Today, the FDA released a report on the safety of silicone gel-filled breast implants, including recommendations for both women who have or are considering the implants and health care providers.

In 1992, silicone breast implants were taken off the market after the FDA decided that the manufacturers had not adequately addressed safety concerns. In 2006, the agency approved several styles of silicone breast implants made by two companies, putting the devices back on the market for cosmetic purposes, and asked that the makers conduct additional safety studies. Today’s release provides recommendations based on information from the studies that have been completed so far.

The FDA concludes that implants are “safe and effective” when used “as labeled,” and that “Despite frequent local complications and adverse outcomes, the benefits and risks of breast implants are sufficiently well understood for women to make informed decisions about their use.”

Common local complications and adverse outcomes are listed as:

capsular contracture, reoperation, implant removal, and rupture or deflation of the implant. Other complications include wrinkling, asymmetry, scarring, pain, and infection at the incision site…Women with breast implants may have a very small but increased likelihood of being diagnosed with anaplastic large cell lymphoma.

Women considering implants are advised to be aware of the potential for these complications, and to have periodic MRI exams to detect “silent rupture” of the implant. These MRIs are supposed to be done at 3 years after implantation, and every 2 years after, which the agency warns “is costly and may not be covered by your insurance.”

The FDA materials also urge women to “recognize that breast implants are not lifetime devices” and “assume that you will need to have additional surgeries.”

The agency has provided this one-page consumer guide, Things to Consider Before You Get Breast Implants, a more detailed booklet on local complications and adverse outcomes, and a guide to questions to ask before getting implants.

This week, the U.S. Food and Drug Administration released information describing “a possible association between breast implants and the development of anaplastic large cell lymphoma (ALCL), a rare type of non-Hodgkin’s lymphoma.”

The FDA reviewed literature and related information from 1997-2010 and identified 34 unique cases of ALCL in women with either saline or silicone breast implants. This is a relatively small number, and the agency indicates that more data is needed to better understand any possible link between implants and the disease. As a result, the agency is asking healthcare providers asking to report all confirmed cases of ALCL in women with breast implants through the MedWatch Program.

A consumer update has been provided by the FDA – women with breast implants and no unusual symptoms are advised to continue monitoring their implants and to notify their physicians if any changes are noticed. They also advise that “women considering breast implants should be aware of the very small, but increased risk of developing ALCL and discuss it with a physician.”

Additional FDA Resources:

• Questions and Answers about Anaplastic Large Cell Lymphoma (ALCL)
• Anaplastic Large Cell Lymphoma (ALCL) In Women with Breast Implants: Preliminary FDA Findings and Analyses
• FDA Medical Device Safety Communication: Reports of Anaplastic Large Cell Lymphoma (ALCL) in Women with Breast Implants
• Breast Implants – general consumer and safety information

View all Women’s Health Heroes. Voting closes May 14. Background info here.

Entrant: Melinda Bartlett
Nominee: Carol Ciancutti-Leyva, Director of “Absolutely Safe”

I nominate Carol Ciancutti-Leyva as a Women’s Health Hero for the 2010 Our Bodies, Ourselves Women’s Health Heroes awards. She is the director of “Absolutely Safe,” a documentary exploring the safety of breast implants in the United States.

Ms. Ciancutti-Leyva has a personal connection to her project, as she believes silicone breast implants contributed to her mother’s decline in health. According to the documentary’s website, “Absolutely Safe” does not set out to prove that all breast implants are harmful to women, but rather it explores both sides of the argument and puts forth all information pertaining to the safety of implants.

I admire Ms. Ciancutti-Leyva’s bravery to question implant safety in the United States. I admire her conviction to question what we have been told about breast implant safety by medical professionals, plastic surgeons, and those set to profit from breast augmentations.

I believe that women deserve to know whether there is a possibility that breast implants could be harmful to their health, and Ms. Ciancutti-Leyva is making great strides in creating a new discourse surrounding the absoluteness of breast implant safety.

