,,25689-2203951,00.html They are no longer available in the UK. http://mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&nodeId=738 and the UK Times wrote: http://www.timesonline.co.uk/article/0,,25689-2203951,00.html

Uhm, some of these links are NOT about hydrogel implants at all, but rather some crude direct injection that's quite unsafe. Al 23:40, 2 June 2006 (UTC)

Yes, you are right, Al. Sorry about that UK Times article. I missed that. The others are about Hydrogel implants, however, if you read them. One is positive and the other is not. MollyBloom 23:46, 2 June 2006 (UTC)

Hmm, even the negative one wasn't that negative. Mostly, they need better clinical trials, but there don't seem to be any serious problems with them. Al 23:52, 2 June 2006 (UTC)

I also added an external link, that links to a non-profit corp website that focuses on women's health. ON the BI, there are many links to studies, and it presents some of the concerns that still exist about silicone.MollyBloom 21:45, 1 June 2006 (UTC)

Not just no, but hell no on linking to Zuckerman's outfit. It's a political entity led by the person most identified with sensationalizing this issue.Droliver 02:59, 2 June 2006 (UTC)

Yes, and Hell Yes. Rob, you only think it is a political entity because you don't like it. It is a valid non-profit corp, and Dr. Zuckerman is an epidemiologist who just happens to disagree with you. This article should be NPOV, and not just what Rob thinks. That means have pros and cons. PLease see below. MollyBloom 03:30, 2 June 2006 (UTC)

NPOV is the IOM report & the other major studies. That is what is going to lead the summary of this issue. Zuckerman's talking points can be referred to, but they should be clearly identified as the minority viewDroliver 23:10, 2 June 2006 (UTC)

Rob, you are not the final arbiter of this article, although I know you want to think so. There is absolutely no reason that this non-profit needs to be 'clearly identified' as anything, since it is merely an external link. You are out of your mind if you think that is going to happen.MollyBloom 23:27, 2 June 2006 (UTC)

Is there any particular reason for not linking to this place? Keep in mind that if it's known to be biased, all we need to do is label it as such. Consider how abortion links to clearly labeled advocacy groups on both sides of the issue, deftly handling their bias. Al 23:40, 2 June 2006 (UTC)

Al, external links should not be labeled as 'biased'. You will open a can of worms here, because many can say studies funded by Dow Corning were biased. There is no reason to not include this link, along with others that are more favorable towards implants. The reader should be smart enough to see the difference, don't you think?MollyBloom 23:43, 2 June 2006 (UTC)

Even abortion doesn't actually call its links biased. Rather, they're identified as pro or con. This not only defuses bias but can be helpful to readers. For example, if I want to hear the worst case stories about hydrogel implants, I don't want to waste my time on an article that talks only about how nice they feel. Al 23:52, 2 June 2006 (UTC)

AI, you're falling into the trap of confusing politics with science by trying to play nice on this. As much as this is political to Molly, there is no medical "pro" or "con" view of this, there is just the data & the literature. The Institute of Medicine & others are not some "shill" for for Dow Corning, there are the regulatory agencies who have sequentially been commisioned to review this. You don't have to be fluent in reading medical literature to understand the consensus view. In addition, we're nominally charged with reflecting the world-view on this, where there is even less debate on this as reflected by the reviews and policies of other health ministries.Droliver 16:04, 3 June 2006 (UTC)

You insulted Al. He is capable of thinking on his own, and coming to a conclusion, Rob. You are not the end all and be all here. This link is very appropriate as an external link, and it stays.

