By Dr Ananya Mandal, MD
A panel of expert advisors to the FDA has been asked to look into the matter of the thousands of women who enrolled in studies designed to evaluate rare complications that might arise years after they received silicone gel breast implants.
In June, after a preliminary review of study data, the FDA concluded that breast implants were largely safe and effective but were not “lifetime devices,” citing high reoperation rates for complications like hardening of the breast and rupture of the implant. Although the review at the time had found no evidence that silicone implants were linked to rare problems like breast cancer or connective tissue diseases, concerns that have plagued the devices for decades. The agency noted then that studies were still in progress to better answer some of those questions about rare events.
Some of the potential rare events that the FDA and patient advocacy groups wanted continued monitoring for included connective tissue diseases like lupus, rheumatoid arthritis, and scleroderma; nerve problems; cancer; suicide; interference with mammograms; problems in babies born to women with breast implants; and women with implants who might have had trouble getting pregnant or breastfeeding.
Now, however, it seems those studies have lost so many of the women they were supposed to follow that they are unlikely to offer any insight into the long-term safety of the devices. The said studies were designed that enrolled more than 82,000 women with silicone breast implants and 16,000 women with saline implants for comparison. The studies were supposed to follow the women for 10 years.
But three years into the studies, Mentor, the maker of Memory Gel implants, has lost 79% of the patients they enrolled, while Allergan, the maker of Natrelle implants, has lost nearly 40% of their study participants two years after enrollment. As a result, experts said the studies had already lost the power to detect the rare events they were designed to look for.
“Based on these study designs, it's not going to be more powerful to just double the length of time the studies are running,” said Phil Haeck, president of the American Society of Plastic Surgeons, who attended the hearing. It is the panel's task in the two-day meeting to help the FDA find a way to “fix the current dilemma,” Haeck said.
“Mentor's top priority has been and always will be patient safety,” said John Canady, medical director of Mentor Worldwide in testimony to the General and Plastic Surgery Devices Advisory Panel to the FDA. “The current large, post-approval study, unfortunately, though, has not given us the additional data that we hoped for, but I can assure you that plastic surgeons have tried hard in this effort,” he said.
Canady said the major reason many women were lost was that most women who get their implants feel fine after their surgeries and that “patients who feel well just don't go to the doctor.”