Talk:Breast implant/Archive 6

message: Let's first go back to the complications section, since several important complications were deleted by droliver.  It is a less complicated (no pun intended) section.  Only 2 complications are currently listed, although there are many more well-established complications. And systemic disease is under that heading, whereas it should be a separate heading 
I also agree with whoever said that the comments on this page are too long and it a full-time job just to read them.  Let's try to be brief. 
And, consistent with wiki rules, I request that droliver show more respect to people he disagrees with, stop calling me "Diane" (which is not my name and seems condescending, since nobody here calls him by his first name), stop questioning my motives, and stop misrepresenting my expertise.  Let's call each other by the names we list. Drzuckerman 19:55, 20 December 2006 (UTC)
replies: text: Unfortunately, I have also asked that Dr.Oliver be more respectful.  I don't know how else to stop the rudeness.   Also, I will note that "consensus" does not mean 100% agreement, and if consensus is accurate, then it should be acceptable to edit accordingly.  Obviously, if the consensus is a false statement, etc, then it should be stopped.  But that is the beauty about consensus - usually it does prevent a single editor's POV pushing.  At lease, we hope it does.  Jance 21:41, 20 December 2006 (UTC)

text: David also agreed that necrosis was a complication worth mentioning, esp if there is a difference wrt reconstruction v. augmentation.  Consensus exists on this, and it should be added.  DrOliver does not have to agree for there to be consensus on a legitimate edit.Jance 21:44, 20 December 2006 (UTC)

text: I do not want to add it, since I have had had problems already with DrOliver.  However, it is clear that there is a consensus (among doctors and non-doctors alike) and someone should add it.Jance 01:15, 21 December 2006 (UTC)
replies: text: I read Dr. Ruben's page.  He said, list complications if they're significantly special to the particular surgery (as all surgery working with skin has these complications to some extent).  So with the statistics provided by Dr Carter (and how big are these two companies? If a significant percentage of the market, we can use them in the article), let's get the statistics for other surgeries that involve skin.  Post them here in Talk.  If they're like, 1-2%, then what's the deal?  Only 2% of patients with (brandname) implants had post-op breast pain?  Damn, I wish my oral surgeon were that good.  Or are these longterm breast pain?  This is important, too.  If there's significant breast pain/nipple problems that go beyond post-op, then it should definitely be in the article, because it's relevent info. Just remember that any woman going under the knife is supposed to recieve info about possible complications.  Sure, quacks might not, but that's what lawsuits are for :) Dikke poes 17:19, 21 December 2006 (UTC)
replies: text: I do not know what causes the loss of nipple sensation.  However, I would like to see a source on that, and not take the word of any one person.  .Jance 23:55, 21 December 2006 (UTC)

text: Right, Oliver.  That was what I meant in my last sentence (that someone actually undergoing the surgery should get a booklet or something with all of the possible effects).  So you're wanting main Complications section in the Wikiarticle to be 1: capsular contracture and 2: reoperation.  The others want the skin/nipple stuff.  So I'm asking them to add numbers here of other skin-involved surgeries and then we can see easily if there's a particular possiblity that we should add under "Complications".  For instance, if probablility of nipple numbness were like 72% and for other surgeries numbness is only 20%, then it's obviously a notable complication.  If however the probabilities are the same, then it's not notable-- nipples are important, sure, but so are lips.  If someone having lip surgery has the same possibility of numbness, than I'd chalk it up to "Bad things that might happen from surgery" and should be left on the surgery page (I'm sure there's a wiki page on it). Dikke poes 20:48, 26 December 2006 (UTC)
thread_title: Complications

message: Also from the FDA</b>
There are two concerns associated with the effects on children:
# the safety of the milk from mothers with breast implants for breast feeding children
# the effects of silicones and other chemicals on children born of mothers with breast implants (second-generation effects).
It is not known if a small amount of silicone may pass from the silicone shell of an implant into breast milk. If this occurs, it is not known what effect it may have on the nursing infant. There are no current methods for detecting silicone levels in breast milk. The IOM report49 said that there is convincing evidence that infants breast-fed by mothers with breast implants receive no higher silicon (not silicone) intakes from breast milk than infants breast-fed by mothers without breast implants. (Silicon is an element that is one component of the polymer silicone and is one of the most abundant elements on the earth. Everyone is exposed to silicon.)
Concerns have been also raised about the potential damaging effects on children born of mothers with implants. The IOM report said that the information is insufficient or flawed to draw definite conclusions about this issue. In other words, it is not known what effect breast implants may have on an unborn baby (fetus) and the nursing infant.
Several studies since the IOM report have suggested that the risk of birth defects overall is not increased in children born after implant surgery.51,52 These studies are comforting, but, because they are small and of short duration, they cannot rule out a very small risk.Jance 21:06, 22 December 2006 (UTC)
thread_title: Effects on Children