The IOM simply reviewed the studies that were done that were funded by Dow, Rob. There is a controversy on this issue, which is why the FDA has NOT approved silicone implants yet. There is no harm in adding an external link of a research NON-PROFIT organization. The consensus is to keep it. It stays. MollyBloom 18:09, 3 June 2006 (UTC)

External Links

I would like to ask others (NOT ROB) what they think about the non-profit link that I added. It offers a differing view, but it is academic, and it links to academic articles, as well. Dr. Zuckerman is a Harvard epidemiologist who should be linked to on this issue, as much as the plastic surgeons. I welcome others to view this website, and explain why it is not acceptable as a legitimate link. (I don't think others will.) MollyBloom 03:34, 2 June 2006 (UTC)

It is a vocally political lobbying group. Compare the tone of the articles, press releases, & breathless proclaimations/press releases there to the IOM, FDA, UK-IRG, Canadian health ministry, & other health ministries around the world. It represents a political group with an agenda & dismisses the large body of careful researchDroliver 23:07, 2 June 2006 (UTC)

We all know what you think, Rob. I want to see what others think. As I said before, this is a non-profit group, on women's health. The director is an epidemiologist. The tone is not 'breathless'; it is just not an advertisement for breast implants so it isn't up your alley. Furthermore, this group does not 'dismiss' other studies. They are discussed. This is ONLY an external link, Rob, among many. You can't filter out everything.MollyBloom 23:20, 2 June 2006 (UTC)

I think that this fits within standards for an external link. Al 23:30, 2 June 2006 (UTC)

Thanks, Al.MollyBloom 23:31, 2 June 2006 (UTC)

"Furthermore, this group does not 'dismiss' other studies. They are discussed"...You obviously haven't looked at the site then because that's all it does. It's a discussion that's about as unbiased as the dailykos.com or redstate.org are on politics. If we're to keep links NPOV you cannot put political groups like that in the area segregated for external links. The 'controversy' over silicone should be discussed in context in the article & presented as the alternative view to the mainstream. Linking to the group in that context would be less objectionable if you wanted to briefly point out organizations that object (eg. N.O.W., etc..).Droliver 15:53, 3 June 2006 (UTC)

External Links

We need to discuss external links here.MollyBloom 23:23, 2 June 2006 (UTC)

Since Droliver is insulting the website of the nonprofit organization that I am president of, I will respond. Our organization is not "known" to be biased, except perhaps by individuals who have never read the epidemiological studies that we have reviewed. I would be happy to debate, in civil dialogue and in specific detail, any information on our website. I am trained in epidemiology from Yale Medical School, directed a longitudinal research project at Harvard, and am currently a Fellow at the Center for Bioethics at the University of Pennsylvania. The National Research Center for Women & Families is very concerned about the often-quoted poorly designed implant studies, virtually all of which are funded by implant makers and plastic surgeons. Our detailed criticisms of these biased studies are available on our website, and not a single author of any of those studies has ever complained about our criticisms. We usually rely on data from independent studies, such as those funded by the US government or the Canadian government. Summaries of those government studies are available on our website, as are links to those articles. In addition, we often quote the findings of industry-funded studies that have been analyzed by the FDA, since those findings are more accurate than the analyses conducted by the companies themselves. Unfortunately, those findings have never been published by the companies, apparently because they do not want to publicize their high complication rates. 216.164.59.38 01:59, 3 June 2006 (UTC)Diana Zuckerman, PhD dz@center4research.org

Diana, I'm not insulting your organization but I am calling it for what it is- A political entity determined to keep silicone implants off the market by any means neccessary, despite the general consensus (both here and abroad) of the medical literature to the safety of the devices. It is in no way accurate to describe yourself as just some disinterested "non-profit organization" without a political agenda, and linking to your site would be as inappropriate as putting links to the corporate office of Inamed, Mentor, or other manufacturers. It is a ridiculous position to paint the systemic reviews of every industrialized nation on earth as tainted who have weighed in on this subject.Droliver 15:40, 3 June 2006 (UTC)

ROB, YOU have discussed this. The consensus was to LEAVE this link. Your analogy to Inamed is ludicrous. They are for-profit corporations. This is not. And the consensus was to keep it. This is not YOUR article. It stays.MollyBloom 18:07, 3 June 2006 (UTC)

