Yolanda Foster made headlines recently with a shocking announcement: the Real Housewives of Beverly Hills star decided to have surgery to remove her silicone breast implants.  The choice was made with the hope that relieving her body of the 20 year old implants, which had leaked and spread silicone throughout her breast tissue, would help her immune system as she battles Lyme disease. Celebrities and many other women are opting to ditch their silicone implants, for a broad range of reasons.

Silicone’s controversial history

Two American doctors first introduced silicone breast implants in the 1960s. After their rise in popularity, in the 1980s, several high profile lawsuits emerged, as it was suggested that silicone was linked to systemic autoimmune disorders. In 1992, silicone implants were taken off the market in the United States due to safety concerns, and later were only permitted for reconstructive surgeries. After a flurry of lawsuits and settlements, numerous additional studies found that silicone breast implants were not linked to autoimmune disorders, and they were once again allowed for cosmetic purposes. Since then, silicone has remained a popular choice, due to its more natural look and feel compared to saline implants.

Although silicone implants have not been clearly linked to immune disorders such as lupus and rheumatoid arthritis, there may be a link to a rare form of cancer: anaplastic large cell lymphoma. This particular form of cancer can develop in the scar tissue surrounding the implant. Dr. Mark Clemens at MD Anderson says that about 0.1 to 0.3 cases emerge per 100,000 women with breast implants.

Even though the risk is small, many women are still choosing to have their silicone implants removed, and some are looking to more natural procedures that use the body’s own fat to increase breast size or reshape the breasts.

Why women are choosing to remove their implants

The reasons celebrities and other women choose to have their breast implants removed are varied:

  • Scarring and changes in shape and symmetry over time are common.
  • Ruptures and leaking can occur from falls, car accidents, or other unknown causes.
  • Neck or back pain from large breasts. (Little House on the Prairie star Melissa Gilbert says she had her implants removed for this reason, and that they interfered with exercise).
  • The trend towards organic foods and minimizing exposure to environmental toxins has motivated many women to seek more natural treatments.

Safer alternatives?

Autologous fat grafts for breast enhancement have the added bonus of removing fat from areas where it is less desirable, such as the stomach and thighs, and moving it to the breasts. While the initial cost of the procedure tends to be higher than the cost of a surgery using silicone implants, using autologous fat grafts for breast augmentation is in reality not one but two procedures: a liposuction procedure and a breast augmentation. Over the longer term, fat grafts may be less expensive.

Statistics from the U.S. Food and Drug Administration show that among women who have silicone breast implants, 20 to 40 percent will require another operation to remove or replace their implants in the 10 years following the original surgery. Among reconstructive surgery patients with silicone implants, up to 70 percent may need a replacement within 10 years. Many younger patients don’t realize that breast implants require not a single surgery, but a series of surgeries over a lifetime. Implants typically need to be replaced every 10 to 15 years due to scarring and capsular contracture, rupturing of the implant, wrinkling, asymmetry that develops over time, or pain. Fat transfer does not require the exchange of aging implants multiple times.

In contrast, the risks of fat grafts for breast augmentation include

  • Re-absorption of the transplanted fat by the body over longer periods of time.
  • Fat necrosis, which occurs when fat cells die. Doctors point out that the techniques used to harvest and transplant fat (including the doctor’s training and experience) affect the probability that the fat will survive in its new location.
  • Previously, the concern was that calcification of fat interfered with mammograms. Enhanced imaging techniques and trained radiologists can better distinguish calcification due to cancer from benign calcification. Other common procedures like breasts lifts can also alter mammogram results.

An individual choice

Some women may still prefer or may be better candidates for silicone implants, such as thin women who don’t have enough fat to harvest, or women looking for more than a cup size increase.  Silicone is still deemed safe enough to remain on the market, and many women decide that the risks of silicone implants are minimal compared to the benefits. While Yolanda Foster expects her immune system to benefit from the removal of her implants, some of her children, who do not have breast implants, are also battling Lyme disease.

The breast implant removal is one of several treatments among many Foster has tried, including stem cell therapy, colonics, ozone therapy, chelation therapy, and hyperbaric oxygen. When her friend Erika Girardi was asked if she was considering having her own silicone implants removed, her response was “No. Never. I worked hard for these,” adding “I always wanted gorgeous boobs – so I went and got some.”

As decades of controversy and differing studies and opinions persist, the future of the widely used silicone implant remains uncertain, especially as newer, more natural procedures continue to gain popularity.