message: -In response to the agreement and debate on this page, I have re-instated several complications with specific statistics.  I did not include hematoma yet, although I would be glad to add it if there is agreement.  Other possible additions include breast mass (3% for Mentor augmentation patients) and malposition (4% for Allergan augmentation patients).  
In response to the questions -- the manufacturer specifies that these are all long-term serious complications, not short-term pain after surgery, etc.  And Allergan/Inamed and Mentor are the 2 major manufacturers worldwide.
In response to Jance's comment, changes in nipple sensation are not specific to incisions around the nipple area (although nerve damage is believed to be more likely with those incisions).  Also remember that the statistics given are for the best plastic surgeons that the implant companies could recruit.  Presumably the complication rates would be higher for "average" and less experienced plastic surgeons.
With the help of the administrators, I assume that droliver will respect the wishes of the majority on these pages and not delete these well-documented complications.
I also want to remind folks to sign their comments on this page. Drzuckerman 19:41, 22 December 2006 (UTC)
replies: text: Thanks for answering some of my questions :) Dikke poes 20:54, 26 December 2006 (UTC)
replies: text: These complications are already in fact mentioned and referred to in both the context of breast surgery & specific to implants. The 4 year CORE data table figure summarizes these rates in a way that clearly speaks to this in a way that makes at length descriptions of less specific complications redundant. Droliver 19:26, 24 December 2006 (UTC)

text: I know I'm adding this out of place, but a woman looking for surgery info should not rely on Wikipedia or ANY encyclopedia.  'Pedias describe and explain.  It's a good START.  But listing all complications is not our job.  That is the surgeon's job.  The surgeon MUST inform you that, before you get your wisdom teeth yanked for example, there's a 2% chance of infection.  Is that important? Yes, of course.  Does it belong in an encyclopedia? No, other than perhaps a sentence like, Like all surgeries, there is a possibility of etc etc etc'.  The especialy notable complications specific to breast implants, though, DO belong here. Dikke poes 20:54, 26 December 2006 (UTC)
replies: text: Yes, and necrosis was not mentioned in your edit, although several here (including David) thought it was significant enough to mention.  There is nothing "unwieldy" about a short discussion of the complications.  There is far more unnecessary detail in the generations of implants, for example, or the specfic techniques.  And certainly, what you had previously with multiple charts was far more unwieldy than a couple of paragraphs, and was also redundant.  Jance 01:08, 25 December 2006 (UTC)

text: I changed back to what a consensus had been on complications.  I also removed the unwieldy charts.Jance 23:05, 25 December 2006 (UTC)
replies: text: Actually, you just reverted back what was an attempt to address the issue of both relevence & brevity to the complications area while incorporating some of your concerns about more serious local complications that primarily involve reconstructive surgery. The list of independent reviews of the literature is also important to communicate the continual & ongoing reevaluation of the literature of this topic & it puts in context the contention that a paucity of study has been done or that there has been much in the way of inconsistancy of the literature. If you can find such systemic reviews that have been overlooked, please bring it to attentionDroliver 16:26, 26 December 2006 (UTC)
thread_title: Complications

message: We need to find a compromise between the current version and this version. Dr. Zuckerman, I agree that the opening of the systemic disease paragraph should reflect that no cause and effect relationship has been found between connective diseases and breast implants. The paragraph should, however, elaborate on the fact that there have been reports of systemic disease in women with silicone gel implants. Let's start with Dr. Zuckerman's first paragraph:
No causal relationship has been reported between silicone implants and systemic diseases, including connective tissue diseases; however, thousands of women have claimed that they became ill from their implants, particularly when silicone implants ruptured. Complaints include neurological and rheumatological problems. Peer-reviewed studies suggest that subjective and objective symptoms of many women with implants improve when their implants are removed. [1] More research is needed to determine how often implant removal results in a reduction in rheumatological symptoms.
Thoughts -- Samir धर्म 06:12, 18 December 2006 (UTC)
replies: text: What would you propose?  My objection was what Droliver had stated, "a number of" - 200,000 plus (many more than that, since many never registered for the class action) is hardly "a number of.  "A number of" implies a few.  Jance 01:31, 27 December 2006 (UTC)
replies: text: Yes, although I think it necessary to say there is no evidence of.. (instead of a categorical statement).   Other than that, I agree completely.  (My issue still is the rupture rate and effects of rupture, which for all these many studies, still do not study.)Jance 01:10, 28 December 2006 (UTC)
thread_title: Once again, Samir's suggestion, as a paragraph to discuss

message: Previously I had created subpages to act for editors to use as an "off-line" version. I don't think this has been much used as of late and Sarah recently posted to me a problem with this approach and that she has kindly moved and preserved the page under her userspace as a result:David Ruben  Talk  04:57, 31 December 2006 (UTC)
replies: text: David, there's another companion to that scratchpad still lingering as breast implant controversy that needs to be put out of its misery Droliver 10:21, 31 December 2006 (UTC)
replies: text: If you want that one "put out of its misery," you'll have to take it to AFD.Sarah 16:23, 31 December 2006 (UTC)
thread_title: Previous "off-line" version moved