Made in 2007, “Absolutely Safe” follows the stories of five women and their experiences with breast implants. Some women are considering getting breast implants; others want their implants removed, or have had their implants removed and yet still feel ill.

While some women in the film are excited about their upcoming surgery, others share their negative experience with breast implants, as the women explain how they felt sick after getting implants, and how their health has steadily declined. Many of the women believe that their implants have been detrimental to their health.

“Absolutely Safe” explores these issues and speaks with doctors and advocates on both sides of the argument. I nominate Ms. Ciancutti-Leyva for her advocacy on behalf of women everywhere.

The current issue of the journal “Clinical Risk” has of a series of articles commenting on risk and cosmetic surgery, from reputation and regulatory risks to physicians to clinical outcome risks for patients.

Because the journal is based in the UK, much of the discussion of the regulatory environment is focused there, but the articles also address the trend of cosmetic surgery tourism between nations and general perceptions of and risks to patients seeking cosmetic surgery.

In the editorial for the issue, plastic surgeon Nigel Mercer writes that “We have reached a stage where public expectation, driven by media hype and, dare one say, professional greed, has brought us to a ‘perfect storm’ in the cosmetic surgical market.”

He also describes a “massive increase in ‘marketing’, including discount vouchers, 2-for-1 offers and holidays with surgery! In no other area of medicine is there such an unregulated mess. What is worse is that national governments would not allow it to happen in other areas of medicine. Imagine a ‘2-for-1’ advert for general surgery?”

Another author, Khoo, notes the “grey area between advice and advertising” when surgeons provide information to prospective customers (patients). Similarly, Bradbury writes that cosmetic surgeons should be prepared to decline to do procedures, to say “no” or “not now,” and should avoid pushing extra procedures on a client.

The idea that cosmetic surgery carries minimal risk is also criticized. Mercer writes that “the media and both published and broadcast ‘marketing’ have wittingly or unwittingly given the public the impression that cosmetic surgery procedures are quick fixes and carry no risk of downtime or complications. Nothing could be further from the truth and it defies common sense to think otherwise.”

The BBC has additional coverage of the issue. On a related note, The Guardian published a story last Friday on labiaplasty and the increase in the number of these procedures in the UK in recent years.

Over at the Huffington Post, Marcia Yerman examines arguments surrounding the safety of breast implants, as presented in the documentary film “Absolutely Safe” — and efforts underway to require doctors to provide accurate information about breast implants.

Our Bodies Ourselves has teamed up with “Absolutely Safe” director Carol Ciancutti-Leyva and the film company Amaranth Productions to advocate for legislation that will require plastic surgeons to provide prospective patients with a  booklet outlining the risks, complications and unknowns, along with alternatives to reconstructive breast implant surgery.

As Yerman notes, such legislation is not without precedent:

[The] model for legislation is a New York State Law (State of New York – Article 24-E, Section 2499w New York State law) that required the state’s Department of Health to publish a booklet that must be received by every woman considering a hysterectomy. It succinctly outlines risks, complications, alternative treatments, and recuperation expectations. Presently, the FDA has a guide on breast implants, but it is not legally mandated that prospective patients receive it. The “FDA Breast Implant Consumer Handbook” was published in 2004. Ciancutti-Leyva told me that the information reads as “a cautionary tale.” [...]

The need for informed consent was addressed as far back as 2000, in an editorial appearing in the Fall issue of The Journal of the American Medical Women’s Association. Written by Nancy Neveloff Dubler, LLB and Anna Schissel, JD, it was entitled “Women, Breasts, and the Failure of Informed Consent.” The authors examined whether “informed consent for breast augmentation is too fragile a reed to withstand the storm of commerce.”

You better believe opposition will be strong. Last year I discussed a marketing campaign by breast implant manufacturer Allergan that recasts augmentation surgery as a feminist act — a choice women can make for themselves. Allergan actually says its “empowering” women with information about size and shape options. The company has one goal in mind: to increase the number of breast implant procedures from 400,000 per year to more than 1 million.

