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Tuesday, November 08, 2005

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The FDA's draft guidance document says that two to three years of
follow-up data may not be enough to allow the agency to evaluate the
safety and effectiveness of breast implants. The agency recommends
the use of tests that can predict clinical outcomes, such as how long
breast implants will last before rupturing in the body, as well as tests
that explain how and why the breast implants rupture. In addition, the
agency recommends that more data be gathered regarding the rate of
rupture over time, as well as the health consequences of rupture.

Monday, November 07, 2005

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In January 2004--contrary to the recommendation of the agency's
advisory panel--the FDA determined that the new silicone gel-filled
breast implant PMA was "not approvable" at that time. This meant
that the implants were not approved for marketing pending additional
information, but that women would continue to have limited access to
them by enrolling in clinical studies.

Sunday, November 06, 2005

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A Turn of Events
In October 2003, the FDA held a two-day advisory panel meeting to
discuss a manufacturer's PMA for a silicone gel-filled breast implant.
Some people complained that the meeting was premature in light of
the fact that long-term studies had not been completed, but the FDA
proceeded because the agency was required by law to consider the
pending PMA within a specified time frame. The meeting also
provided patients and others with timely access to information and
expert analyses on the issue. The issues before the panel reflected
much of the decades-long debate over the implants. Moreover, the
meeting provided a valuable public forum for discussing the issue from
many diverse perspectives and for raising important additional
questions.

Saturday, November 05, 2005

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In the years that followed that decision, thousands of women filed
lawsuits against the manufacturers of silicone gel-filled implants,
claiming the devices had caused serious ailments, such as connective
tissue diseases, neurological diseases, and cancer. Consumer groups
repeatedly filed petitions urging more studies on the implants. But
many women said they were pleased with their implants, including
cancer patients who had pleaded for the opportunity to choose
silicone gel-filled implants for reconstruction.

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In April 1992, the agency decided that no PMA yet submitted
contained sufficient safety and effectiveness data to support approval.
However, access to these silicone gel-filled breast implants would
continue for women enrolled in certain clinical studies.

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In January 1992, the FDA called for a voluntary moratorium--a delay
on the use of these implants--until new safety information could be
thoroughly reviewed. The moratorium was not intended to "ban" the
implants, but instead to allow time to review the new safety
information.

Friday, November 04, 2005

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But over the years, questions did arise about the effects of silicone on
the body. In 1991, the FDA published a regulation that required
manufacturers of silicone gel-filled breast implants to submit
premarket approval applications (PMAs). This requirement meant
that the FDA needed to agree that the manufacturer has presented
data showing a reasonable assurance of safety and effectiveness in
order for the devices to remain on the market.

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The Silicone Controversy
Breast implants were first marketed in the early 1960s, before the
1976 Medical Device Amendments to the Federal Food, Drug, and
Cosmetic Act required a reasonable assurance of safety and
effectiveness to be shown for certain medical devices. The 1976 law
gave the FDA authority over such devices, but breast implants were
"grandfathered" into the regulatory scheme, meaning that
manufacturers were not required to provide the agency with scientific
evidence of product safety unless questions arose about the safety
and effectiveness of these already-marketed devices. Silicone was
initially assumed by manufacturers to be biologically inactive and,
therefore, to have no harmful effects.

Wednesday, November 02, 2005

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While every surgical procedure has potential risks, such as infection,
bleeding, and scarring, there are risks that are specific to breast
implants. Learning about them is key to being properly informed
about the procedure.

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Some people see an enormous benefit to getting implants and are
willing to accept associated risks. They say that using breast implants
to rebuild the breast (reconstruction), or change its size and shape
(augmentation), significantly improves the quality of life for many
women. Advocates of breast implants also say that a woman's
consent to the surgery should be considered valid as long as she
weighs the risks and benefits of the procedure.

Tuesday, November 01, 2005

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Making an Informed Decision About Breast Implants
By Carol Rados