Okay, Al. I dont have a problem with legitimate links. I do think they should be discussed here. We will leave all three.MollyBloom 18:13, 3 June 2006 (UTC)

Now that there has been a prolonged stagnation

Now that the editorial moratorium seems to have run it's course with this entry, we are left with an article that's still unsatisfactory. At the time it was arrested, it had been freshly edited to aggressively represent a controversial POV on this topic. There is no hint of the mainstream data, reviews, and opinions of the professional bodies who work in the field. We are still left with deliberately pointed sections fiercly guarded from moderation by one said editor who has used this entry as a platform for political crusading on a percieved cover-up of the real-world consequences of these devices by the medical-industrial complex. Even well-documented historical aspects of development which should be pretty non-controversial have been distorted (ie. the bizarre deviation on the history of the saline implant section). It remains clear that when someone who

* regards each piece of the mainstream work on this as tainted - You consider mainstream only the work that supports one view. That is absurd. THere is no mainstream view on the new platinum study for example. But I am sure you dismiss it because a couple of your plastic surgeon friends dismissed it.

* regards each major systemic review as tainted

• • No, the only ones you consider mainstream are all glowing about silicone. You dismiss other equally important works, that are even noted by the FDA.

* highlights controversy over consensus at all times

• • That too is untrue, as can be evidenced in my edits.

* dismisses the expertise of people who work with or on the devices

** No, I only dismiss you, because I do not respect you, based on your actions here.

is not someone who can be collaborated with in a productive way. Outside of the technical aspects of the article, the bulk of this is such a jumble of dis-coherent & inacurate information that it begs to be scrapped.Droliver 22:45, 5 June 2006 (UTC)

Every statement in there that I have added is supported by academic citations. You just have a problem with my raising anything negative about silicone implants. HEavens, you didn't even want to include the LOCAL complications, which are not even controversial.MollyBloom 06:01, 6 June 2006 (UTC)

Droliver, I'm rather new to this article and its behind-the-scenes upheavals. I gather you are referring to Molly Bloom. It seems to me that communications between the two of you have broken down and there may be some difficulty finding a consensus or compromise position between. I'd like to offer to help as a mediator if I can. I am almost entirely ignorant of the subject matter. This is problematic in that I will have to be educated before I can make intelligent decisions, but beneficial in that I am not bringing any previous biases or perceptions to the discussion.

I'd like to see a balanced and stable version of this article arise. As I mentioned before, there are a lot of aspects not being covered which don't seem to be involved in the "are they good or bad" controversy, such as motivation, availability, etc. Images of the "finished product" - completed breast implants in situ photographed from outside the skin - are also conspicuously missing. I feel that these problems at least could have be fixed with little need for mediation, and yet nothing has been done. My guess is that neither camp can make any significant edits without being immediately reverted by the other, and too much attention is being focused on whether breast implants are a "good" or a "bad" thing. As a result, actual progress on uncontroversial aspects has languished.

Would anyone here object to my entering this discussion as a moderator? Kasreyn 02:38, 6 June 2006 (UTC)

Nope. Fine with me.MollyBloom 15:12, 8 June 2006 (UTC)

Would like David to mediate-- As to the 'finished product', a number of people voiced objections about that as being unnecessary, since most people know what breasts look like - large and small. I think you were aware of that, Kas. I don't really care, but I also think it unnecessary.MollyBloom 05:54, 6 June 2006 (UTC)

Yes, above on this page I replied to one such comment. As I said before, there is a very clear visible difference between large real breasts and large false breasts (though some of the more expensive varieties are becoming harder to detect). This is notable as it speaks to the successfulness (or lack thereof) of the intended effect. Kasreyn 22:11, 6 June 2006 (UTC)

In fact, given your stance against implants, I find it very surprising that you don't want the page to include a photograph of breasts which fail to pass as real. I would think you would be in favor of any information that might dissuade women from going through with the procedure. Surely a photograph of obviously false breasts would indicate that, at least in some cases, the illusion is not complete. Almost no women get implants because they want to look like a woman with false breasts. The great majority of women get implants because they want to foster an illusion that they have large natural breasts. Breast implants which "give away" the secret are clearly failures in this light. Kasreyn 22:16, 6 June 2006 (UTC)

No objection - I had mediated previously - see above discussions. Also the purely descriptive info of what they are & how they are inseretd should be split from the description of concerns raised for longterm risks, research into this, regulation issues (see Talk:Breast_implant#Sub-pages_for_article_split). I had created 2 sub-pages for the split article to be worked on in a constructive matter.

