Talk:Breast implant

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Balanced Article

The currently protected version is not a balanced article. The section on complications that was agreed to by everyone except droliver, a plastic surgeon who says clearly that he believes that implants have no worrisome risks, has been deleted by him. Instead there is a chart that needs a magnifying glass to be read, and is only based on one of the 6 major populations that were studies in prospective clinical trials. The version that droliver deleted included a range of complication rates based on those 6 major study populations.

The section on systemic diseases that I had carefully revised started with a summary paragraph proposed by Samir and agreed to by DrCarter, the GU editor, and the public health person. It was deleted, apparently by droliver. The current (protected) version includes several errors which I had previously corrected. The corrected version was supported by DrCarter and others (Dr Ruben?). But it is now not possible to restore those corrections because the article is protected.

Droliver, we all know from your writings that you believe that implants are safe. You are entitled to your own opinion, but the facts are the facts. This article should have the facts, not your opinion. When a regulatory agency or research center says that there is no conclusive evidence that implants cause specific diseases, that does not mean that there is NO evidence that implants cause ANY systemic illnesses, symptoms, or diseases, and it doesn't mean that there is conclusive evidence that implants DON'T cause disease. As the scientists repeatedly explain, the absence of proof is not the proof of absence.

Remember that the same National Academy of Sciences/Institute of Medicine that wrote one report on breast implants also wrote 3 widely publicized reports on Agent Orange and dioxin stating that there was no clear evidence that Agent Orange or dioxin caused disease -- until a few years later, when they wrote a report saying that "now there is such evidence." Interestingly, if you look at the Agent Orange article on wiki, the previous reports saying there was no association between dioxin and disease aren't even mentioned. Drzuckerman 23:27, 1 January 2007 (UTC)

Droliver made the last revert, to Curtis' version that included Curtis' edits. To be fair, Droliver has stated here that he does not agree with Curtis' edit. Of course, Droliver did not correct it in the article when he reverted to a version that he liked, which was not discussed on this talk page. Jance 00:58, 2 January 2007 (UTC)

Why has the article been reverted back to the previous version. I thought that discussion was being done to reach an editorial compromise. Instead one or some of the authors has deleted the version prior to New Year's that I, and a couple of other commentators, felt represented a NPOV (ie DrZ's version). DrCarter12 16:54, 2 January 2007 (UTC)

Editorial suggestions

Um, minor changes, really:
disease.[8][9][10][11][12] .[13] I'd move the period from between link 12 and 13
Thousands of women still claim that they have become ill after getting their implants. Complaints include neurological and rheumatological problems. Critics of silicone implant use have pointed to the difficulty of effectively studying rare autoimmune diseases (which may take years to develop) and potential conflicts of interest with industry-funded research as reasons to be skeptical of studies finding no correlation to diseases they believe are caused by silicone or saline breast implants. They point to studies which have identified increased self reported rheumatologic symptoms and others that suggested that the subjective and objective symptoms of women with implants may improve when their implants are removed [19]. I'd move the period to before the link. Generally, this paragraph version seems more speculative than previous ones we've had on this talk page. I (personally) think that if "potential conflicts of interest" and other newer add's are left, there should be more sources (as in, who makes these claims that industry studies are biased?) Sure, it's logical, but because this is an encyclopedia, I think this phrase needs more documented support...
As studies have followed women with implants for a longer period of time, more information has been made available to assess some of these issues. A 2004 Danish study, I'd remove this comma reported that women who had breast implants for an average of 19 years were no more likely to report an excess number of classic rheumatic symptoms then THAN control groups.[20] A large study of Swedish plastic surgery patients found a decreased standardized mortality ratio in both breast implant and other plastic surgery patients, but a relatively increased risk of respiratory cancer deaths in breast implant recipients compared to other forms of plastic surgery, which the authors attributed to possible differences in smoking rates. [21][22] Another large study with long-term follow-up of nearly 25,000 Canadian women with implants reported a 43 percent lower rate of breast cancer compared with the general population and a lower-than-average risk of developing cancer of any kind. [23] I'd also remove the spaces between the ends of sentences and links. Plus, question: are these studies ALL implants, or just the suspected silicon gel ones?
In 2001 a study reported an increase in fibromyalgia among women with extracapsular implant rupture. [24]. Remove space and extra period This association has not been observed in a number of related studies[25] , Remove space between sentence and comma and the US-FDA hyphen? concluded "the weight of the epidemiological evidence published in the literature does not support an association between fibromyalgia and breast implants." [26] Again, space between end of sentence and link. Also, I asked a question on Dr Ruben's page, but I don't think he saw it :) Are we okay to mention the FDA, or is it US-centrism as Dr Oliver believes? Though I think I'd (personally) leave it in, as the US has a lot of influence on the world (for better or worse). My two cents, and if the paragraph is otherwise kept, I hope my copyedits remain... Dikke poes 12:25, 3 January 2007 (UTC)

EDIT oops, I thought the version to comment on was the current one. Ignore my comments above. The only change I would make to the Zuckerman version is, there is a mention of "CTD" but I didn't see it explained in earlier paragraphs (maybe I missed it); so could the first mention be, CTD (connective-tissue disease) and maybe a link if this is first mention? Since a reader might not necessarily know CTD is referring to rheumatological disorders, etc. Again sorry... maybe I should strike-through my comments above... Dikke poes 13:04, 3 January 2007 (UTC)

<After an edit conflict>:Hey Dikke, thank you for your input and suggestions. You're actually a step ahead of us. :) At the moment, the article is fully protected. When articles are protected, we usually use the time to try to reach a consensus on the version to use as a starting base, then we will go through the article and address content and stylistic issues, such as those raised by yourself. The version we're selecting won't be the final "locked-in" version; it is just the base to build on. I was wondering if you think Dr Zuckerman's version [1] of the article would be a satisfactory starting base? Sarah 13:10, 3 January 2007 (UTC) No need to apologise or strike through your comments; you're just ahead of your times. :) Sarah 13:10, 3 January 2007 (UTC)

No, Sarah, my EDIT oops statement is now referring to the link up above described as "Zuckerman's version" (and it looks like the same one you just now linked to). Yeah, I know the article's protected, I just didn't read the way-above comments where it clearly has a diff to the version to be commented on... I just didn't see it and looked at the locked page instead (the struck-through part) :) So my comments in EDIT oops are indeed my view of Zuckerman's version (It looks to me like the one posted earlier where many editors seem to have liked it). I'm not a doctor or a person with really any experience with implants, and I've made no edits to the page at all ever... actually, I saw this article listed in the "Needs copyediting" wiki page, but when I got here it had a different tag, so came directly to the talk page. :)

But also, I heard this is a 4-day vote, but I think we should wait for input from Mr Curtis and Dr Oliver, since they're often on the other side of the debate. I mean, (geez, how do I say this without looking like an asshole?) many of the editors who've voted haven't edited anything except the BI talk page. I'm not saying they're not real editors or anything, just that in my very personal opinion, their votes maybe should be looked at differently than Dr Zuckerman's, Jance's, or Oliver's. Maybe even mine, since I haven't edited anything medical before. But in any case, with my note on the mention of CTD, I'll add my vote to the top. Cheers, Dikke poes 14:26, 3 January 2007 (UTC)

• Dikke, I believe the term you're looking for in re. to the "unusual" pattern of participation is meat puppet[2]
• Dr. Zuckerman's proposal is not an accurate reflection of how you would discuss this and extends a generalized discussion on general complications of any breast surgery into a segment now many pargraphs long. As has been pointed out, every complication is already mentioned (with some FDA data on augmentation patients attached) with expansion of the areas that are truly unique to implants so I'm not sure what the agenda is. Is it to represent how this is discussed on an everyday basis, or is it to reflect an exagerated emphasis on somewhat uncommon complications?
• The version that exists is both a concise and accurate representation of this as would be discussed in either a professional meeting or when going over issues with patients preoperatively. There are many,many sources of series of long-term follow ups of breast implant patients discussing complication and the common denominators are capsule issues and reoperations. One of the article referenced (" Decision and Management Algorithms to Address Patient and Food and Drug Administration Concerns Regarding Breast Augmentation and Implants." Plastic & Reconstructive Surgery. 114(5):1252-1257, October 2004)

specifically address the concerns re. complications the FDA asked of surgeons and industry during the pre market approval period. Droliver 14:46, 3 January 2007 (UTC)

To answer Dikke's question, the stats include saline implants too. Although I share his concern that the article not be too US-centric, the FDA data are based on studies done by the two largest implant companies in the world (and they sell all over the world). The FDA is one of the few countries that required safety studies be done (the EU does not require clinical trials for medical implants) and the only one to make the data public and require it to be available for patients. So, it's a good source of info.