message: The article seems to have descended back into edit warring.  I have protected it again. Guy (Help!) 17:47, 31 December 2006 (UTC)
replies: text: Actually, hundreds of thousands of women, not thousands, have claimed breast implants caused their illness.,  SO yes, it is true.  We could cite the lawsuits.  We could cite that thousands of documents.  Which would you prefer, Curtis?Jance 20:24, 31 December 2006 (UTC)
replies: text: You can cite anything you like so long as it is relevant and verifiable.  However, as to the claim that the implants caused the illness, you'll also have to provide scientific evidence to support the claim.  But since there is no scientific evidence to support a causual link between implants and various illnesses, you're going to have difficulty doing that.  --Curtis Bledsoe 20:39, 31 December 2006 (UTC)
replies: text: Curtis does not seem to understand the comment he removed.  The statement was "hundreds of thousands of women, not thousands, have claimed breast implants caused their illness."
That is a true statement.  Also, it is not true to say there is no scientifice evidence to support a causal link.  Even Oliver would not say that.  I think you need to stop wikistalking.Jance 00:44, 1 January 2007 (UTC)

text: I actually agree with Droliver, on most of this.  "No clear evidence" is more accurate.  Also, for the reasons I already stated in this talk page, "hundreds of thousands" or citing the lawsuit is probably not a good claim.  There may be hundreds of thousands, I don't know.  We all agree that there were 'thousands.'  Off topic but interesting is that both asbestos and BI litigation had claimants (or litigants) who were attempting to preserve their rights in a lawsuit before either SOL ran or the settlement, and were not necessarily ill.   In both cases, some may never become ill.  That was the problem with both class actions, imho.  (Let's not debate the 'science' which could go on forever).  The ABA has addressed the asbestos issue.  The BI class action settlement will soon be ending, and I am glad of that.  My hope is that more research will be done on rupture, and its effects - there is little evidence one way or the other on this.  Most of the many many studies that do exist do not look at these issues.  So of course we do not have clear evidence.  I personally do not believe we have all the answers.  And, we may never.  Jance 20:15, 1 January 2007 (UTC)

text: So truthfully, what source gives us this "thousands of women" or "hundreds of thousands?"  Yes, I saw the earlier remark on the 200,000 involved in the class-action lawsuit, but as some here have already said, there is a problem with using that number... so where else do we find them?  C'mon, I'm sure that like, TIME or someone has done stories on Breast implants during the whole disease-claim rage during the 90's, and have a number from some expert here or there that we can use.  I don't agree with Mr Curtis' removal of the sentence, but I've been bothered by the source for the number for a while now.  Comments? Dikke poes 14:10, 3 January 2007 (UTC)
thread_title:  Protection 

message: The currently protected version is not a balanced article.  The section on complications that was agreed to by everyone except droliver, a plastic surgeon who says clearly that he believes that implants have no worrisome risks, has been deleted by him.  Instead there is a chart that needs a magnifying glass to be read, and is only based on one of the 6 major populations that were studies in prospective clinical trials.  The version that droliver deleted included a range of complication rates based on those 6 major study populations. 
The section on systemic diseases that I had carefully revised started with a summary paragraph proposed by Samir and agreed to by DrCarter, the GU editor, and the public health person.  It was deleted, apparently by droliver.  The current (protected) version includes several errors which I had previously corrected.  The corrected version was supported by DrCarter and others (Dr Ruben?).  But it is now not possible to restore those corrections because the article is protected. 
Droliver, we all know from your writings that you believe that implants are safe.  You are entitled to your own opinion, but the facts are the facts. This article should have the facts, not your opinion. When a regulatory agency or research center says that there is no conclusive evidence that implants cause specific diseases, that does not mean that there is NO evidence that implants cause ANY systemic illnesses, symptoms, or diseases, and it doesn't mean that there is conclusive evidence that implants DON'T cause disease.  As the scientists repeatedly explain, the absence of proof is not the proof of absence. 
Remember that the same National Academy of Sciences/Institute of Medicine that wrote one report on breast implants also wrote 3 widely publicized reports on Agent Orange and dioxin stating that there was no clear evidence that Agent Orange or dioxin caused disease -- until a few years later, when they wrote a report saying that "now there is such evidence." Interestingly, if you look at the Agent Orange article on wiki, the previous reports saying there was no association between dioxin and disease aren't even mentioned. Drzuckerman 23:27, 1 January 2007 (UTC)
replies: text: Droliver made the last revert, to Curtis' version that included Curtis' edits.  To be fair, Droliver has stated here that he does not agree with Curtis' edit.  Of course, Droliver did not correct it in the article when he reverted to a version that he liked, which was not discussed on this talk page. Jance 00:58, 2 January 2007 (UTC)
thread_title: Balanced Article