If you really want to do something empowering, get involved with the informed consent campaign. Leave a comment on Marcia Yerman’s story (a good way to help promote the piece at Huffington Post). Visit the “Absolutely Safe” website for more information about what informed consent means, and check out the film’s trailer below.

You might also want to bookmark Ciancutti-Leyva’s blog for the latest news about breast implant safety. Finally, the Politics of Women’s Health section of “Our Bodies, Ourselves” contains a good amount of information on breast implants, including articles and online resources.

Chemicals in Toyland: The Consumer Product Safety Improvement Act (CPSIA) took effect this week, mandating stricter enforcement of lead and phtalates in children’s products and toys.

“While the ban was hailed as a victory for children’s health, it’s no guarantee that the products are safe,” reports NPR’s “Morning Edition.” “That’s because companies currently aren’t required to publicly disclose the chemicals they use in place of phthalates — and little is known about the health effects of one of the most widely used alternatives.”

Pthalates have been shown to affect the development of the male reproductive system in lab animals. They’re also present in some cosmetics, personal care products, pharmaceuticals, food packaging and cleaning and building materials — making them almost impossible to avoid. Check out NPR’s timeline of phthalate regulation and an interactive look at chemicals in the home.

IVF – New Lab for Studies: “In addition to helping thousands of infertile couples have children, ‘test tube’ babies are offering scientists a novel laboratory for resolving one of the most vexing debates in science: nature vs. nurture,” writes Rob Stein in the Washington Post.

In the first study of its kind, British researchers have studied children conceived through in vitro fertilization (IVF) to examine whether children whose mothers smoked during pregnancy were more likely to develop behavioral problems because of the toxic effects of smoking — as has been suspected — or because their mothers passed on a genetic predisposition to antisocial behavior.

The study, which appears to debunk the notion that smoking’s effects on the brain of a developing fetus result in antisocial tendencies, could be the first in a series of attempts to use the approach to disentangle whether genes or various prenatal exposures are responsible for later behavioral problems.

Friends Don’t Let Friends Get “Booty” Injections: And definitely not from a woman who administers shots without a medical license. Two women are now hospitalized in critical condition in Tampa, Fla. “It almost is bootleg cosmetology here,” said sheriff’s office spokesman JD Callaway.

Plus: The economy is having some effect on cosmetic enhancements, reports The New York Times. Natasha Singer writes that doctors and pharmaceutical executives thought antiwrinkle shots like Botox would be resistant to the downturn, but the latest earnings report from Allergan, the maker of Botox, fell almost 9 percent compared with a year earlier. Allergan’s sales of breast implants were down 12 percent.

“You could forecast that with implants, but the bigger question was, ‘How have injectables been holding up?’” said Gary Nachman, an analyst with Leerink Swann, a health care investment bank. “Now, even the injectables have been impacted significantly.”

Maternal & Child Health in the Obama Administration: “[...] President Obama has lauded and pledged to expand presidential initiatives to fight HIV/AIDS, TB and malaria — recognizing the sizeable effect they have had not only in saving hundreds of thousands of lives, but also in improving U.S. foreign policy. Now is the time for President Obama to elevate the issue of global family health to that high level,” argues Maurice Middleberg, vice president for public policy at the Global Health Council.

Council members, including global maternal health, child health and family planning organizations, are developing a framework for a Global Family Health Action Plan.

On Their Own Terms: “[B]etween the clinic demonstrations, the political discussions and the imprecations from the pulpit, too many American women have come to feel that their pelvis is public property. Slowly, quietly, a new abortion method has become part of the landscape, and it’s no accident that those women who have chosen it often cite reclaiming privacy and control as the reason,” writes Anna Quindlen at Newsweek, describing how RU-486 has allowed women to keep abortion private and personal.

Plus: Glamour magazine recently featured a whole section on abortion, acknowledging that one in three women will have at least one abortion by age 45. Eight women share their personal stories.