I don't know what a meatpuppet is, but I assume it is not a compliment. However, I think health experts who have been commented on the implant page should be taken seriously, whether or not they spend much time on other pages. Many of us who are editors started on one page and then moved to others. I've now edited about 6-8 articles, and would like to do more but this one is so time-consuming it's difficult to get involved in others. For the time I have spent on this one, I could have published a few additional articles in medical journals, and that has a big advantage: nobody can delete my work just because they disagree. I'm sure that most doctors and public health folks feel the same way about wikipedia, and if we want their input on wiki we shouldn't make it so difficult for them to participate.

And, to respond briefly to droliver, I have already said that your table is too small to read, and apparently (altho I can't see it) too specific to one company and to one study population. Why have one microscopic table on complications when there are so many less important details in this article? Here's an idea: let's put the detailed technical information on incisions etc (which is really for doctors only) in a microscopic size table instead, and keep the info of more general interest in a font size that people can read. 72.75.6.148 16:00, 3 January 2007 (UTC)

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I am PERSONALLY insulted by the term "meatpuppet!!" To make an assumption based on the mere fact that someone performed a search to see where else I have chosen to comment on Wik articles and discussions is not constructive. Could it ever have been supposed that I have a major interest in this topic. Or that I personally feel strongly about this topic. Or that maybe I felt that too few medical professionals have represented the patients' concerns and confusion regarding this topic. I am a pretty busy person with doing a day job during the week, working in urgent care on weekends, and attending school during evenings ( I am getting a master's degree). Therefore, I am unable to write voluminous articles on Wik as many of you are. But when I have an opinion, I wish to present it without being challenged on my reputation and motives. Thank you. PS. I have written a short section on asthma if you were curious about what other subject matter I find interesting. DrCarter12 17:12, 3 January 2007 (UTC)

Dr. Carter, I am sorry about this disparagement. Wikipedia is like anything else, I guess...it takes all kinds. The term "meatpuppet" should not be directed at new users, but at people who are deliberately disruptive -- which you are not. No one editor owns Wikipedia, and we were all new at some point.Jance 17:58, 3 January 2007 (UTC)

Oh man, I knew I'd sound stupid. Just like in real life :) I apologise to anyone who thought I was calling anyone a meat or whatever puppet. I am at fault since I mentioned the numbers, and I really should listen more to that little voice that says "This will make you sound like an asshole." I regularly click on people's names out of curiosity, to see where their interests are etc (and I note that my own record makes me look like I actually own a TV :). Maybe I worried that this was some kind of vote using raw numbers, but Sarah has corrected me on this. Again, to Dr Carter and anyone else I've insulted, I'm really sorry. Dikke poes 14:57, 6 January 2007 (UTC)

Moving forward

I've archived everything up until the straw poll. If we need any of those comments, we can restore them later. For now, I want to resolve this issue, so we can move forward and start editing.

There are some new rules on this page and I'm very serious about enforcing them. I don't want anyone making personal comments about other editors, speculating about their motives or making accusations. I don't want any such comments here on this talk page, I don't want them on my talk page (or anyone else's) and I don't want to be emailed with a run-down of information on other editors and their backgrounds and alleged motives. This kind of behaviour is entirely inappropriate and I'm starting to see it as an attempt to paralyse this article in certain forms. Well, that's just not going to work anymore. We are going to decide on a version of the article to start editing and then we are going to start editing it. We aren't aiming for a promotional brochure for patients or an article biased in the other direction. What we are aiming for is a balanced and honest article. I hope you all will stick around and help build that, but if it doesn't interest you, please feel free to bow out. This article is currently ranked at number 3 in "Breast implant" g-searches and so I think that is reason enough to ensure this article is an unbiased, honest article.

Like Dikke,I am not a doctor (or a scientist or an academic). I just have a medical nursing background. The degree I studied at uni was a Bachelor of Applied Science. I can follow this material, but others with both medical and non-medical backgrounds have said that they find these arguments and rants tedious and they give up on trying to help. I don't want that to happen anymore. I don't care about people's educational and career backgrounds. I don't care if people are high school students, doctors, campaigners or forum leaders or whatever. All I care about is writing a decent, accurate and balanced article. Please, when you can, try to be concise on this talk page because needlessly engaging in long academic rants is academically exclusive and not what Wiki is about. Sarah 18:12, 3 January 2007 (UTC)

It was protected in the wrong version after an edit war between Jance and someone who hadn't edited here before. For the record, I would like to know which version of the article editors support as the base to move forward from here. If there is consensus, I will change it. Please sign under your preferred heading. Sarah 17:20, 2 January 2007 (UTC)

Thank you, Sarah. I promise to comply.Jance 22:10, 3 January 2007 (UTC)

Expression of opinions seems to be progressing smoothly and civily. In particular a larger number of opinions being expressed than we have previously seen discussing this article. I hope this helps both with current option being considered and then for the furture taking the article forward (eg the sourcing number of women who have complained below).

Given the previous prolonged dispute over this article, I think it is important to obtain as large a number of editor opinions as possible before an admin closes and enacts decission - the current page protection "tranquility" is conducive to encouraging other editors to this discussion. I have put an open invitation to participate at Wikipedia_talk:WikiProject Clinical medicine#Breast implants (so that those with a general interest in medical topics may be encourged to help participate here) and would suggest that discussion be left open for a few more days yet.

I've tried to stay neutral in previous dicussions, so I'ld rather see additional editor opinions posted than perhaps add my own posting and thus exclude myself from helping Sarah conclude this discussion or then help enact the consensus/page protection :-) David Ruben ^Talk 03:19, 6 January 2007 (UTC)

Oh, David, I'm sorry. I didn't see your message here until just now. I've already restored the Dr Zuckerman version...I'm leaving the page protected, though, so if anyone wants to comment in the next few days, I consider the poll still open and we can just revert it again. But I would like to try to move forward soon. I am not happy seeing the article paralysed or either side of this dispute being beneficiaries of an unfortunate edit war. I am hoping that if both sides are willing to give an inch we will end up on common ground with an article that might not be what they consider their ideal article but something both find acceptable. Thanks for mentioning on CLINMED. The poll is not closed; if anyone would like to particpate they are most welcome. Sarah 11:43, 6 January 2007 (UTC)

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(moved my comments here after re-reading what Sarah said): Since the early 1990s, a number of systemic reviews have examined studies concerning links between silicone gel breast implants and systemic diseases. Does "systemic reviews" mean a way of reviewing the data, or reviews of "systemic illness-reports"?

Thousands of women still claim that they have become ill from their implants. Can we add Dr Carter's source here? Complaints include neurological and rheumatological problems. Peer-reviewed studies suggest that subjective and objective symptoms of many women with implants improve when their implants are removed. [18] Space between fullstop and link remove

As studies have followed women with implants for a longer period of time, more data are available... I know data can be both plural and singular, but don't we normally say "data is"? Just wondering, I wouldn't change it unless someone agreed. "Data are" sounds rare/older style to me though.
...but were "significantly more likely" to report "fatigue", "Raynaud-like symptoms... even though there's a brief expl, I wouldn't mind a link to Raynaud's just out of interest.

Note, I just looked back at an old history, and I like Dr Oliver's chart, it's a quick and easy skim (if it were readable). Charts are supposed to show "redundant" info, info that's already in paragraph from somewhere else. If Dr Oliver could make this a .png instead of a .jpg (apparently you can resize .png's because they're vectored?), could it go back into the article (I dunno the correctness of the numbers, and it's only one manufacturer, but I thought it's nice to have a list of probability of complications and which type somewhere in the article). Dikke poes 15:02, 6 January 2007 (UTC)

The chart to which you refer is very long, and biased. The summaries are cherry-picked, without information about the whole summaries included in the reports and studies. The consensus (twice) was to delete it. Jance 22:37, 6 January 2007 (UTC)

And the correct grammar is "data are". "Datum" is the singular.Jance 01:37, 7 January 2007 (UTC)

Straw poll

The last version by User:71.8.78.88 [3]

• In no way does that version reflect a truly accurate discussion. There has yet to be a case made that the current verion hasn't already addressed the complications accurately and attempts at original research reimaginations of the literature in particular are innacurate & not representativeDroliver 14:53, 3 January 2007 (UTC)

I think you posted in the wrong section, Oliver. And again, Dr Zuckerman's version is both accurate and representative - as a woman, I surely would want to know this information!Jance 15:59, 3 January 2007 (UTC)

The last version by Dr Zuckerman on December 28 [4]