message: ===The last version by User:71.8.78.88 ===
* In no way does that version reflect a truly accurate discussion. There has yet to be a case made that the current verion hasn't already addressed the complications accurately and attempts at original research reimaginations of the literature in particular are innacurate & not representativeDroliver 14:53, 3 January 2007 (UTC)
replies: text: I think you posted in the wrong section, Oliver.  And again, Dr Zuckerman's version is both accurate and representative - as a woman, I surely would want to know this information!Jance 15:59, 3 January 2007 (UTC)
thread_title: Straw poll

message: * In no way does that version reflect a truly accurate discussion. There has yet to be a case made that the current verion hasn't already addressed the complications accurately and attempts at original research reimaginations of the literature in particular are innacurate & not representativeDroliver 14:53, 3 January 2007 (UTC)
replies: text: I think you posted in the wrong section, Oliver.  And again, Dr Zuckerman's version is both accurate and representative - as a woman, I surely would want to know this information!Jance 15:59, 3 January 2007 (UTC)
thread_title: The last version by [[User:71.8.78.88]] [http://en.wikipedia.org/w/index.php?title=Breast_implant&oldid=97516601]

message: * Yes, please. This seems to be the most neutral, yet informative posting for women. LynnMB 21:34, 2 January 2007 (UTC)
thread_title: The last version by Dr Zuckerman on December 28 [http://en.wikipedia.org/w/index.php?title=Breast_implant&oldid=97086525]

message: ====The last version by Nakamomita ====
I had made adjustments to the structure of the article which I would like to see implemented (which was reverted because I didn't see I needed to get a straw vote before making changes.  I apologize for that).  I think that "Procedure" and "Recovery" should be part of the article.  In addition, "Incision type", "Type of Implants", and "Implant Pocket Placement" are variables that should be listed under "Procedures".  The current structure lists "Incision Type" and "Implant Pocket Placement" under "Systemic illness and disease" which is very odd.  I would like to make those changes without affecting other parts of the article--hopefully avoiding any controversy while improving the structure.  Thank you.  Nakomomita 07:25, 27 February 2007 (UTC)
thread_title: A different version (please specify)

message: I had made adjustments to the structure of the article which I would like to see implemented (which was reverted because I didn't see I needed to get a straw vote before making changes.  I apologize for that).  I think that "Procedure" and "Recovery" should be part of the article.  In addition, "Incision type", "Type of Implants", and "Implant Pocket Placement" are variables that should be listed under "Procedures".  The current structure lists "Incision Type" and "Implant Pocket Placement" under "Systemic illness and disease" which is very odd.  I would like to make those changes without affecting other parts of the article--hopefully avoiding any controversy while improving the structure.  Thank you.  Nakomomita 07:25, 27 February 2007 (UTC)
thread_title: The last version by Nakamomita [http://en.wikipedia.org/w/index.php?title=Breast_implant&oldid=110275289]

message: I've restored Dr Zuckerman's last edit as a result of the above straw poll. I just want to say something about the poll and how I have viewed it. There have been allegations made here on the talk page of meatpuppetry, and privately concerns of sockpuppetry were raised with me. I never saw this as a vote and anyone running sockpuppets has wasted their time. I considered the polled in terms of an AFD and looked at actual comments and credibility, rather than pure numbers. I won't point out specific accounts that I discounted, but there were some who I completely ignored. If someone had made a cogent argument against either version, that would have held far more weight than people who just signed their names. Also, this is not an endorsement of the Dr Zuckerman version. This is just a starting base. Now it's time to move forward with editing and I encourage people to start nominating under the "Content issues" section above issues they have with the actual content, including information that may need to be added, merged, removed, edited, verified etc. Sarah 11:31, 6 January 2007 (UTC)
thread_title:  Straw poll 

message: 1. In response to Dikke's suggestion, I agree that we need to explain CTD (connective tissue disease) when it is first used in the systemic disease section. A good way to do this is to insert in the previous paragraph on fibromyalgia that the study found a significant increase in "fibromyalgia and several other autoimmune and connective tissue diseases (CTDs)" That is an accurate statement and kills 2 birds with one stone by explaining the overlap between CTDs and autoimmune diseases, which is good since both terms have been used in the article.
2. And, in response to Dr Carter's suggestion, and Dikke's concurrence, I would support Sarah inserting the article that Dr Carter cited as a reference for "Tens of thousands of women" claim that they have become ill from their implants." The source is: A Status Report on Breast Implant Safety, by the US FDA: http://www.fda.gov/fdac/features/995_implants.html 
3. It looks like Sarah fixed most of the typos that Dikke suggested, and his major substantive change in this section. Thanks to Sarah and everyone for working together on this. Drzuckerman 20:23, 7 January 2007 (UTC)
thread_title: Small Revisions to the systemic disease section