Salma Hayek Sparks Breastfeeding Discussions: By now you’ve probably heard about Salma Hayek breastfeeding an infant in Sierra Leone. ABC’s “Nightline” filmed Hayek during a trip to Africa to spotlight efforts to eliminate tetanus through vaccinations. The infant’s mother had no milk, so Hayek did what came naturally. Tracy Clark Flory nicely sums up some of the respectful and sophmoric public reactions.

Hayek, who is still breastfeeding her 1-year-old daughter, said, “I actually think my baby would be very proud to share her milk. And when she grows up I’m going to make sure she continues to be a generous, caring person.” Read more reactions and more about Hayek’s journey. The full “Nightline” episode is quite moving.

Happy Valentine’s Day: Some feminist advice from RH Reality Check. Plus, researchers at the University of Iowa report on what college-age men and women are looking for in a mate and how priorities have changed since the 1930s. While it’s nice to see that “chastity” is no longer an important characteristic, I’m surprised “similar political background” is considered unimportant as well.

And here’s the best act of defiance I’ve seen mentioned for Valentine’s Day — members of the Facebook group “A Consortium of Pub-going, Loose and Forward Women” are encouraged to “Join us on Feb. 14, Valentine’s Day, the day on which Indian women’s virginity and honor will self-destruct unless they marry or tie a rakhi. Walk to the nearest pub and buy a drink. Raise a toast to the Sri Ram Sene.” Swati Prasad explains the rebellion against the right-wing Sri Ram Sene.

OBOB readers may have heard about nonsociety.com, a site developed by internet celebrity Julia Allison and friends (if you haven’t, you’re doing just fine — really). I normally wouldn’t point to it, but Mary Rambin’s post — titled “My Body, My Botox” — deserves mention, if only to note that this is what passes for reasoning when it comes to cosmetic surgery. Fortunately, Amelia at The Frisky pretty much has the outrage covered.

On the subject of acceptance, Mary, who admits to starting Botox at age 23 for forehead wrinkles (she is 26 now), writes that while breast implants once had a stigma, today “women are proud to not only admit to this procedure, but some women will also rave about their doctors and ask you if you would like to feel his/her handiwork. Furthermore, as the NY Times pointed out the other day, boobs are now a standard high school graduation gift (and in my experience they have been for years now). Breast implants are now socially acceptable. ”

And to what do we owe thanks for this advancement? Here, with all its glorious typos, is the answer:

I site Roe v. Wade because it serves as a marker of people accepting (maybe not respecting) a woman’s right to choose. Although abortion is still an issue at the forefront, it’s notable the Supreme Court recognized women should be able to do what they feel is right for themselves.

Cosmetic procedures should be viewed in the same light. Not to mention the procedures are in no way effecting another human being, so the severity of the issue is considerably less. But as with breast implants, time will have to pass before others view cosmetic procedures as acceptable. I won’t say “the norm” because I do think artificial enhancement should carry with it serious consideration before you undergo any sort of procedure. Other things like manicures and pedicures, dental work, highlighting your hair, are all “procedures” that are completely unnatural but we consider normal.

And may God bless the United States of America!

(Commence head-banging.)

Who Decides? A State-by-State Analysis: NARAL Pro-Choice America has released its 18th edition of “Who Decides? The Status of Women’s Reproductive Rights in the United States.” The report summarizes the state of women’s access to reproductive healthcare nationwide, including legislation considered and enacted in 2008. This year’s edition also examines attacks on choice in the states and in the courts and highlights pro-choice legislative and non-legislative victories, including NARAL’s Prevention First initiative.

Trading in “Barefoot and Pregnant” for Economic and Reproductive Justice: “The relevance of barefoot and pregnant remains central to an inclusive and just America,” writes Gloria Feldt. “Economic parity and reproductive justice are still intertwined, not only in the lives of individual women; they are indivisibly connected to our economic recovery as well.”