• Yes, please. This seems to be the most neutral, yet informative posting for women. LynnMB 21:34, 2 January 2007 (UTC)
• I vote for this version, because I believe that it provides the most neutral point of view. GUHealth 21:50, 2 January 2007 (UTC)
• I vote that Wik keeps this version too. DrCarter12 22:04, 2 January 2007 (UTC)
• I also think this is the more accurate and neutral version.Jance 23:44, 2 January 2007 (UTC)
• This is a nice surprise. Of course, I also support my last version as the one to be protected, so that we can work together toward compromise. Thanks to Sarah for asking for this straw poll. Drzuckerman 01:23, 3 January 2007 (UTC)
• As a plastic surgeon who specializes in removal of implants, and not wishing to get into another ridiculous debate, I would strongly support Dr Zuckermans' version which seems to be the most balanced. Dr Melmed — Preceding unsigned comment added by 68.95.131.197 (talk • contribs) 04:24, 3 January 2007 (UTC)
• My comments below (starting with "EDIT oops") withstanding, I do find the Zuckerman version an acceptable base. Dikke poes 14:27, 3 January 2007 (UTC)
• I just read the current article and also think it's one-sided. The Zuckerman version appears much more balanced and accurate. OBOS Editor 21:02, 3 January 2007 (UTC)
• I also find this version much more fair. Owen 19:12, 6 January 2007 (UTC)

A different version (please specify)

The last version by Nakamomita [5]

I had made adjustments to the structure of the article which I would like to see implemented (which was reverted because I didn't see I needed to get a straw vote before making changes. I apologize for that). I think that "Procedure" and "Recovery" should be part of the article. In addition, "Incision type", "Type of Implants", and "Implant Pocket Placement" are variables that should be listed under "Procedures". The current structure lists "Incision Type" and "Implant Pocket Placement" under "Systemic illness and disease" which is very odd. I would like to make those changes without affecting other parts of the article--hopefully avoiding any controversy while improving the structure. Thank you. Nakomomita 07:25, 27 February 2007 (UTC)

Content issues

Please add to this list and we can start trying to resolve them.

• What is the source for thousands of women?

I suspect that the existing editors thought it was common knowledge (the actual number is probably higher than 'thousands'). I am sure someone can find a source, however, and it is reasonable to ask. Jance 22:10, 3 January 2007 (UTC)

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Jance, this item may be helpful in answering your question. I also provided my source for the information. Between Jan. 1, 1985, and Sept. 17, 1996, FDA received 103,343 adverse reaction reports associated with silicone breast implants and 23,454 reports involving the saline implants. Because these figures come from all databases, there may be a few duplicate reports. The reports included risks clearly associated with the devices, as well as adverse effects attributed to the implants, but not proved to be linked to them. Therefore it was reasonable to generalize the figure to "tens of thousands." Source: A Status Report on Breast Implant Safety, by the US FDA: http://www.fda.gov/fdac/features/995_implants.html Thanks. DrCarter12 21:05, 4 January 2007 (UTC)

Thank you, DrCarter. This should be a good resource. Jance 22:33, 4 January 2007 (UTC)

Awesome++, Dr Carter. This is exactly what we needed! Dikke poes 14:35, 6 January 2007 (UTC)

Thanks Dr Carter - good catch for the reference and I agree with the conclusion of the likely number of events reported. However your markup above needs tweaking, in as much that the last sentance in bold is not in that article, but instead was your sensible comment on the quote (it should be in plain text and after the sourcing information) :-) With the article currently protected, I'll await further comment before transfering over the full citation template markup:

Segal M (March 1997). "A Status Report on Breast Implant Safety". FDA. Retrieved 2007-01-07.

Although stating the obvious, I am fine with it.Jance 01:35, 7 January 2007 (UTC)

Straw poll

I've restored Dr Zuckerman's last edit as a result of the above straw poll. I just want to say something about the poll and how I have viewed it. There have been allegations made here on the talk page of meatpuppetry, and privately concerns of sockpuppetry were raised with me. I never saw this as a vote and anyone running sockpuppets has wasted their time. I considered the polled in terms of an AFD and looked at actual comments and credibility, rather than pure numbers. I won't point out specific accounts that I discounted, but there were some who I completely ignored. If someone had made a cogent argument against either version, that would have held far more weight than people who just signed their names. Also, this is not an endorsement of the Dr Zuckerman version. This is just a starting base. Now it's time to move forward with editing and I encourage people to start nominating under the "Content issues" section above issues they have with the actual content, including information that may need to be added, merged, removed, edited, verified etc. Sarah 11:31, 6 January 2007 (UTC)

Addit: The straw poll is still open. If people wish to comment in general or in support of a particular version, they are most welcome. Sarah 11:47, 6 January 2007 (UTC)

Small Revisions to the systemic disease section

1. In response to Dikke's suggestion, I agree that we need to explain CTD (connective tissue disease) when it is first used in the systemic disease section. A good way to do this is to insert in the previous paragraph on fibromyalgia that the study found a significant increase in "fibromyalgia and several other autoimmune and connective tissue diseases (CTDs)" That is an accurate statement and kills 2 birds with one stone by explaining the overlap between CTDs and autoimmune diseases, which is good since both terms have been used in the article.

2. And, in response to Dr Carter's suggestion, and Dikke's concurrence, I would support Sarah inserting the article that Dr Carter cited as a reference for "Tens of thousands of women" claim that they have become ill from their implants." The source is: A Status Report on Breast Implant Safety, by the US FDA: http://www.fda.gov/fdac/features/995_implants.html

3. It looks like Sarah fixed most of the typos that Dikke suggested, and his major substantive change in this section. Thanks to Sarah and everyone for working together on this. Drzuckerman 20:23, 7 January 2007 (UTC)

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Hi, I voted earlier but I should probably introduce myself. I am one of the editors of Our Bodies Ourselves, a book on women's health issues that has been translated into 19 languages and is currently in its 8th printing. Breast implants is one of the topics in our book. I agree with Dr Zuckerman's comments above for the systemic disease section:

1. I agree that it should be added that "fibroymyalgia and several other autoimmune and connective tissue diseases (CTDs)"
2. Changing "Thousands of women still claim..." to "Tens of thousands of women claim that they have become ill from their implants" and then use the citation that Dr Carter gave above. (A Status Report on Breast Implant Safety, by the US FDA: http://www.fda.gov/fdac/features/995_implants.html)
OBOS Editor 16:17, 11 January 2007 (UTC)

This article needs pictures.

systemic disease section

The references to recent studies were worded to accurately reflect the conclusions of those studies, in particular the Danish long-term follow up studies [PMID 14676691] & [PMID 15220596] which clearly concluded the opposite of what was impliedDroliver 04:21, 11 February 2007 (UTC)

Huh? Can you rephrase that? Dikke poes 18:25, 11 February 2007 (UTC)

It seems what Dr Oliver wants to do is make sure the Wikipedia article correctly cites the conclusions of the papers in question. It would be wrong to take the paper's data and draw conclusions from it that the paper itself does not draw. That would be tantamount to original research and prohibited by Wikipedia policy.

May I suggest that the references are actually cited with their full academic references rather than just by PubMed URL. This makes it easier to see who the authors are, when it was published, and in which journal. JFW | T@lk 21:55, 11 February 2007 (UTC)

• JFD, the oft cited pair of articles & their Medline synopsis are linked up to their PMID's to review what the papers actually conclude. There is little ambiguity I'd submit as compared to what was being suggested prior:

"Self-reported musculoskeletal symptoms among Danish women with cosmetic breast implant." Kjoller K, et al Ann Plast Surg. 2004 Jan;52(1):1-7 [PMID 14676691]

"Long-term health status of Danish women with silicone breast implants." Breiting VB, et al Plast Reconstr Surg. 2004 Jul;114(1):217-26 [PMID 15220596]

Droliver 00:01, 13 February 2007 (UTC)

I did not write that particular section, but I did read the studies. The section was correct as written, and the article was not misquoted or misrepresented. A number of editors have read the article and agreed with the way it was described. The full academic reference is important to cite. Droliver has continuously claimed misrepresentation and it is getting old. And Dikke poes, I urge you to read the article, and then ask if it is incorrectly represented. I disagree wtih the assessment that Oliver wants to make sure the articles are correctly cited. I have found way to many instances of "mistakes" to accept that. Jance 07:08, 13 February 2007 (UTC)

Jance, sure, I'll give it a look (give me a few days, I hope to have it done by weekend). BTW, you removed a pic of a three table-sitting silicone implants because they were in the saline section (in History I can see they were originally called saline implants, which may be why the pic was there). Can you re-add that, but put it under the into for silicone? (Or even top paragraph of article.) No, I don't mean the other one you deleted :) That one was ew. Dikke poes 06:50, 14 February 2007 (UTC)

Dikke, would you mind? I will, but am rushing right now. Am swamped. But it's fine with me. The other one is back, and shouldn't be. I have to run now....Jance 21:40, 15 February 2007 (UTC)

Balance needs to be restored

I had taken a few weeks off this page and was sorry to see that the language that Samir and numerous other administrators and health experts had agreed to had been changed. The article is noticeably less balanced as a result.

Most notably, in the systemic disease section, even the Danish studies paid for by Dow Corning concluded that there were significant increases in auto-immune SYMPTOMS for women with implants. There were no significant increases in diseases, however. Both symptoms and diseases are important issues and that information should not have been deleted. Several editors and administrators had agreed to that compromise language. So, I restored it and will ask the administrators for help. It should not be changed again until we hear from the many editors who have read the research literature on this.