message: I had taken a few weeks off this page and was sorry to see that the language that Samir and numerous other administrators and health experts had agreed to had been changed.  The article is noticeably less balanced as a result.
Most notably, in the systemic disease section, even the Danish studies paid for by Dow Corning concluded that there were significant increases in auto-immune SYMPTOMS for women with implants.  There were no significant increases in diseases, however.  Both symptoms and diseases are important issues and that information should not have been deleted.  Several editors and administrators had agreed to that compromise language.  So, I restored it and will ask the administrators for help. It should not be changed again until we hear from the many editors who have read the research literature on this.  
The section on the benefits of augmentation surgery had also been edited in a way that was not reflective of the most recent studies.  If one reads Dr David Sarwer's research (which is widely quoted by plastic surgeons) one sees his greater concern and data supporting an increase in body dysmorphic disorder among patients, rather than other problems such low self-esteem that were emphasized in this article.  So, I added that information, as well as his study showing that the benefits are quite specific to the breasts, and not to improvements in general self-confidence or self-esteem. 
The longest-term studies on self-esteem etc, which are 3-4-year studies, clearly show a no improvement on most mental health and quality of life measures, and Inamed even reported a decreased confidence on a well-established self-concept scale.  So, obviously this article should reflect those better designed studies.  There can be no accusation of bias against implants in these findings, since the companies include the information in their patient booklets (see "Important Information for Women About Breast Augmentation with Inamed Silicone Gel-Filled Implants." Available at http://www.fda.gov/cdrh/pdf2/P020056d.pdf )
 Drzuckerman 16:21, 15 February 2007 (UTC)
thread_title: Balance needs to be restored

message: Dr Oliver has pointed out that if one study shows a significant relationship between breast implants and health problems, such as the Brown study of rupture and fibromyalgia, that doesn't prove that implants cause problems.  Similarly, it is not appropriate to quote single studies suggesting various cures for capsular contracture when there is no general agreement on prevention or treatment because there are no conclusive studies.  I deleted a few of the most egregious examples that had been inserted without consensus on this page.  I seek comments about some of the other ones in the capsular contracture section.  Do these articles represent any kind of scientific consensus? And if so, why aren't all plastic surgeons following their advice? Drzuckerman 04:57, 24 February 2007 (UTC)
thread_title:  Single Studies are not conclusive 

message: I know it doesnt relate much to the article, I will try my best to make sure it does. I dont know where else to ask!
Can short/petite women get breast implants? I am short and I was wondering if it will be possible for me to get the size of implants I want. I'm around 5'0 tall, an inch or two shorter. 
Maybe this could possibly be added to the article? If not, I guess I just wanted to know since I dont know where else to ask. --67.185.26.89 08:19, 25 February 2007 (UTC)
replies: text: Why would that be a problem? This should only really be added to the article if there is a documented record of shorter women having problems finding a suitable surgeon/implant. JFW | T@lk 10:21, 25 February 2007 (UTC)
replies: text: Curbside consult here: There's a school of thought re. implant sizing that the base-width of your breast (plus analyzing soft tissue coverage)is the proper way to size implants. This tends to use smaller implants then many patients think they would want but clearly looks like it can reduce reoperations, mostly due to not putting as heavy an implant in. This was particularly true with bigger saline implants (which are heavier per volume unit then silicone) which "bottom out" with regularity. Bigger implants will also end up being wider which can leave a bulging breast lateral to your chest wall which is not very aesthetic. Smaller implants will serve you better with longer lasting results which is what I think should be the endpoint. I touched on this a year ago in my blog if you're interested  
Droliver 19:14, 25 February 2007 (UTC)

text: I'm curious.  Dr Oliver, is this a very common question from patients/interested people?  Do you think body-size should be mentioned in the article? Dikke poes 15:16, 28 February 2007 (UTC)
thread_title: Question...

message: "Stem cell technique helps women grow their own implants", the Daily Mail, 12th February 2007. --Ty580 15:48, 26 February 2007 (UTC)
replies: text: This isn't really ready for prime time yet & premature to include in an encyclopedic entry IMODroliver 01:56, 2 March 2007 (UTC)
thread_title:  Stem cell breast enlargement treatment 

message: My entries directly quote from the peer-reviewed literature as well as government regulatory agencies.  I have repeatedly balanced the article with all sides of the controversy.  In contrast, droliver's revisions only focus on the most "pro-implant" statements, which generally point to the lack of conclusive evidence for specific systemic diseases.  However, the same people and agencies that droliver likes to use as experts ALSO clearly state that there are high complication rates and problems associated with breast implants. 
The versions of this article that I have supported tell both sides of the story.  The versions that droliver prefers are one-sided POV of plastic surgeons. Numerous other editors, including physicians, an editor of an international health reference book, and others have agreed with me, disagreed with droliver, but he just ignores them.  
I am directly quoting many of the same references that droliver uses, but if I use quotes that he disagrees with, he deletes them.  The issue is not who we are quoting, but whether we include both sides of the controversy.  I'd be glad to show exactly what I mean if JFW or dikke are interested.
Drzuckerman 16:33, 3 March 2007 (UTC)
thread_title:  Standards for wikipedia 

message: I voiced this opinion before about the picture of breasts that had undergone augmetation in the front of the article.  I am still wondering what purpose it serves other than the obvious.  However, I don't believe that the picture adds to the discussion.
There is a concern that women who are going for any plastic surgery may have psychiatric issues before undergoing the procedure. 
 
