Treating Patients with Implants

By Michael Reed, DC, CCSP, CSCS
An estimated 2 million women in the U.S. have had breast implants. A small but growing trend among bodybuilders, of both sexes, is the surgical insertion of silicone implants under muscles to enhance physique.

Recent news stories have posed questions about the connection between ruptured implants, silicone leakage, and cancer. According to a recent report, silicone gel bleeding can migrate through the body into adjacent tissue and lymph nodes; some experts believe the silicone can eventually cause serious autoimmune disorders or even cancer.

"All implants can rupture," cautioned Dr. Richard Rand, assistant professor of plastic reconstructive surgery at the University of Washington Medical Center in Seattle. He said the ruptures he has seen have usually been a result of trauma, usually accidental, although sometimes intentional. He knows of one woman who ruptured an implant when she bumped into someone on the dance floor.

Dr. Rand explained the technique of "closed capsulotomy" that plastic surgeons used to employ. If a breast implant developed a hard capsule around it, the surgeon would squeeze the implant to rupture the capsule and soften the area.

Dr. Rand pointed out that a ruptured implant cannot be routinely detected by simple examination. A mammogram can sometimes show loss of integrity of an implant, but Dr. Rand says, "There's no perfect test."

"Ruptures require surgery to remove the damaged materials and replace the implant," he stated.

Why should we be concerned about implant ruptures? To render the best chiropractic care possible, you need to be aware of the risks and the special measures necessary for treating patients with silicone implants.

Allegations that chiropractic adjustments have ruptured silicone breast implants are beginning to show up in malpractice lawsuits. Some simple preventative measures can help avoid claims that chiropractic care caused such a rupture.

The process begins when a patient first enters your office. I added a question on the patient intake form, which includes an area for the date the implant was placed. Keep in mind that older implants could be more fragile than recent versions.

Remember that not all patients will reveal they have implants, which may be especially true of the growing number of male recipients. An anterior/posterior x-ray of the thoracic spine will usually reveal areas of increased density in the breast shadows, which is an immediate tip-off that implants are present.

Once I know that implants exist, I formulate my treatment program. A well-documented and informative consent discussion is advisable before treating a patient with implants. Make your patients aware of the risks, but let them know that generally chiropractic care will not upset implant placement or integrity. You can then explain the extra precautions you will be taking when adjusting the thoracic area.

Chiropractic adjustments -- particularly thrusting adjustments to the thoracic region -- require special care. Treat the patient as you would an elderly person with brittle bones. Adjustments with a patient lying prone require at least three inches of cushioning to protect the implants.

Most chiropractic tables offer adequate cushioning. I prefer to use a table with a spring-loaded piece that drops down for thoracic adjustments. This ensures that the spring will give before the implant does.

An alternative to silicone implants using saline was introduced in the late '60s. According to the American Society of Plastic and Reconstructive Surgeons (ASPRS), early problems with saline leakage have since been eliminated. If a saline implant ruptures, the patient's risks are drastically reduced because the fluid leaked is a natural element. The society reports, however, that in a recent survey of implant patients, the overwhelming choice was still silicone.

Considering that more and more of your patients are likely to have implants, it's a good idea to keep as current as possible on developments in this area. Local plastic surgeons are probably your best source of reference.

The ASPRS' patient brochure, "Straight Talk about Breast Implants," also contains helpful information. To receive the brochure and a copy of the society's official position statement on breast implants, you can call the society's toll-free referral service at (800)635-0635.

Michael S. Reed, DC., FACC
Scottsdale, Arizona

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