The section on the benefits of augmentation surgery had also been edited in a way that was not reflective of the most recent studies. If one reads Dr David Sarwer's research (which is widely quoted by plastic surgeons) one sees his greater concern and data supporting an increase in body dysmorphic disorder among patients, rather than other problems such low self-esteem that were emphasized in this article. So, I added that information, as well as his study showing that the benefits are quite specific to the breasts, and not to improvements in general self-confidence or self-esteem.

The longest-term studies on self-esteem etc, which are 3-4-year studies, clearly show a no improvement on most mental health and quality of life measures, and Inamed even reported a decreased confidence on a well-established self-concept scale. So, obviously this article should reflect those better designed studies. There can be no accusation of bias against implants in these findings, since the companies include the information in their patient booklets (see "Important Information for Women About Breast Augmentation with Inamed Silicone Gel-Filled Implants." Available at http://www.fda.gov/cdrh/pdf2/P020056d.pdf ) Drzuckerman 16:21, 15 February 2007 (UTC)

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I have been away from the site for a while. Many unfortunate changes have ensued. For example, the new picture at the start of the article, what scientific purpose does it serve? Secondly, the article now appears to be less evidence based (with scholarly references) and less neutral. I too thought, along with Dr. Zuckerman, that we were not going to make such generalized deletions. I was under the impression that we agreed to let the editors do their job in a step wise, consensus provoking matter. DrCarter12 19:16, 15 February 2007 (UTC)

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I'm an editor for the women's health reference book, "Our Bodies, Ourselves" (often called the "bible" of women's health), and my organization has been following breast implant research studies and findings for years. I agree that Dr. Zuckerman’s explanations of systemic diseases and benefits are more neutral and balanced than the previous version. OBOS Editor 16:19, 21 February 2007 (UTC)

• • Please point to any major health organization in the world suggesting associations of silicone implants to systemic disease. There aren't any. Four of the standard textbooks in Plastic Surgery published 2006 editions, each of which summarized this issue similarly. The positions of every health ministry in the world are similar and easy to demonstrate. Likewise every large study published in the literature has demonstrated similar findings. If we're to have an accurate portrayal of this topic it starts and ends with what we actually know about this. There have been position papers in 2006 from Canada, the US-FDA, and the UK/E.U reaffirming the same view as well. Still maintaining that accuracy/neutrality is lacking flies in the face of this broad consensus. Droliver 03:25, 22 February 2007 (UTC)

• • I remind Droliver and other editors that changes must be voted on in this discusion page. You can't just change things because you disagree. Dr Carter and several other editors have agreed with the revisons I had made, and also have pointed out that there are other major sources of medical information that are considered less biased than plastic surgery textbooks. I just talked to an editor of JAMA about this, and he agreed that studies that include women with implants (of any type) for "at least one day" or "at least one month" are not appropriately designed to determine safety. Drzuckerman

• I think you misunderstand the process Diane. Accuracy, particularly in medicine/science entry isn't something "voted" upon, particularly by a number of anonymous single-issue editors. You can make your contrarian arguments, but at the end of the day an encylopedia is not an advocate, but rather a reflection. There is not one health ministry, professional organization, or medical textbook supporting the implications you keep pushing about this topic. It's beyond ridiculous of you to suggest that every current plastic surgery textbook is biased de novo when that is the logical starting point for review of any subject. Droliver 21:17, 24 February 2007 (UTC)

Single Studies are not conclusive

Dr Oliver has pointed out that if one study shows a significant relationship between breast implants and health problems, such as the Brown study of rupture and fibromyalgia, that doesn't prove that implants cause problems. Similarly, it is not appropriate to quote single studies suggesting various cures for capsular contracture when there is no general agreement on prevention or treatment because there are no conclusive studies. I deleted a few of the most egregious examples that had been inserted without consensus on this page. I seek comments about some of the other ones in the capsular contracture section. Do these articles represent any kind of scientific consensus? And if so, why aren't all plastic surgeons following their advice? Drzuckerman 04:57, 24 February 2007 (UTC)

• I'm curious re. your issue with the capsular contracture section. It is reflective of many of the techniques and ideas re. both pathophysiology and treatment that we commonly discuss in our literature and professional meetings. As someone who actually treats this, I can tell you that your off base with your implication re. the relevence
• In point of fact re. the Brown study you mention suggested a protective effect from intracapsular rupture and when the study is grouped appropriately, no difference is found. Brown suggested an implausible conclusion based on their own data & this is pointed out in a number of articles that subsequently look at this issue. At least half a dozen large series have also not substantiated the Brown findings and the FDA implant homepage specifically mentions it as not being corroborated as well.Droliver 21:17, 24 February 2007 (UTC)

Single studies may not be worthwhile including, but that depends on the individual merits of that study. On pulmonary embolism I've just included the one study that investigated thrombolysis in haemodynamically unstable pulmonary embolism, even though it included only 8 patients and has not been replicated (PMID 10608028). That is because that study is widely regarded as the evidence base for a life-saving treatment. Conversely, if particular studies on capsular contracture are small/non-replicated but are heavily cited, regarded as important and reliable by the field etc then there should be no grounds to delete it from the article. JFW | T@lk 10:21, 25 February 2007 (UTC)

Question...

I know it doesnt relate much to the article, I will try my best to make sure it does. I dont know where else to ask! Can short/petite women get breast implants? I am short and I was wondering if it will be possible for me to get the size of implants I want. I'm around 5'0 tall, an inch or two shorter. Maybe this could possibly be added to the article? If not, I guess I just wanted to know since I dont know where else to ask. --67.185.26.89 08:19, 25 February 2007 (UTC)

Why would that be a problem? This should only really be added to the article if there is a documented record of shorter women having problems finding a suitable surgeon/implant. JFW | T@lk 10:21, 25 February 2007 (UTC)

Curbside consult here: There's a school of thought re. implant sizing that the base-width of your breast (plus analyzing soft tissue coverage)is the proper way to size implants. This tends to use smaller implants then many patients think they would want but clearly looks like it can reduce reoperations, mostly due to not putting as heavy an implant in. This was particularly true with bigger saline implants (which are heavier per volume unit then silicone) which "bottom out" with regularity. Bigger implants will also end up being wider which can leave a bulging breast lateral to your chest wall which is not very aesthetic. Smaller implants will serve you better with longer lasting results which is what I think should be the endpoint. I touched on this a year ago in my blog if you're interested [6]

Droliver 19:14, 25 February 2007 (UTC)

Ok, because I had heard from SEVERAL people (not surgeons or anything) that because small people have smaller bodies and less room, they cant get big implants. --67.185.26.89 21:47, 27 February 2007 (UTC)

• Again, respecting your existing anatomy is important to minimizing uneccessary reoperations. Large implants do not hold up well over time.Droliver 23:30, 1 March 2007 (UTC)

I'm curious. Dr Oliver, is this a very common question from patients/interested people? Do you think body-size should be mentioned in the article? Dikke poes 15:16, 28 February 2007 (UTC)

• no, I don't think body-size is really something that is of much importance to an overview entry. We discuss things like that a great deal during in professional discussions, but it's a little too much "inside baseball" for thisDroliver 23:30, 1 March 2007 (UTC)

This is not the place for medical advice

This is NOT the place for plastic surgery advice to potential patients, either in the article or in the discussion section

Drzuckerman

1)I definitely agree that this is not the place to give people personal advice regarding surgical options. 2)I know that there is no causal evidence that links silicone breast implants with collagen vascular disease. But how do we explain how patients generally feel better after having their implants removed? I think there are a lot of questions still needing to be answered Dr. Oliver before you can just write this occurrence off as not having any possible association. DrCarter12 16:09, 26 February 2007 (UTC)

Dr Zuckerman: this is in reference to a general enquiry. Obviously specific advice was not given; Dr Oliver was explaining what his professional approach would be to smaller people. Are you enraged that he is doing that? Who says this anonymous user is a "potential patient"? It is correct that Wikipedia is not for personal medical advice, and people soliciting this should be referred to their own physicians.

