Breast Implants May Contribute to Increased Use of Public Health Services

Mindy Hung

December 05, 2003

Dec. 5, 2003 — Women with breast implants are hospitalized and visit physicians more frequently than women who have not undergone implantation surgery, according to a retrospective cohort study funded by the British Columbia Centre of Excellence for Women's Health in Vancouver, Canada.

"Although many researchers have tried to investigate links between breast implants and health outcomes, there are challenges that make it nearly impossible to come up with conclusive results" writes Aleina Tweed, a research assistant at the center. "Rather than investigating health outcomes, [this study] focuses on the issue of health care utilization."

The investigator collected data over an 11-year study period (1988/89 to 1998/99) from a study group of 147 women who self-identified as having had breast implant surgery. The study group subjects were sent a survey that collected demographic information; implant information such as the year of implantation; type of implant and repeat surgeries; lifestyle information; and use of alternative health care services and out-of-country health services.

Tweed also used data collected from an anonymous comparison group of 583 women matched to the study group by birth cohort and geographic region. Subjects were selected randomly from the British Columbia linked datasets by the Center for Health Services and Policy Research at the University of British Columbia. The investigator excluded women from the comparison group who appeared to have had a breast implant.

Statistical tests performed included tests for normality of outcome variables, odds ratios (ORs) and confidence intervals (CIs) to examine relative risk (RR). The investigator also attempted to identify significant health care utilization between the two groups using Wilcoxon rank sum tests and Pearson's chi-square tests.

Ninety-two women in the study group completed questionnaires. Of the respondents, 51% reported at least one additional breast-implant related surgery. Forty percent of women who responded had their implants permanently explanted.

Subjects who had received implants were more likely to be admitted to hospital than those who did not have breast implants (OR, 4.26; 95% CI, 2.58 - 7.02). Women in the study group were also more likely to be admitted electively (OR, 1.90; 95% CI, 1.50 - 2.39) and less likely to be admitted as urgent cases (OR, 0.60; 95% CI, 0.46 - 0.78) or as emergency cases (OR, 0.53; 95% CI, 0.35 - 0.79) than women in the comparison group.

Despite limited relationships, neither lifestyle factors, nor implant factors accounted for increased health utilization. Smoking, however, was associated with a significant increase in all outcome areas among women in the study group. Those who had ever smoked at all (n=50) reported an average of 4.12 hospital visits compared with those who had never smoked (n=42; P = .48).

Study group respondents who reported having smoked also visited the doctor more on average over the study period than those who had not smoked (160.20 visits vs.126.02 visits; P = .006). The longer implants had been in place the fewer hospitalizations women underwent.

Some of the limitations include sample bias as a result of having participants identify themselves as having undergone breast implant surgery. Tweed also notes that the inability to create a random study group limited the project. She acknowledges the possibility that some women in the comparison group might have had breast implants.

"Breast implant surgery is not deemed medically necessary and is performed — and paid for — privately in the vast majority of cases. However, it appears to directly contribute to an increased need for public health care services among the women receiving these devices," Tweed writes.

"This study points the way towards more research in order to more definitively and completely investigate the health care utilization patterns of women with breast implants and to better understand the causal relationship between breast implants and health care use," she concluded.

Reviewed by Gary D. Vogin, MD

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