I vote for the serial MRIs.  Whether there is evidence that links silicone breast implant leakage to CTDs.  The seepage of silicone into the body does cause local inflammation and pain.  It is also dificult to remove from tissue once the leak has occurred.  This leakage is not clinically detectable so can go on for years until symptoms encourage diagnostic studies.  Possibly with performing regular MRIs we can diagnose this potential problem early.DrCarter12 16:34, 6 March 2007 (UTC)
replies: text: Is that supported by evidence, guidelines? JFW | T@lk 21:06, 6 March 2007 (UTC)
replies: text: JFW, routine serial MRI's have been endorsed by no one except the USFDA. Health Canada specifically mentioned they felt it was not evidence based medicine just one month prior to American approval, a reflection of the unique American political history with these devices. Standard recomendations for the rest of the world would be along the lines of screening on a clinical exam basis and doing ultrasound prior to MRI if rupture is suspectedDroliver 02:27, 7 March 2007 (UTC)
thread_title: DrCarter speaks

message: I am very concerned by some  apparent misunderstandings and misrepresentations of what I and other administrators have said. 
:"And, the 2 administrators, Dr Ruben and Sarah, both warned that no changes should be made to the article without a straw poll."
I have never said that no changes should be made without a straw poll. That is certainly not my position, it never has been and while I do not wish to speak for Dr Ruben, I do not believe it has ever been his position either. As I said at the time of the straw poll, I was looking for a version to use as a starting base to move forward with editing in order to stop the edit warring that was occurring between the two versions of the article. I thought I was quite clear that I did not intend the article to become locked down in that version, it was not an endorsement of that version and I certainly did not intend for that straw poll to lead to an ongoing editing process that involved straw polls for any and every change. That is not the way Wikipedia works and I believe that it is a violation of policy and Jimbo's foundation principles which mandate open editing. The straw poll was a once-off process to try to avert the edit warring. If other people wish to propose other straw polls, that is fine, but straw polls are not to be used as a strategy to prevent an editor, or a group of editors, from making edits.  
I am not sure why there is some sort of suggestion that Dr Oliver is not welcome to edit or not welcome to edit controversially. I am not aware of any grounds for imposing editing restrictions on Dr Oliver and anyone who wants to impose such restrictions needs to either propose community sanctions at the noticeboard or they need to request the arbitration committee impose editing restrictions. The only things I have asked Dr Oliver to do is to respect Dr Zuckerman's request that he not refer to her by her first name and that he refrain from injecting invective into discussion. I certainly do not and have never supported editing restrictions on Dr Oliver or any other editors here. I believe his input is valuable, as is the input of editors on the opposing side, and that the most well-rounded article probably lies somewhere in the middle of both points of view.
I am currently on a wiki-break but I was very concerned that my opinions and statements are being mistakenly misrepresented. Reverting on the basis that a straw poll is needed before changes are made to the article is not acceptable. Please do not do this. Thanks, Sarah 09:47, 10 March 2007 (UTC)
replies: text: Hi, I'm on a bit of a wikibreak currently, but would largely agree with Sarah. Certainly I would hope that any past comments of mine are not taken to mean that a straw poll has to be undertaken before any editing takes place (clearly silly at the level of spelling corrections). Editors are free to edit the article as they see fit - it is nolonger protected. Admins carry no real special weight in content disputes (vs perhaps how editors behave in such content disputes) other than perhaps a level of experience over a number of topics (and other disputes) that the various parties might choose to listen too (or not). All editors are free to edit this article, if an editor is thought problematic then raise a WP:RFC to discuss the perceived problems to try and reach understanding (or at least an appreciation of views). However the previous edit warring was most unpleasant and care needs be taken by everyone to try and prevent a return to mutiple sequential edits or revert-warring. So, no straw polls absolutely required, but it would seem sensible for editors to voluntarily try to discuss proposed major changes or altering tone/POV/NPOV or at least agreeing how to disagree, before rekindling the flames :-) That said there is no requirement in content discussion for straw polls, Wikipedia is not a democracy (one can be bold) likewise it is not a bureaucracy, but nor is it an anarchy :-) David Ruben  Talk  20:31, 12 March 2007 (UTC)
thread_title:  Misunderstandings 