DrCarter12: obviously, if someone attributes being ill to having breast implants then removing these will have a substantial placebo effect. The problem is that neither "feeling ill" nor recovering from this is measurable objectively like urea & creatinine are in renal failure. If the Institute of Medicine in a 560 page report cannot give this answer, it would be ludicrous to expect an individual plastic surgeon to provide this. By the way, I see that most of your work on Wikipedia is on this very talkpage. Have you got any other clinical interests? JFW | T@lk 18:19, 26 February 2007 (UTC)

I did write some material on exercise induced asthma- but it was edited out because someone felt that the information was covered under another heading. I have not had the opportunity to read the article again to see where I may contribute. DrCarter12 17:24, 28 February 2007 (UTC)

I am a communications professional who has worked with health and women’s issues, and I have been following this discussion for a while now. This is my first time weighing in. It’s clear that Dr. Oliver is a plastic surgeon with a positive POV about breast implants. He seems to delete a lot of things from the entry -- even solid scientific research -- that would make a reader think hard or even twice about the advisability of the procedure as a cosmetic enhancement. Now, a random question has been entered by a potential breast-implant recipient who basically asks, because of her small size, whether or not she could get the procedure, and if so, whether it could be done with bigger rather than smaller implants. Dr. Oliver skips over the first question and answers the second in a very reassuring way, with the subtext being, “Yes, get implants.” I don’t know if his response could be considered a “curbside consult,” since it basically encourages the woman to pursue her desire without any caution about potential risks, which responsible doctors do. But “curbside consult” or not, his answer is inherently biased, so it has no place in this discussion, which, anyway, is about the breast implants ENTRY. In the future, such random questions should be ignored or, at the very most, the questioner directed to a physician who could review her medical history. WrdFox 00:18, 27 February 2007 (UTC) WrdFox

• What a strange way to interpret the question & my response to it. While the discussion page of wikipedia is not a way I'd encourage getting personalized medical advice, a generalized mention of the single most effective way to avoid complications from elective breast augmentation (if you choose to have it) is pretty much a non-issue. My POV with this sticks to what is mainstream and broadly agreed upon international treatment of this topicDroliver 23:38, 1 March 2007 (UTC)

Ok. You have it ALL wrong. First off, I realize my question was a little off-topic, but where else was I supposed to ask it? I figured if someone felt they could answer it and help me, great, if not, they could simply ignore it. I also thought people wouldnt make such a big deal over it and just delete it after I got help. Not fuss over it!

I was also thinking that if small people could not get large implants, this would be a reasonable add to the article. Why not TELL small people that bigger implants wont last longer for them? I STILL, as of right now, DONT have an answer as to whether or not small people CAN, or can NOT, get large implants. And if they can NOT, I personally think this should be put in the article. I wasnt creating any controversy over this. Or at least I didnt mean to. I thought people would, you know, answer if they wanted to or ignore it, not create an argument about the one person who answered, regardless of whether or not it was a helpful answer--which it wasnt, really...but oh well. And oh yeah, I forgot--I was NOT asking for medical advice! Advice is a recommendation. I was asking if something was POSSIBLE, not 'should I do this'. I'm getting implants whether the world likes it or not, but I was ASKING if it is POSSIBLE to go up to the size I want--a C or D cup. Not SHOULD I, CAN I. There IS a difference. I'm not trying to sound rude, please believe me, I just dont want you all thinking I came to cause trouble. =)--67.185.26.89 06:26, 10 March 2007 (UTC)

This is the place for straw polls BEFORE changes to the article

And, the 2 administrators, Dr Ruben and Sarah Ewart, both warned that no changes should be made to the article without a straw poll. DrOliver, you should not be changing the article when your changes are specifically opposed by other editors (see above).

Lastly, does anyone think the intro to this article should say that using breast implants to enlarge the breasts is called "breast enlargement"? One would think that is obvious, therefore it was deleted. Why was it put back in?

I added "breast enlargement" several days ago. Unlike merely descriptive terms like "making the breast larger" or "breast enhancement", the phrase "breast enlargement" is terminology that is often times used instead of "breast augmentation". Likewise, it would also be considered "obvious" then to say that breast implants used to augment the breast is called "breast augmentation". I think it should be put back in. Nakomomita 07:12, 27 February 2007 (UTC)

I just noticed that the talk page already shows what I mean. On this talk page, Ty580 has a post "Stem cell breast enlargement treatment." Nakomomita 07:30, 27 February 2007 (UTC)

I agree that the treatment of capsular contracture is relevant, but we should not be adding information that is not fully supported by research. I agree with JFW that there are situations where a small clnical trial is very important. However, the capsular contracture articles that had been cited were "studies" of one or a few doctors' experiences -- they were not clinical trials. The gold standard treatment for capsular contracture is still removal of the capsule.

In our previous discussion, Droliver has said that the Brown et al study (paid for by the FDA and conducted by researchers at FDA and several medical schools) is just a single study (which happens to show that women with extracapsular silicone leakage are significantly more likely to have several autoimmune diseases)and therefore not worthy of inclusion. The Brown study is a peer-reviewed study that is unique because it is independent (no financial ties to implant makers or plastic surgeons), included women with implants for a very long period of time, and measured extracapsular silicone leakage with MRIs that were read by several experts. There are no other studies of autoimmune diseases that have those methodological strengths.Drzuckerman 19:41, 25 February 2007 (UTC)

If the Brown study has not been replicated by other investigators then it may not be notable individually. If no other work has been done at all (which would surprise me), then the Brown study could be presented as a puzzle. If its design is unique from all other trials then its results may not be generalisable and a larger trial along the same lines may be required to settle the issue.

I disagree that Dr Oliver is not allowed to make edits at all, even if they are slightly controversial. The straw poll was quite specific in its conclusion, and not all his edits have been in contradiction to this conclusion. JFW | T@lk 18:23, 26 February 2007 (UTC)

JFW, The Brown study was/is notable but has indeed not been duplicated in a number of much larger related studies. When you actually look at that study, what you see is both an usual way of grouping patients (intact/intracapsular rupture vs extracapsular, rather then 3 groups) that exagerated rates of fibromyalgia and the implausible suggestion that women with intracapsular rupture had fibromyalgia rates substantially lower (8.0%) than women with intact implants (14.8%). These irregularities have been discussed in several subsequent papers and commented upon by the FDA in it's consumer handbook. A 2004 review of the literature of the papers up to that point by Lipworth,et al [PMID 15156983] comments on a number of these which I can email to you if you like. Additionally an updated long term Danish study that is most comprehensive in follow up going to print this month confirms findings reported in 2001 re lack of correlation to [PMID 17321754]Droliver 00:30, 2 March 2007 (UTC)

JFK, who determines how controversial a potential edit is? What is non-controversial to one side could be totally beyond belief for the other. The bottom line is, this entry has been so contentious that it had to be locked. Obviously, both sides are ultra-sensitive about the biases of the other side. That’s why, to maintain a level of stability in this entry (so that is can serve in some capacity as a reference for the general public), ground rules are important. If one of the ground rules is to submit potential changes to a straw poll, then it should be followed to the letter. WrdFox 00:21, 27 February 2007 (UTC) WrdFox

WrdFox, with due respect, I'm a bit hesitant to enter into a long discussion with a new editor who has immediately come to this page to choose sides. Have you been asked by anyone to do this? JFW | T@lk 07:15, 2 March 2007 (UTC)

What I see is, when everyone did the poll, Dr Oliver didn't say anything. He clearly disagreed with the result, though. So far, nothing on the talk page has been study-specific. Maybe that's what we need. Dr Wolff seems to be the only one really getting into what the studies actually say. That seems to be Dr oliver's contentious point. So we need to show 1)whether there are more implant/rheumatoid linkage studies besides Brown, and what were the results 2)what exactly Brown and the other 2 studies (reff'd further up the talk page here) actually say in their conclusions.

I'd promised jance I'd take a look myself, but work started to really steal time (computer time). I still hope to try.

And do we really need a "straw poll" before every edit? I'd rather the facts of the aformentioned studies get sorted out here before more edits that touch on them, but hey, I did a bunch of edits a while back and didn't straw any polls.

Also, I don't see Oliver saying small women shouldn't get huge new boobs as "medical advice." It's not like it's on the Wikipedia article page anyway. Dikke poes 15:28, 28 February 2007 (UTC)

Dikke, I and Dr Z have made references to various studies on the talk page.DrCarter12 17:26, 28 February 2007 (UTC)

Dikke, for the people with casual experience with this topic who are trying to make sense of this I would suggest asking several things.

• 1 - What have the major international reviews of silicone implants concluded?
• 2 - What do contemporary medical & plastic surgery texts say about breast implants?
• 3 - How are these devices treated by different countries' health ministries?
• 4 - What topics and issues are being discussed in professional meetings?

