Health:
                   Women Find It Difficult to
                   Get Breast Implants Removed
                   By Joan E. Rigdon

                   03/20/1992
                   The Wall Street Journal
                   PAGE B1
                   (Copyright (c) 1992, Dow Jones & Co., Inc.)
 

                   When Cynthia K. Buford decided to enlarge her breasts with silicone-gel
                   implants in 1983, her doctor quickly scheduled surgery and billed her
                   insurance.

                   But when she decided to get the implants removed after black goo began
                   leaking from her nipples recently, Ms. Buford got a rude shock. Plastic
                   surgeons, demanding cash up front, issued stern warnings about potential
                   disfigurement. One doctor told her to imagine "a very huge fat lady and
                   look at the skin under her arms. That would give" her an idea of what her
                   breasts would look like if she didn't replace the implants after removing
                   them, Ms. Buford recalls. "I came home and cried for three weeks."

                   In the end, she sought help at a county hospital, which demanded a down
                   payment of $525 on a charge card. The total bill: more than $4,000. (A
                   spokeswoman says the hospital normally asks for the whole fee up front
                   because the surgery is considered cosmetic and shouldn't be funded with
                   taxpayer money.)

                   Women are finding that it was much easier to get implants than it is to get
                   rid of them. While Esther Rome, a member of the Boston Women's
                   Health Book Collective, says "it's impossible to document" the scarcity of
                   doctors willing to remove implants, she adds that "it seems fairly
                   widespread."

                   Getting the procedure performed is also emotionally draining. Many
                   plastic surgeons predict deformity or encourage women to get
                   replacement implants even if they don't want them. Most also say the
                   procedure isn't medically necessary, so insurance companies are refusing
                   to pay for it. (Some women have persuaded their insurers to pay by
                   bypassing their surgeons and obtaining letters from family doctors and
                   rheumatologists instead.)

                   Under fire from angry women, one implant manufacturer is offering
                   financial aid to those who want implants that it made removed. Dow
                   Corning Corp., which is getting out of the silicone implant business,
                   increased its financial aid offer this week to $1,200 a patient from $1,000
                   offered in February. Dow Corning is a joint venture of Dow Chemical
                   Co. and Corning Inc. Other breast-implant makers declined to comment
                   on the issue of financial assistance or said they haven't decided whether to
                   offer it.

                   But financial aid is small consolation to women who can't find doctors
                   willing to perform the procedure. Many plastic surgeons are reluctant
                   because they fear lawsuits from other patients: Removing implants is
                   tantamount to admitting they're not safe. Critics charge that the implants
                   can cause or trigger a variety of diseases, ranging from muscle pain to
                   chronic immune disorders.

                   Even doctors who are willing to extract implants say they are being
                   discouraged from doing so by insurers. One plastic surgeon says his
                   insurance company, Doctor's Co. of Sonoma, Calif., advised him against
                   performing a large number of removals. "They didn't want me to be a
                   potentially higher risk person . . . because it's such a lethal issue right
                   now," the surgeon says. Dr. Mark Gorney, medical director of Doctor's
                   Co., says that's "utter nonsense" and that removing implants isn't
                   considered riskier than putting them in.

                   Removing implants can require more surgery than putting them in,
                   because if the implants have ruptured, stray silicone must be scooped out.
                   Polyurethane-covered implants can be especially difficult to remove if the
                   polyurethane has mingled with scar tissue or surrounding muscle tissue.

                   Women's health groups have been steering women toward a few
                   surgeons who also remove and study scar tissue to see if it has reacted
                   with the silicone. One such surgeon, Dr. Lu-Jean Feng of Cleveland, has
                   performed almost 100 implant removals on women from all over the U.S.
                   But Ms. Rome of the Women's Health Book Collective says that so far
                   she has searched unsuccessfully for a plastic surgeon in the Boston area
                   who will remove and study scar tissue along with implants or send the
                   tissue and implants to other researchers.

                   Some surgeons may be reluctant to remove implants for fear they will
                   anger their colleagues or hurt their practices. One Texas woman, who
                   traveled to Florida to have her implants removed in 1990, says her plastic
                   surgeon told her he didn't want to remove too many implants in too short
                   a time because "that would imply there was something wrong with them."
                   The woman, a medical records worker, declines to be named.

                   Dr. Charles Plows, a member of the American Medical Association's
                   Council on Ethical and Judicial Affairs, says there's no policy on how
                   quickly surgery should be performed on women who want to remove
                   their implants. In general, "valid concerns by patients should be
                   investigated," he says.

                   The American Society of Plastic and Reconstructive Surgeons says it
                   "applauds" Dow Corning's decision to offer financial aid to women
                   seeking implant removal and encourages members to "further minimize"
                   costs for patients who don't have insurance. It says it will help to arrange
                   doctor visits for women who have lost touch with their plastic surgeons.

                   Nonetheless, for many women, the quest for removal has become an
                   odyssey. Ms. Buford, whose gel implants were covered with
                   polyurethane foam, says she decided to have them removed after she
                   developed knots in her breasts and "black stuff" began leaking from her
                   nipples. The first plastic surgeon she consulted encouraged her to get
                   replacements.

                   A second surgeon, Dr. Richard Burkett of Dallas, "told me I would want
                   another set because I was going to look so disfigured" without implants.
                   After comparing the likely result to a fat lady's arms, Dr. Burkett called
                   her at home to repeat his warning that "I would not look right" without
                   implants, Ms. Buford says. Dr. Burkett declined to return several phone
                   calls seeking comment.

                   Devastated, Ms. Buford waited weeks before consulting another plastic
                   surgeon, Dr. Diane Gibby of Dallas, who told her that surgery would
                   make her flat-chested, not disfigured. "She's the one who started making
                   me feel good about myself again," Ms. Buford says.

                   But there was another obstacle: Dr. Gibby required $5,000 in cash up
                   front, Ms. Buford says. Unable to pay and no longer covered by
                   insurance, she sought treatment at Parkland Memorial Hospital, a county
                   hospital in Dallas. Her doctor required $1,500 up front but later settled
                   for a $525 down payment made with her American Express card.

                   Other women say they had to travel long distances for treatment. Patti
                   Scher, a former nursing director who lives in Charlotte, N.C., flew with
                   her husband to Cleveland so she could be operated on by Dr. Feng.

                   Ms. Scher says that before her implants were removed, she suffered
                   fatigue, blurred vision and night sweats that made her so weak she had to
                   quit her job. Normal errands became Sisyphean tasks. "My family would
                   have to be fed off of whatever I was able to get in the grocery cart in the
                   first two aisles, because I couldn't master the rest," she says. Now,
                   several months after surgery, she says she is feeling healthier.

               -30-
 

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