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Gel ethics: To replace or not to replace?

Article-Gel ethics: To replace or not to replace?

A patient with problem-free saline implants wishes to replace them with silicone. What does a physician do?

"I personally don't believe doctors should be doing that. Surgeons in general like to perform surgery. If one's only tool is a hammer, all one sees are nails," says Amy E. Newburger, M.D.

She adds, "I'm sure many doctors will replace" such implants, assuming FDA approval assures the products' safety. However, Dr. Newburger notes, "That's not what FDA clearance means — it's not the Good Housekeeping seal of approval." According to Michael Rosenberg, M.D., "At the end of a very careful discussion with the patient about the risks and benefits of additional surgery and silicone, I would fall back to the old axiom that if it ain't broke, don't fix it."

"If they're having no problems with the saline but just think silicone might be better, I would tend to discourage switching," he says.

"The basic rule of thumb is, leave well enough alone," states Mark Berman, M.D., F.A.C.S. "If one is going to revise implants, one must advise patients that it opens a bit of a Pandora's box. There's a risk of infection or capsular contracture subsequent to the treatment." But if the pocket is well formed, he says that, technically, "All one is doing is exchanging for size, which is potentially a 10-minute procedure." As long as the patient understands the risks, switching to gel implants wouldn't be unethical, Dr. Berman says.

"If a woman is self-conscious because her breasts feel like water balloons and she wants them to feel more natural, then it sounds completely appropriate as long as it's reasonable and safe," he adds.

Thanks to the FDA's ruling, "Now anyone for any reason — provided they meet the requirements — can simply switch from saline to gel," says Angelo Cuzalina, M.D., D.D.S. "That's going to happen more and more often."

For him, this presents an ethical dilemma. "One sees a patient who's had a very nice result, and one realizes that, by changing implants, one may create a problem. Most of the women in this category are probably going to have something they don't like about the saline" most likely the ability to see or feel a degree of rippling, he says.

"I've had several patients already — and I expect to have a lot more from years past — come in wanting to switch," he says.

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