The answers to the first three are pretty easy to demonstrate in print & having sat all morning in one of the major surgery symposiums today on this, I can tell you the answer to the last agrees with the others. Breast implants have been called by US-FDA officials as the most scrutinized medical device in history and there is a large body of work to point to. A number of sequential expert panels have periodically reviewed this literature en bloc and have repeatedly failed to confirm some of the implications that continue to be highlighted here by several editors. Repeating such a "science trial" in the talk page of Wikipedia is beyond the scope of what's practical, which is again why I refer people to the mainstream of medical/scientific/governemental positions. Droliver 00:09, 2 March 2007 (UTC)

We cannot deny that the allegation has been made. My solution for the whole problem is:

• List the initial reports that led to the banning of silicon implants.
• List the IOM/other reports that have unnerved these allegations.
• List which organisations are nevertheless of the opinion that there is a problem. If these views are not backed by organisations, they probably fall below the notability horizon. JFW | T@lk 07:15, 2 March 2007 (UTC)

Stem cell breast enlargement treatment

"Stem cell technique helps women grow their own implants", the Daily Mail, 12th February 2007. --Ty580 15:48, 26 February 2007 (UTC)

This isn't really ready for prime time yet & premature to include in an encyclopedic entry IMODroliver 01:56, 2 March 2007 (UTC)

Standards for wikipedia

My entries directly quote from the peer-reviewed literature as well as government regulatory agencies. I have repeatedly balanced the article with all sides of the controversy. In contrast, droliver's revisions only focus on the most "pro-implant" statements, which generally point to the lack of conclusive evidence for specific systemic diseases. However, the same people and agencies that droliver likes to use as experts ALSO clearly state that there are high complication rates and problems associated with breast implants.

The versions of this article that I have supported tell both sides of the story. The versions that droliver prefers are one-sided POV of plastic surgeons. Numerous other editors, including physicians, an editor of an international health reference book, and others have agreed with me, disagreed with droliver, but he just ignores them.

I am directly quoting many of the same references that droliver uses, but if I use quotes that he disagrees with, he deletes them. The issue is not who we are quoting, but whether we include both sides of the controversy. I'd be glad to show exactly what I mean if JFW or dikke are interested. Drzuckerman 16:33, 3 March 2007 (UTC)

Straw Poll for Changes

As requested by Administrators, we will once again do a straw poll.

Systemic Diseases

We already did one on the section on systemic diseases, and droliver's version was rejected just a few weeks ago, and again about a week ago. So, neither droliver nor JGWolff should be reverting to that version, unless they can muster enough votes from regular editors to this article to support such a change. Drzuckerman 05:34, 6 March 2007 (UTC)

Patient Characteristics

droliver's version of the "Patient Characteristics" section is not accurate. For example, Dr. David Sarwer is cited in a 2003 article, but his more recent articles specify that women undergoing breast augmentation are similar to other women in terms of self-esteem, depression, etc. There is no evidence that they are more likely to kill themselves before they had surgery.

There is only one study showing women choosing augmentation were more likely to have a psychiatric history. That was in a country where women could get free augmentation surgery if they had a medical history showing they needed augmentation for psychiatric reasons. So -- surprise!! -- the women got the psychiatric history they needed to get free augmentation.

There is a growing body of literature indicating that when objective pre/post measures are used, breast augmentation does not improve self-esteem or quality of life, even in the short-term. I have cited those articles and can cite more if anyone thinks that is necessary. Meanwhile, I welcome your votes on this issue. Drzuckerman MRIs

droliver's statement about MRIs not being required in other countries is misleading. He cites a 2005 article. However, the implant manufacturers did not specify the need for MRIs until 2006. That is now in the implant companies' official labels. Votes welcome on whether a 2006 decision by the implant companies to warn women that they need MRIs trumps an older summary article. Drzuckerman

You cannot possibly revert on the basis of a new straw poll that nobody has yet voted in, as you have done today! The previous straw poll was a while ago and cannot inform your recent actions. You are simply asking for an RFC.

My advice, Drzuckerman, consists of the following. Please disagree with it as you wish, but I've dealt with these situations before.

1. Stop reverting. If you don't like particular content, remove it in individual edits given ample reasons. Just stating that Droliver makes "POV edits" is not a valid reason; every edit needs to be challenged individually.
2. Start discussing. If you want other editors to support you in your quest to make this article WP:NPOV and WP:ATT, please make it your habit to precede every planned major edit with a post on the talkpage. It may actually be wise to wait for other editors to support you (or disagree with you).
3. Accept that other editors will have an alternative viewpoint from you, and that you need their support if you ever want this article to reflect all views.

Let me make this clear: your serial reverting is not the way forward. JFW | T@lk 21:06, 6 March 2007 (UTC)

• Dr. Zuckerman, as you know there is a well & often cited establish body of literature in re. to issues about patient charcteristics and the like. You seem to be trying to reinvent this in a way not consistent with how this is treated by mainstream reference sources. We have data (of varying quality) which has been fairly consistant in characterizing cosmetic surgery patients (as a cohort) as having higher psychopathologic rates as well as a number of surveys on patients specific to breast surgery. I'm not sure what exactly you're trying to achieve with your edits?Droliver 17:41, 7 March 2007 (UTC)

• Getting back to the point above, Dr Zuckerman is asking for a straw poll vote, which is what the administrators requested. So in respects to that, I do think that her version is more accurate. OBOS Editor 20:53, 8 March 2007 (UTC)

Also, I believe that Dr Oliver's section on systemic diseases is biased--note that he deleted direct quotations indicating statistically significant increases in autoimmune symptoms even from the EXACT SAME authors he cited. In other words, if an article showed an increase in symptoms but not in diagnosis, he cites the part about diagnosis but NOT the part about the significant increase in symptoms. Since symptoms often precede diagnoses, this is biased. There isn't a reason to delete this (that is, unless you want to make it sound like implants are safer than they are). 71.124.137.236 21:01, 8 March 2007 (UTC) --(Whoops, that was me)OBOS Editor 21:03, 8 March 2007 (UTC)

Which administrator asked for a straw poll? I am an administrator, and I think Drzuckerman should follow my advice above. There are no "good and bad versions". There are versions that need work. JFW | T@lk 23:27, 8 March 2007 (UTC)

Why is the section biased? Would you say the Institute of Medicine is biased? The whole reason they were asked to comment is because they are not biased. JFW | T@lk 23:28, 8 March 2007 (UTC)

And what on earth are "autoimmune symptoms"? JFW | T@lk 23:31, 8 March 2007 (UTC)

When you speak of administrators requesting or "demanding", as some people have said, a straw poll, if you are refering to me, you are mistaken. I have not requested any straw polls other than the one I conducted myself and I have no opinion regarding the straw poll currently being requested. I also want to note that I endorse Dr Wolff's comment that serial reverting is not acceptable and it needs to stop immediately. I support discussion of edits and examination of the literature but I certainly do not support edit warring from either side or the use of straw polls to retard development of this article. Sarah 09:59, 10 March 2007 (UTC)

• JFD,I agree. The whole notion that some international conspiracy exists that has co-opted the body of literature ans surgery journals, the medical textbook industry, multiple independent systemic review panels, and the health ministries of every industrialized nation on earth relating to this is ridiculous. The argument supporting links to illness at this time is a distinct "counter-culture" movement & is worthy of mention, but clearly in the context of how widely embraced it is. I think the current descriptor in the article is fair
• OBOS,the several dozen subjective symptoms that fall under the grab-bag of rheumatologic indicators are not diseases in and of themselves. What we've seen over and over again is the distinct lack of any identifiable pattern or increased frequency re. these symptoms which is what the long-term Scandanavian studies again reported. This conclusion is echoed in each and every major review of this topic. To suggest that these papers and the related literature in fact support what you're implying is wholesale reinterpretation of those papers as well as misunderstanding rheumatology diagnosis and disease.Droliver 01:43, 9 March 2007 (UTC)

DrCarter speaks

I voiced this opinion before about the picture of breasts that had undergone augmetation in the front of the article. I am still wondering what purpose it serves other than the obvious. However, I don't believe that the picture adds to the discussion. There is a concern that women who are going for any plastic surgery may have psychiatric issues before undergoing the procedure. PMID 16777929

I vote for the serial MRIs. Whether there is evidence that links silicone breast implant leakage to CTDs. The seepage of silicone into the body does cause local inflammation and pain. It is also dificult to remove from tissue once the leak has occurred. This leakage is not clinically detectable so can go on for years until symptoms encourage diagnostic studies. Possibly with performing regular MRIs we can diagnose this potential problem early.DrCarter12 16:34, 6 March 2007 (UTC)

Is that supported by evidence, guidelines? JFW | T@lk 21:06, 6 March 2007 (UTC)

JFW, routine serial MRI's have been endorsed by no one except the USFDA. Health Canada specifically mentioned they felt it was not evidence based medicine just one month prior to American approval, a reflection of the unique American political history with these devices. Standard recomendations for the rest of the world would be along the lines of screening on a clinical exam basis and doing ultrasound prior to MRI if rupture is suspectedDroliver 02:27, 7 March 2007 (UTC)

Misunderstandings

I am very concerned by some apparent misunderstandings and misrepresentations of what I and other administrators have said.

"And, the 2 administrators, Dr Ruben and Sarah Ewart, both warned that no changes should be made to the article without a straw poll."

