Silicon, silicone, and breast implants - Letter to the Editor
Pediatrics, Nov, 2002 by Jae Hong Lee, Diana Zuckerman
To the Editor.--
More than 200 000 breast implant augmentation procedures have been
performed annually in the United States in recent years, most on
teenagers and young women of reproductive age. (1) As a result, many
nursing mothers have breast implants--all composed at least in part of
silicone.
The American Academy of Pediatrics (AAP) recent policy statement on
silicone breast implants and breastfeeding concluded that the
"Committee on Drugs does not feel that the evidence currently
justifies classifying silicone implants as a contraindication to
breastfeeding." (2) We agree that there is a lack of data to
contraindicate breastfeeding by women with breast implants, but there
are also no convincing data proving it is safe. The available studies
have too many methodologic shortcomings, and this problem is apparent
in the 3 reports cited by the policy statement as evidence supporting
the safety of breastfeeding by mothers with breast implants. (3-5)
The AAP statement quotes one study, by Semple et al, (4) to note that
"silicon is present in higher concentrations in cow milk and formula
than in milk of humans with implants." (2) That may be true, but
silicon differs substantially from silicone, and silicon levels are
not an adequate measure of silicone content in breast milk. (6)
Silicone is an organic polymer that contains elemental silicon, and
silicone is not biologically inert. (7) It is unknown what long-term
effects silicone ingested through breast milk will have on the health
of nursing infants.
A second study cited by the policy statement directly assayed silicone
polymer and found that silicone levels in the milk of women with
implants were not significantly different from those in other human
milk samples. (5) However, only 6 samples of milk from lactating women
with breast implants were obtained--a sample size too small to permit
broad generalizations. Silicone is known to leak from breast implants
when they are intact, and even more when ruptured. (8) The highly
variable condition of breast implants could cause significant
variation in the silicone content of breast milk.
The third study cited by the AAP statement purports to demonstrate no
increased risk for connective tissue diseases or congenital
malformations among children of mothers with breast implants. (3)
However, it included only 279 children born after their mothers
received breast implants. That sample size is too small to adequately
study the incidence of such uncommon disorders.
Breastfeeding confers numerous benefits on nursing infants (9) and
physicians should continue encouraging the practice. However, the
safety of breastfeeding by women with silicone breast implants has not
been adequately studied--a fact these women should be told. We urge
the AAP to revise their policy statement to acknowledge the lack of
safety data. More importantly, additional studies need to be conducted
on this very important issue.
JAE HONG LEE, MD, MPH
DIANA ZUCKERMAN, PHD
National Center for Policy Research for Women &
Families
Washington, DC 20006
REFERENCES
(1.) National Plastic Surgery Statistics: Cosmetic and Reconstructive
Plastic Surgery. The American Society of Plastic Surgeons. Available
at: http://
www.plasticsurgery.org/mediactr/natstats2001.cfm Accessed
May 8, 2002
(2.) American Academy of Pediatrics, Committee on Drugs. The transfer
of drugs and other chemicals into human milk. Pediatrics. 2001;108:
776-789
(3.) Kjoller K, McLaughlin JK, Friis S, et al. Health outcomes in
offspring of mothers with breast implants. Pediatrics.
1998;102:1112-1115
(4.) Semple JL, Lugowski SJ, Baines CJ, et al. Breast milk
contamination and silicone implants: preliminary results using silicon
as a proxy measurement for silicone. Plast Reconstr Surg.
1998;102:528-533
(5.) Berlin CM Jr. Silicone breast implants and breastfeeding.
Pediatrics. 1994;94:547-549
(6.) LeVier RR, Harrison MC, Cook RR, et al. What is silicone? Plast
Reconstr Surg. 1993;92:163-167
(7.) Bondurant S, Emster V, Herdman R, eds. Safety of Silicone Breast
Implants. Washington, DC: National Academy Press; 2000
(8.) Beekman WH, Feitz R, Hage JJ, et al. Life span of silicone
gel-filled mammary prostheses. Plast Reconstr Surg. 1997;100:1723-1726
(9.) American Academy of Pediatrics, Work Group on Breastfeeding.
Breastfeeding and the use of human milk. Pediatrics.
1997;100:1035-1039