Making The Best Choice

Last week's FDA decision sharply reduces the options for women seeking to augment or rebuild their breasts. Not only were silicone-gel devices easy to insert but their look and feel best approximated the real thing. For 90% of women, they were the method of choice. While implants inflated with salt water are still available and considered safe (if they leak, the saline does no harm), they have drawbacks. They can shift as a woman moves, and the water may settle into the lower portion of the breast, stretching and tightening the skin. They are not recommended for thin women or for those who have undergone mastectomy, since these women do not have enough extra padding to support the viscous envelope.

A second alternative is surgical: rebuilding the breast with tissue taken from the stomach or buttocks. But this involves a lengthy and costly operation and is appropriate only for women who have usable tissue to spare.

Women might be best advised to make do with what they have or wait until more choices are available. One implant being tested is filled with peanut oil, which, unlike silicone, does not interfere with mammograms. With a multimillion-dollar industry at stake, manufacturers are under the gun to offer alternatives.