I have never said that no changes should be made without a straw poll. That is certainly not my position, it never has been and while I do not wish to speak for Dr Ruben, I do not believe it has ever been his position either. As I said at the time of the straw poll, I was looking for a version to use as a starting base to move forward with editing in order to stop the edit warring that was occurring between the two versions of the article. I thought I was quite clear that I did not intend the article to become locked down in that version, it was not an endorsement of that version and I certainly did not intend for that straw poll to lead to an ongoing editing process that involved straw polls for any and every change. That is not the way Wikipedia works and I believe that it is a violation of policy and Jimbo's foundation principles which mandate open editing. The straw poll was a once-off process to try to avert the edit warring. If other people wish to propose other straw polls, that is fine, but straw polls are not to be used as a strategy to prevent an editor, or a group of editors, from making edits.

I am not sure why there is some sort of suggestion that Dr Oliver is not welcome to edit or not welcome to edit controversially. I am not aware of any grounds for imposing editing restrictions on Dr Oliver and anyone who wants to impose such restrictions needs to either propose community sanctions at the noticeboard or they need to request the arbitration committee impose editing restrictions. The only things I have asked Dr Oliver to do is to respect Dr Zuckerman's request that he not refer to her by her first name and that he refrain from injecting invective into discussion. I certainly do not and have never supported editing restrictions on Dr Oliver or any other editors here. I believe his input is valuable, as is the input of editors on the opposing side, and that the most well-rounded article probably lies somewhere in the middle of both points of view.

I am currently on a wiki-break but I was very concerned that my opinions and statements are being mistakenly misrepresented. Reverting on the basis that a straw poll is needed before changes are made to the article is not acceptable. Please do not do this. Thanks, Sarah 09:47, 10 March 2007 (UTC)

Hi, I'm on a bit of a wikibreak currently, but would largely agree with Sarah. Certainly I would hope that any past comments of mine are not taken to mean that a straw poll has to be undertaken before any editing takes place (clearly silly at the level of spelling corrections). Editors are free to edit the article as they see fit - it is nolonger protected. Admins carry no real special weight in content disputes (vs perhaps how editors behave in such content disputes) other than perhaps a level of experience over a number of topics (and other disputes) that the various parties might choose to listen too (or not). All editors are free to edit this article, if an editor is thought problematic then raise a WP:RFC to discuss the perceived problems to try and reach understanding (or at least an appreciation of views). However the previous edit warring was most unpleasant and care needs be taken by everyone to try and prevent a return to mutiple sequential edits or revert-warring. So, no straw polls absolutely required, but it would seem sensible for editors to voluntarily try to discuss proposed major changes or altering tone/POV/NPOV or at least agreeing how to disagree, before rekindling the flames :-) That said there is no requirement in content discussion for straw polls, Wikipedia is not a democracy (one can be bold) likewise it is not a bureaucracy, but nor is it an anarchy :-) David Ruben ^Talk 20:31, 12 March 2007 (UTC)

Changes for accuracy

I'm truly sorry that I misunderstood the previous statements made asking for a straw poll. Nevertheless, several editors have agreed with my concerns about droliver's and jwolff's revisions, and more important, it is not appropriate for anyone to keep reverting to inaccurate information.

The revisions made by Jwolff and droliver regarding the mental health benefits of implants are inaccurate. The data clearly show that for all plastic surgery, including breast augmentation, the benefits are specific to the body part that has been changed, but not to mental health or self esteem. In fact, the most recent studies indicate that women and men with body dysmorphic disorder, many of whom undergo cosmetic surgery, do not benefit at all. Those well documented facts should not be deleted.

Similarly, there was general agreement about the risk information, and the only disagreements came from droliver, and perhaps jwolff. They are entitled to their opinions, and the current version includes much of their content, but let's make sure the article is accurate and balanced. Drzuckerman 02:50, 11 March 2007 (UTC)

• I'd submit that you are somewhat incorrect with your characterization of the research on psychosocial aspects cosmetic surgery. There are a great many papers pertaining to this, many of which have been referred to as index papers for nearly 3 decades. The tools and methods used have gotten more refined, but it doesn't really overturn a great deal of information that existed previously. Your associate colleague (Dr. David Sarwer) at the University of Pennsylvania Medical School reported only 5 years ago that their study [PMID 1178684] and that of Rankin [PMID 9811016] provide growing evidence to suggest that cosmetic surgery leads to improvements in at least 3 areas of psychological functioning: body image, quality of life and depressive symptoms. There are similar papers still going to print even more recently [PMID 16181718] and a host of related outcomes data from other plastic surgery procedures generally report similar findings. I think this is summarized fairly accurately as the paragraph concludes mentioning that some of the improvements that have been reported may in fact be transitory (at least as reflected in the USFDA implant adjuct studies). Droliver 19:19, 11 March 2007 (UTC)

Dr Oliver, I think the last paper there (PMID 16181718) hurts the case. Only 25 patients, all having cosmetic surgery, given questionaires, the last being only 4 months after the surgeries. I personally would prefer a battery of psychologocal tests a year or two after surg, with like 1000 people or so :) And you've got something wrong with the Sarwer number, it leads to mice inhaling benzine or something evil like that. The Rankin one is better. Dikke poes 15:47, 20 March 2007 (UTC)

Sorry for the PMID error, the correct one for Dr. Sarwer's article is [PMID 11786842] (which you isn't summarized for you on pubmed). The French article with 'only' 25 patients was mentioned only to illustrate the fact there continue to be similar reports to what's been reported for nearly 50 years re. psychological aspects of breast augmentation procedures. I can point you to this continuem of papers if you're interested, but it's really beating a dead horse. There's also a whole other line of research on psychologic endpoints re. breast reconstruction & reduction patients which tend to imply many of these same outcomes. Again, my takehome point is that there is a long track record of attributing positive attributes, some of which may have been overstated. I think that's communicated in the entryDroliver 02:02, 22 March 2007 (UTC)

Let's discuss compromises and avoid a edit war

JFW, I'd like to talk to you about the edits you want, and hope we can compromise. Let's discuss one at a time. For example, there is a large new literature on the association between cosmetic surgery and body dysmorphic disorder, so why do you want to delete it?

Similarly, did you want to add that women getting breast augmentation are more likely to be married with children? You listed the Brinton study, but I believe that was based on marital status an average of 12 years AFTER surgery, not at the time of surgery. If I'm wrong, and there is good data to support that addition, it's fine with me. Drzuckerman 03:21, 11 March 2007 (UTC)

You left this posting only 16 minutes before reverting again to your preferred version, insisting you had a mandate from a straw poll several weeks ago! I am not endorsing either version, but neither do I support large reversions on insufficient basis. In fact, I aim to facilitate here rather than actually choose sides. I state from the outset that while I'm probably not 100% neutral, I am one of the few remaining administrators who is committed to taking this article forward.

I was one of the editors who was supportive of inclusion of material on BDD. I support the addition of 2-3 references to large, well-constructed studies. I do not want a proliferation of 50 references on something that is rare in absolute terms.

I did not list the Brinton study, and with no access to the fulltext I cannot comment on the marital status issue. However, if the authors draw a conclusion but you disagree with that on methodological grounds, you should be writing to Plast Reconstr Surg rather than bring out this point here. This should remain strictly objective, rather than trying to characterise the recipients of breast implants (1) as nutcases, (2) as vulnerable people preyed on by a cynical industry. JFW | T@lk 08:05, 11 March 2007 (UTC)

If breast implants are succesful in getting their recipients married over a 12-year timeframe, that can surely be presented as a favourable consequence :-)? JFW | T@lk 08:07, 11 March 2007 (UTC)

• A more then passing tangent on BDD is not really specific to an entry on breast implants and is really lumped in with all other psychopathology (depression, etc..)when this has been addressed in the breast implant literature. It's more appropriately included in an entry on cosmetic plastic surgery (as a whole)where it's been estimated to exist in 10-15% of all comers. I think the take-home point re. this is well-characterized in the existing entry. Droliver 19:35, 11 March 2007 (UTC)

• Wow Jfdwolf, I hope that comment about breast implants increasing the likelihood of women marrying was just a touch of sarcasm and not your interpretation of the Brinton article. I have also recently read the article. It is difficult to draw any temporal conclusions because there is no association between when women had their implants and when they were married. I don't think Dr. Zuckerman has a problem with the article but with your interpretation of the results. I find your comments off the mark as well. Also you must keep in mind that the comparison group was other plastic surgery recipients (not having breast implants) and the actual numbers of those married or common law were 62.7% with breast implants and 56.1% with other plastic surgery. The adjusted odds raito was even 1.00 not making it any different than chance. I believe that Dr. Z presents a more thoughtful discussion of the literature. I hope that a compromise can be reached that is not representative of one view over another. DrCarter12 00:03, 12 March 2007 (UTC)

• • I thought the smiley was sufficient indication that my comment was whimsical. JFW | T@lk 15:32, 12 March 2007 (UTC)

Thanks Dr Carter, you are right about the Brinton article. It is an excellent article, but misquoted on this wiki article until I changed it. JFW, to respond to your earlier comment about the Institute of Medicine report: it was written in 1999, and only a few epidemiological studies were published at that time. Dozens have been published since, and most are longer-term and better designed than the studies quoted by IOM. However, I have quoted them on complications, and droliver has repeatedly deleted that.

