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This is an old revision of this page, as edited by Drzuckerman (talk | contribs) at 19:36, 25 February 2007 (→This is the place for straw polls BEFORE changes to the article). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

Archived discussions

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)[reply]

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)[reply]

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)[reply]

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)[reply]

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)[reply]
<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)[reply]
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)[reply]
  • 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)[reply]

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)[reply]

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)[reply]

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)[reply]

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)[reply]

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)[reply]

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

(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)[reply]

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

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)[reply]
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)[reply]

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

A different version (please specify)

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)[reply]

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)[reply]

Thank you, DrCarter. This should be a good resource. Jance 22:33, 4 January 2007 (UTC)[reply]
Awesome++, Dr Carter. This is exactly what we needed! Dikke poes 14:35, 6 January 2007 (UTC)[reply]
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)[reply]

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)[reply]

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)[reply]

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)


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)[reply]

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)[reply]

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

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)[reply]
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)[reply]
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)[reply]

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)[reply]

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)[reply]

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)[reply]

    • 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)[reply]
    • 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)[reply]

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)[reply]

  • 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)[reply]

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)[reply]

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)[reply]

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)[reply]
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 [5]

Droliver 19:14, 25 February 2007 (UTC)[reply]

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

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 agree that the treatment of capsular contracture is relevant, but we should not be adding information that is not fully supported by research. A study of one or even a few doctor's experiences is not a clinical trial. The gold standard treatment for capsular contracture is still removal of the capsule. It is hypocritical to say one study is enough for one topic for this article, but not for others, such as the Brown article, which you have not accurately described.

Drzuckerman 19:24, 25 February 2007 (UTC)[reply]

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