message: I'm truly sorry that I misunderstood the previous statements made asking for a straw poll.  Nevertheless, several editors have agreed with my concerns about droliver's and jwolff's revisions, and more important, it is not appropriate for anyone to keep reverting to inaccurate information.
The revisions made by Jwolff and droliver regarding the mental health benefits of implants are inaccurate.  The data clearly show that for all plastic surgery, including breast augmentation, the benefits are specific to the body part that has been changed, but not to mental health or self esteem.  In fact, the most recent studies indicate that women and men with body dysmorphic disorder, many of whom undergo cosmetic surgery, do not benefit at all.  Those well documented facts should not be deleted. 
Similarly, there was general agreement about the risk information, and the only disagreements came from droliver, and perhaps jwolff.  They are entitled to their opinions, and the current version includes much of their content, but let's make sure the article is accurate and balanced. 
Drzuckerman 02:50, 11 March 2007 (UTC)
replies: text: Sorry for the PMID error, the correct one for Dr. Sarwer's article is [] (which you isn't summarized for you on pubmed). The French article with 'only' 25 patients was mentioned only to illustrate the fact there continue to be similar reports to what's been reported for nearly 50 years re. psychological aspects of breast augmentation procedures. I can point you to this continuem of papers if you're interested, but it's really beating a dead horse. There's also a whole other line of research on psychologic endpoints re. breast reconstruction & reduction patients which tend to imply many of these same outcomes. Again, my takehome point is that there is a long track record of attributing positive attributes, some of which may have been overstated. I think that's communicated in the entryDroliver 02:02, 22 March 2007 (UTC)
thread_title:  Changes for accuracy 

message: Let me clarify what I meant about the first sentence of this article.  It currently says:  
A breast implant is a prosthesis used to enlarge the size of a woman's breasts(known as breast augmentation or breast enlargement).
Even though the dictionary definition of augment is to "make larger" I think the problem with the sentence is that it says that enlarging the size of a woman's breasts is known as breast enlargement.  That is redundant.  Breast augmentation means the same thing but at least it uses a different word.
I agree with Dikke Poes that breast reduction could be enhancement.  And I also agree with Dikke Poes that enhancement certainly implies improvement, so augmentation or enlargement is a more NPOV term.  The first sentence could instead say:  
 
A breast implant is a prosthesis used to increase the size of a woman's breasts (known as breast augmentation or breast enlargement).
Is there any opposition?  I will wait a few days for feedback before revising it, to make sure that JFW does not object.  
I also agree about the marriage issue -- I will defer to Dr Carter, who mentioned that the study did not find a significant increase in married status. Drzuckerman
:Agree with version containing all synonyms. Most breast enlargements are with the use of implants. JFW | T@lk 07:06, 26 March 2007 (UTC)
thread_title: Compromises:  #1  augment

message: As several of us previously stated, the 2004 Danish study by Brieting et al specified statistically significant increases in several important autoimmune symptoms, including the unusual symptoms of Raynaud's disease.  It is important to distingush between symptoms and diagnosis, because much longer term studies are needed to determine diagnoses.  Symptoms can change significantly first.  So that change has been made. Drzuckerman
:Could you please wait until we're done discussing this?
:Inserting the phrase "More research is needed" is editorialising and fails WP:NPOV.
:Why are the reviews quoted "government" reviews, rather than "independent systemic (comprehensive)"? You haven't explained.
:There's no such thing as "autoimmune symptoms". There are symptoms, and there's autoimmune disease. Hepatitis B and osteoarthritis are not autoimmune, yet both can cause joint pains. JFW | T@lk 07:06, 26 March 2007 (UTC)
thread_title:  Compromises # 2: Symptoms can increase even if diagnoses haven't

message: I was surprised to see DrCarter's comments about "revert" regarding her edits, but realized she didn't revert the entire article but only revised one small section on patients.  She did a great job of clarifying the data on patient characteristics.  JFW or Dikke had asked for more info on the marital status data.  DrCarter, can you provide that?  I think that would help everyone, since that keeps getting changed back despite the lack of data to support it
Drzuckerman
--JWolff, do I understand correctly that you will always revert to droliver's version of this article, no matter who or how many editors disagree and no matter what evidence we provide that droliver's version has inaccurate representations?   Drzuckerman
:This is not about versions anymore. I have already explained that I will revert if edits are not sufficiently discussed and explained. I can't help the fact that Droliver seems to be largely playing things by the book.
:What concerns me more is the fact that there are so many editors (Drzuckerman, DrCarter12, OBOS editor etc) all having empty userpages, all editing this article alone, and occasionally doing things rather similarly (e.g. using HTML markup when this is not strictly necessary). I have tried to assume good faith, but occasionally I wonder whether all those voices could all be coming from the same person. In other words, whether there is sock puppetry going on here. I will not make this point again, but if there are ongoing concerns I will have to request that identities are verified. Undeclared sock puppetry is a bannable offence. JFW | T@lk 07:48, 2 April 2007 (UTC)
thread_title: More revisions