I had intended to return to this article, with perhaps an attempt at a rewrite, but the 2 main editors seemed to be engaging more constructively for a time and so I let things run on for a while. Please do help moderate/comment on the editing required... David Ruben ^Talk 02:58, 6 June 2006 (UTC)

Personal Attacks

I am not going to dignify DrOliver's list of complaints against me, with my own list against him. It is unproductive. I have repeatedly ask that DrOliver be civil. I would like to see the focus on the article, and not on the person. I edit on a number of articles, apart from breast implants. I have not had such problem on any other articles I have edited. But on this, there have been all out wars. I would appreciate help with coming to a reasonable resolution. MollyBloom 05:54, 6 June 2006 (UTC)

Offers to Mediate

I appreciate offers to mediate. Please, someone, help. I also would so appreciate it if Dr. Laub or would come help with this. He said he would but has been absent.. I am not a medical doctor, but I do have a background in science and engineering, and law. I have researched this area extensively. I also know that one cannot cherry pick and choose only the positive or only the negative in an article..

The "mainstream" assessment should be included - it has to be. But when DrOliver did that he made it an advertisement. Then he became hostile. The encyclopedic article is not an advertisement. I would like to see a very factual main article, and then a split (soon) for the controversial areas. NOT a fork, but a split into a separate article, as David suggested,. He too pointed out there was genuine controversy, within the medical profession and scientific community. There are still many women becoming ill from local complications or what they perceive to be systemic complications. In short, this is not a situation like, for example, evolution. Science has definitively weighed in on evolution. (I hope I am not going to inflame here) But the anti-evolutionists argue for a biblical interpretation which is simply not scientific. Science has not definitely weighted in on breast implants, regardless of what Rob insists. As a plastic surgeon who performs breast implants, Rob is understandably enthusiastic about them. But a more tempered approach would be a wiser approach, as some other plastic surgeons have pointed out to me. Anyway, I would be happy to have someone act as mediator.MollyBloom 05:52, 6 June 2006 (UTC)

The same could be said that as the president of an organization that is openly biased against breast implants, you're understandably against them. I am all for voicing your opinion about what you believe in, but it doesn't belong in an encyclopedia entry. As an objective third party, I can most definitely say that the current iteration of the article is quite biased towards the associated risks and not the device/procedure itself. As a relatively new Wikipedian I came upon this article to see what all has been written about a subject I've been curious about for some time now, what I found was an article that has been butchered by people with agendas. Why is it that an overwhelmingly large portion of the article is about the risks of Silicone breast implants when most implants used today are saline? Why is there absolutely no information about why women get implants? I would be more than happy to help expand these subjects but I believe it will be quite pointless until those with agendas have moved on, or take their discussion on the controversy of breast implants to the proper page.Aktornado 20:32, 7 June 2006 (UTC)aktornado

This entry has become bogged down because of one person's hostility towards the consensus data on the subject. As I've said several times, the whole section on risks/controversy can be summed up in one paragraph briefly. It has sprawled to pages long as individual studies are plucked out of context of the body of work to endorse the political view that the devices are dangerous and then elaborated on at great length in the most grotesque of ways. Go to medline, the FDA, the UK-IRG, the IOM, whathaveyou and see where the evidence is for yourself. Also look to the positions and policies of other countries (as this is nominally a world-view entry and silicone is used in 90-95% of all cases world-wide) we're alone in the US for having signifigant regulation or restrictions on the device and even that is likely to change any month.Droliver 04:32, 8 June 2006 (UTC)

My response is below. I agree with you ak. That is why the article will split into two articles, one exactly as you describe. And there is need no prolonged discussion of silicone there - it does outbalance the saline to an absurd degree. The second article will be about silicone only, the risk and controversy. Scientists are still in debate about that, regardless of what Oliver wants us to believe. This is well evidenced by the fact the FDA has NOT yet approved siicone implants.