Also, JFW, if you did not read the article on marital status, then why did you revert to a version that recently added that quote about their marital status?

I repeat my interest in a compromise article, discussing one revision at a time. It sounds like we have dealt with the marital status issue above, so here's a simple one.

Doesn't it seem silly to start the article with a statement that enlarging the breast is called breast enlargement? First of all, it seems silly because it is obvious. Second because the more common terms are breast augmentation and breast enhancement. I have heard from women all over the world with implants, and they all call it ba or breast augmentation.

WordFox's comments seem helpful and I don't understand why JFW dismissed them. New editors should be welcomed, let's not insult them. And, I also agree with Dikke's comments that we should go back to discussing the specific publications that support various points of view. Droliver likes to quote the "international literature" but in fact he is quoting government political/regulatory reports, not scientific or medical ones. The standards are different. In the EU, devices are approved without clinical trials and taken off the market later if conclusively shown to cause serious harm. That does not mean that they are proven safe. If we are discussing science and medicine, let's stick with peer-reviewed research findings. And discuss each revision, one by one before making it.

---

Any comments on the "breast enlargement" issue I raised above or any more on the marital status issue? Drzuckerman 14:04, 12 March 2007 (UTC)

I reverted because this is not a "battle of versions". I have stated that I do not aim to endorse either viewpoint at this stage but to stop the revert warring. You have been encouraged to make piecemeal changes after they have been adequately discussed and consensus has been reached.

The marital status issue will not be resolved unless you can achieve consensus. I have stated that I cannot comment either way without the fulltext. You seem to have DrCarter12 on your side, so let's see what Droliver thinks of this, and OBOS if she is around.

I do not support the removal of "breast enlargement" as a synonym. We use plenty of obvious synonyms, and this term is very popular here in the UK.

You did the same thing today - just revert because the present "version" is not satisfactory to you. This is not acceptable, and has in the past led to people being blocked from Wikipedia. Any further reverts along the same lines will be met with a request for comments. JFW | T@lk 15:32, 12 March 2007 (UTC)

• I'd also submit breast enlargement is fairly commonly used synonym as well for breast augmentation/implantation surgery
• There are a number of sources re. social & health characteristic of patients with implants, some of which specifically address the changes observed with current patients as compared to patient's having the surgery 20-30 years prior. I've never seen one that doesn't mention the marriage rate as being higher presently when it's been indexed, although I think this is a fairly marginal aspect of this entry to begin with. Droliver 17:28, 13 March 2007 (UTC)

•Dr Z mentioned getting a "compromise article" produced. She posed a couple of options that neither Jfdwolff or Droliver want to alter their position on. Perhaps one of you should suggest a place in the article where a consensus can be reached.DrCarter12 03:21, 15 March 2007 (UTC)

Even though it sounds redundant, I don't see reason to take "enlargement" out. I find it more specific than "augmentation" which only means change (breast reduction is also augmentation). "Enhancement" sounds POV to me because it means to make something Better-- but if it's in medical liturature then I wouldn't argue against it, but of course again enhancement doesn't always mean enlargement. For that Punky Brewster chick, her enhancement was a reduction.
Re marriage, sounds kinda trivial. Linking the two would be difficult. Perhaps women who seek implants are more traditional-minded and are more likely to marry than co-habitate? I don't see how you could find a cause-and-effect with this one, and if the numbers are trivial, I wouldn't even add it. Dikke poes 15:37, 20 March 2007 (UTC)

Compromises: #1 augment

Let me clarify what I meant about the first sentence of this article. It currently says:

A breast implant is a prosthesis used to enlarge the size of a woman's breasts(known as breast augmentation or breast enlargement).

Even though the dictionary definition of augment is to "make larger" I think the problem with the sentence is that it says that enlarging the size of a woman's breasts is known as breast enlargement. That is redundant. Breast augmentation means the same thing but at least it uses a different word.

I agree with Dikke Poes that breast reduction could be enhancement. And I also agree with Dikke Poes that enhancement certainly implies improvement, so augmentation or enlargement is a more NPOV term. The first sentence could instead say: A breast implant is a prosthesis used to increase the size of a woman's breasts (known as breast augmentation or breast enlargement).

Is there any opposition? I will wait a few days for feedback before revising it, to make sure that JFW does not object.

I also agree about the marriage issue -- I will defer to Dr Carter, who mentioned that the study did not find a significant increase in married status. Drzuckerman

Agree with version containing all synonyms. Most breast enlargements are with the use of implants. JFW | T@lk 07:06, 26 March 2007 (UTC)

Compromises # 2: Symptoms can increase even if diagnoses haven't

As several of us previously stated, the 2004 Danish study by Brieting et al specified statistically significant increases in several important autoimmune symptoms, including the unusual symptoms of Raynaud's disease. It is important to distingush between symptoms and diagnosis, because much longer term studies are needed to determine diagnoses. Symptoms can change significantly first. So that change has been made. Drzuckerman

Could you please wait until we're done discussing this?

Inserting the phrase "More research is needed" is editorialising and fails WP:NPOV.

Why are the reviews quoted "government" reviews, rather than "independent systemic (comprehensive)"? You haven't explained.

There's no such thing as "autoimmune symptoms". There are symptoms, and there's autoimmune disease. Hepatitis B and osteoarthritis are not autoimmune, yet both can cause joint pains. JFW | T@lk 07:06, 26 March 2007 (UTC)

• I agree completely with JFW. Aside from this particular study there are an avalanche of other large studies & reviews concluding the same thing (ie. no increase in AI disease). Reinterpreting the conclusion of these to imply otherwise is inconsistant with current widespread international consensus and wikipedia's no original research recomendations. Editorializing "More research is needed" and muddying the water over how AI diseases are in fact diagnosed is clearly too much innuendo. The positions of international medical,scientific, and regulatory organizations are VERY clear where they come down on this and are what should ostensibly be represented in an encyclopedic view of this.Droliver 02:33, 27 March 2007 (UTC)

• Why does DrOliver not feel that a fuller description of symptomology is valid when referring to the Danish Study? Though their diagnosis of autoimmune disorders were not more prevalent, associated symptoms as Dr. Z mentioned were. I believe that is an important thing to include in the article.DrCarter12 16:22, 28 March 2007 (UTC)
  • What you propose is in fact an end-run reinterpretation of the conclusions of this paper by tossing out an out of context part of the data. In the larger picture, the idea you're pushing is not currently accepted by any federal or medical organization in the worldDroliver 01:47, 29 March 2007 (UTC)

"Associated symptoms" is a very vague term that is best avoided. As I stated, every so-called "autoimmune symptom" has a long differential diagnosis. As stated, joint pains may be due to a large number of non-autoimmune conditions (I'll add Lyme disease, tuberculosis and infectious endocarditis for good measure).

DrCarter12, could you please start using edit summaries when editing? Your edit today may have its merits, but you should summarise what you've done, preferably without making personal attacks at other editors (as often happens in edit wars). JFW | T@lk 18:01, 28 March 2007 (UTC)

I've corrected the description of the 2004 Danish study. It is important to say that there were significant increases in symptoms of Raynauds disease, as well as fatigue, memory loss, and other autoimmune diseases, even though there was no increase in diagnoses of diseases. As we all know, symptoms tend to be noticed years before these diseases are diagnosed. Dr. Oliver’s edits make this section NPOV. OBOS Editor 19:27, 28 March 2007 (UTC)

• You have a misunderstanding of this paper and how population-based studies on rheumatology are performed and interpreted. You're trying to infer something (a relationship to disease) that is in fact not demonstrated in this paper or any of the other major popultaion study papers or comprehensive reviews. I would again point you to any number of 3rd party sources of authority which have uniformly rejected this. Droliver 01:47, 29 March 2007 (UTC)

--The OBOS editor is correct. I am an epidemiologist and I concur completely. Our Bodies Ourselves (OBOS) is a internationally cited book on women's health, translated into many languages. The OBOS editor is quoting a study funded by implant manufacturers that droliver also cited. She didn't infer causation, she merely listed statistically significant increases in symptoms that may be a sign of a causal relationship since all the other variables were statistically controlled. It's all in quotes, and droliver has repeatedly removed it. The "third party" sources mentioned by droliver are all very brief summaries of data on diagnosis of systemic disease, but they are not saying there is no evidence of symptoms -- as several of us (including Dr Carter) have stated before, that is an important distinction. 3 of us agree (a physician, women's health editor, and epidemiologist), and droliver (a plastic surgeon) disagrees. JFW I hope we can count on your help so that a compromise article can move forward. In recent weeks, droliver's changes have been kept and most other changes have been deleted. Drzuckerman