message: Let's try to reach a concensus this way.  Below is a suggested revision of the capsular contraction section only.  I thought that we could discuss my proposed changes and then hopefully come to a final product that everyone can agree with.  Thanks.
“Capsules of tightly-woven collagen fibers form as an immune response around a foreign body (eg. breast implants, pacemakers, orthopedic joint prosthetics), tending to wall it off. Capsular contracture occurs when the capsule tightens and squeezes the implant. This contracture is a complication that can be very painful and distort the appearance of the implanted breast. The exact cause of contracture is not known. However, some factors include bacterial contamination, silicone rupture or leakage, and hematoma.Capsular contracture may happen again after this additional surgery.
Correction of capsular contracture may require surgical removal or release of the capsule or removal (and possible replacement) of the implant itself. Closed capsulotomy (disrupting the capsule via external manipulation), was once a common maneuver for treating hard capsules; implant makers now warn against the procedure because it can cause implant rupture. Although there is no agreement on effectiveness, nonsurgical methods of treating capsules include external ultrasound{Planas J.Five-year experience on ultrasonic treatment of breast contractures.Aesthetic Plast Surg.2001.25(2):p89-93},treatment with leukotriene pathway inhibitors (Accolate, Singulair){Schlesinger SL, et al.Zafirlukast (Accolate): A new treatment for capsular contracture. Aesthetic Plast Surg.2002.22(4):329-336},and pulsed electromagnetic field therapy{Silver H. Reduction of capsular contracture with two-stage augmentation mammaplasty and pulsed electromagnetic energy (Diapulse therapy).Plast Reconstr Surg.1982. 69(5):802-8}.”DrCarter12 23:56, 30 March 2007 (UTC)
replies: text: In point of fact, prevention is discussed in the literature at least as much as treatment
Droliver 15:22, 24 May 2007 (UTC)
thread_title:  Revision of the "Capsular contracture" section ONLY 

message: I know there was some debate about this before, but if a fair use picture is going to be shown of a completed breast augmentation that didn't work, shouldn't one also be shown of one that did work? Showing neither or showing both seems fair, but showing an image of only one possible result seems like weasel wording the article only with images not words. [2007-05-12 T 23:06 UTC]
::At some point I've been planning on making a gallery for a handful preop/postop pictures of sterotypical cases and results for augmentation, augmentation/lift case, and reconstructive patients. I just haven't gotten around to looking thru pictures I have with consents for releaseDroliver 02:47, 15 May 2007 (UTC)
thread_title: Article Picture

message: The fourth paragraph ends, "MRI data from the US-FDA required "core" studies of contemporary implants has demonstrated low rupture rates ("
Is anyone able to fix this?  It seems there is something missing at the end.   Thank you.    Fanra 22:08, 9 June 2007 (UTC)
thread_title: Rupture

message: It seems the word "revision" is in question here.  Let's look at the line: "Most common indications for re-operations have included major or minor cosmetic revisions, capsular contracture treatment, and replacement of ruptured/deflated implants."
Now let us look at the citation for that line:  http://www.fda.gov/cdrh/breastimplants/handbook2004/localcomplications.html
According to the citation, it does not give actually figures for what are the most common indications for re-operations, however, it does state (without giving numbers) that "You are likely to have the implants removed, with or without replacement, because of one or more complications over the course of your life."  The citation goes on to state the various reasons that women will have to get re-operations.
The word "revision" is used twice.  Once in the section heading, where it states, "Key points to consider whether you are undergoing breast augmentation, reconstruction, or revision:", and again, where it discusses type of surgical procedure(s), "scar or wound revision (e.g., surgical removal of excess scar tissue)".  The word "revision" is not the most common word used to describe the reasons for re-operation, the word used is "complications".  Indeed, while "revision" is used 2 times, "complication" is used 19 times.
When it was changed back from "repairs", which I put in, back to "revisions", it was said that the common medical term is "revisions", not "repairs".  If that is true, then it needs a citation.  Since the citation used was the FDA article, using the word "revision" is wrong, since it is a incorrect citation.  According to the article cited, the word used should be "complications".  If there is a feeling that the word "revisions" should be used instead, then we need to see some citations that support it.  Remember that Wikipedia is all about referenced sources, not what we might think (or know) is correct but what the sources say.
I will give people time to respond to this before I change it to match the source cited.  Fanra 11:19, 14 June 2007 (UTC)
replies: text: "Revision" is the term used for any surgery that needs to be re-done. That applies to hip replacements as much as it does to breast implants. On the whole, references are not needed to support the use of terminology. JFW | T@lk 22:32, 28 June 2007 (UTC)
thread_title: Repair or revision surgery