As to Rob's stance. It was bogged down because of an edit war. As you know, there are always two sides to everything.  ;-) I will not wade in muck, to join Rob in insults. His own venom illustrates my point well. MollyBloom 15:24, 8 June 2006 (UTC)

I will help if I can, Molly. I think input from both sides should be synthesized in the article. I don't feel that either you or Droliver should be prevented from contributing simply because of your viewpoints, merely that a reasonable balance must be struck. One issue is the article's giving a great deal of time to the side effects and harmful effects of implants, and very little time to the motivations of the women who get them and the results when they do work as advertised. As Droliver pointed out, there is also the fact that Wikipedia is an encyclopedia for the whole world, and silicone implants are still very common worldwide. I have no interest in getting into a debate over the benefits and risks of implants. All I'm saying is too much space is being devoted

to benefits-vs.-risks, and not enough space to other aspects important to a reader who wants to learn about the subject matter. Kasreyn 22:27, 8 June 2006 (UTC)

I still dont' think you understand what has been going on, Kasreyn. I have no problem with a balance - however, the article had been 'frozen' until further discussions, and adding a little at a time. Oliver is making wholesale changes to the main article, without discussion. Again. I would like some others to help here.

Also, the article needs to be split, with risk and controversy a separate article, as suggested by David. The history and controversy has been huge in this area. To ignore it is deceitful. There are still settlements going on, still women getting sick and still studies going on - some of the very article Rob cited recommended further study, but he stated there was no need for further study and nobody was recommending it!MollyBloom 16:36, 17 June 2006 (UTC)

Need for article improvement

It seems that Oliver and I tried to edit initially at the same time. So I am going to repost the comment/question, and discuss the article improvement. We all need to be civil, and not disparage other users.

The same could be said that as the president of an organization that is openly biased against breast implants, you're understandably against them. I am all for voicing your opinion about what you believe in, but it doesn't belong in an encyclopedia entry. As an objective third party, I can most definitely say that the current iteration of the article is quite biased towards the associated risks and not the device/procedure itself. As a relatively new Wikipedian I came upon this article to see what all has been written about a subject I've been curious about for some time now, what I found was an article that has been butchered by people with agendas. Why is it that an overwhelmingly large portion of the article is about the risks of Silicone breast implants when most implants used today are saline? Why is there absolutely no information about why women get implants? I would be more than happy to help expand these subjects but I believe it will be quite pointless until those with agendas have moved on, or take their discussion on the controversy of breast implants to the proper page.Aktornado 20:32, 7 June 2006 (UTC)aktornado

Aktornado, I agree with you on all counts. The article needs work, and it will be split into two articles. That was the consensus of all the editors who weighed in.

The main article should be very factual in the main section, including local complications, and maybe some of the things you mention. The Risk and Controversy section is predominantly about silicone implants, because the manufacturers have fought long and hard to get the FDA to approve silicone implants. As yet, the FDA has not, but is expected to rule one way or the other, probably this year.

I am not going to attack any editor. There has been far too much of that. The "Risks and Controversy" section is predominantly about silicone, and will be a separate article. I and others have hoped we could get new blood, so to speak, to help with the article. There has been bias both ways. You can judge the comment below and its tone, for yourself.

My hope is that we can obtain a good, solid factual article for breast implants. The other discussion will be a separate article. By the way, I am a scientist as well as a lawyer, and certainly am not anti-science. I am however well aware of the existing controversy that still exists within the medical community. I have a few letters or emails I from neurologists, rheumatologists and plastic surgeon , and certainly could scan and enter them, if there is serious question that there is still a debate. Moreover, the editor below blasted a Harvard and Yale epidemiologist and expert in this area who disagreed with him. Now. Let's not start another war. let's get new blood to help rewrite!

Why don't you help us rewrite the article? We need some 'new' perspective, from someone who is not overtly biased, one way or the other. Thanks!!  ;-) 04:43, 8 June 2006 (UTC)

Also, the consensus in a long debate on this subject (including other doctors weighing in) was to create a second article, because of the importance of the subject. Certainly not to sum up in a sentence. Please look at the tags and discussion for explanation of this. ThanksMollyBloom 04:50, 8 June 2006 (UTC)[User:Jgwlaw|MollyBloom]] 04:43, 8 June 2006 (UTC)

Actually, "to disparage" is to slight, to reduce esteem, to insult. Did you meant "not to disparage"? Kasreyn 00:30, 9 June 2006 (UTC)

Yes, thank you.

I wasn't ware of the consensus to split this article. I believe above I argued against making a second article. I don't feel the risks & controversies are notable enough to merit their own article. Kasreyn 00:32, 9 June 2006 (UTC)

The majority of those weighing in thought a split important. I had initially disagreed, but conceded with the others. I am aware that you did not, but I do not think that was the consensus. If not split, then a new article can (and will) be written. The issue was not whether to have some information on the controversy, but what, where and how to place it. To say that the controversy is not notable is to either not understand or want to ignore the long history of this issue. In fact, whether you think silicone implant controversy is 'settled' or 'not settled' does not mean there has been no controversy. In fact, there is still controversy as there are very new peer-reviewed studies discussing it. Again, whether one believes the peer-reviewed studies or not is not the issue. Please see David's comments on this, for example:

No fork - I agree with Molly - Silicone needs be kept within main topic, but the article is long and so a split half-way down ((a) what they are and (b) the possible risks which has generated noteworthy public controversy for both types) is sensible encyclopedia article writing. Whilst I don't think breast imlants are as important as perhaps heart surgery or hip replacements (by numbers undertaken or significance to myself as a General Practitioner), they are notable and the controversy over whether there is or is not chronic side-effects has been well aired in public. It is one of a number of topics in which general medical consensus, research evidence, vocal patient groups and regulatory authorities are not in accord and the article does need to observe on these issues (although of course WP is not the place to actually argue out debates).David Ruben Talk 17:02, 28 May 2006 (UTC).MollyBloom 07:39, 11 June 2006 (UTC)

No fork. Splitting it elevates an imagined controversy in the medical literature. There is in fact little medical controversy ongoing, with most involved feeling the issue has largely been settled some years ago. Droliver 22:42, 14 June 2006 (UTC)

Oliver does not know the difference between fork and another article. The controversy is not imagined. The FDA has still not approved silicone implants. Please see what David stated about the history of the controversy and what is ongoing. MollyBloom 16:31, 17 June 2006 (UTC)

Discussion on Main Article

Per what Aktornado and others have said, there is a great deal on silicone implants, which considerably outweighs saline. The percentage of which is used more than the other doesn't make a whole lot of sense, since both are used. In fact, there are more restrictions on silicone than saline. Either way, it makes sense to not go into prolonged detail about the history of silicone implants. A short history should suffice, with the descriptioin of what they used to be (thin shell, liquid gel) and the efforts to make them less prone to rupture (different gel). Then one might mention in a sentence about the gummy bear. That is sufficient. The long dissertation on how each one differs is way beyond the scope of a WIki or encyclopoedia article.

I suggest continuing on the main article, recognizing Wikopedia is not a medical text. As several have said, the main article should be factual and relatively short. Ak made an excellent suggestion in a section on why get implants. Again, this need not be long, but a bullet point or paragraph would do. This is mentioned in passing, but not in a context by itself. Perhaps it should be, since Ak