A Funny Thing Happened on the Way to the Clinic …: That’s the title of an essay in Exhale’s latest issue of its bilingual abortion zine, “Our Truths/Nuestras Verdades” (download the pdf). Yes, it’s the humor issue. As Exhale founder Aspen Baker writes in the intro to the issue:

Abortion is a serious personal issue that is hotly debated in public while real women have abortions in private, often in secret, and with little social support or understanding.

What could possibly be funny about that?

In this issue of Our Truths, we aim to find out. We witness funny women who use humor to get through tough times, truth-tellers who bust ridiculous myths about women who have abortions, and discover laughter that heals the soul. We also question humor that hides what’s real, judges or hurts others.

Check it out.

Massachusetts Adopts Breastfeeding Law: Massachusetts this month became the 48th state to offer legal protection to women who breastfeed their children in public. The Massachusetts Breastfeeding Coalition will provide mothers a “license to breastfeed” card with details of the new law and instructions on how to report violations, according to the Patriot Ledger.

The state Legislature passed the bill, “An Act to Promote Breastfeeding,” in December, and the governor signed it into law Jan. 9. Up to this point, women could have been prosecuted for indecent exposure or lewd conduct.

North Dakota and West Virginia remain the only states without breastfeeding legislation.

The Cutting Edge of Opera: “Skin Deep,” a new production opening in the UK, looks at the work of an unscrupulous fictional plastic surgeon: Dr. Needlemeier. At this BBC video slideshow, composer David Sawyer describes the opera as a story about “fear of death, vanity and the wish for immortality.” The “Skin Deep” website is far from superficial.

NABJ Conference on Health Disparities: The National Association of Black Journalists is hosting a conference on health disparities Jan. 30-31 at Morehouse School of Medicine.

The purpose is to “give journalists insight into health disparities affecting the African American community, resulting in significantly higher mortality rates. Learn how to cover major health and medical stories that make an impact. Topics include obesity, heart disease, stroke, HIV/AIDS, mental health and the aftermath of Hurricane Katrina.”

IVF Doesn’t Restore Fertility in Women Over 40: “A study involving more than 6,000 women who underwent the treatment at a large Boston clinic found that while [in vitro fertilization] could give infertile women younger than 35 about the same chance of having a baby as women typically have at that age, it could not counteract the decline in fertility that occurs among those older than 40,” writes Rob Stein at the Washington Post.

“Even as effective as IVF is, it can’t reverse the effects of aging,” said Alan S. Penzias of Harvard Medical School, who led the study, published in the New England Journal of Medicine. “We cannot reverse the biological clock.” Here’s the study’s abstract.

Kidney Transplants Less Likely to go to Women: A new study indicates that women over 45 are significantly less likely to be placed on a kidney transplant list than their equivalent male counterparts, even though women who receive a transplant stand an equal chance of survival. The study appears online in the Journal of the America Society of Nephrology.

“As woman age, that discrepancy widens to the point where woman over 75 are less than half as likely as men to be placed on a kidney transplant list,” said lead researcher Dorry Segev, M.D., a Johns Hopkins transplant surgeon. “If the women have multiple illnesses, the discrepancy is even worse.”

Fosamax Linked to Two Diseases: “Two recent reports have linked the osteoporosis drug alendronate (Fosamax) with rare but serious side effects,” reports the L.A. Times.

“In a letter to the New England Journal of Medicine published Jan. 1, a Food and Drug Administration official reported that since Fosamax was first marketed in 1995, 23 cases of esophageal cancer in patients taking the drug — including eight deaths — have been reported to the agency. And a USC study published in the January issue of the Journal of the American Dental Assn. reported that nine patients who were taking Fosamax suffered osteonecrosis of the jaw — a bone-killing infection — after having teeth extracted at USC dental clinics.”

Job Bias Bills Pass the House: The House on Friday passed two bills related to sex discrimination and workers’ pay. From The New York Times:

One, approved 247 to 171, would give workers more time to file lawsuits claiming job discrimination.

The bill would overturn a 2007 decision by the Supreme Court that enforced a strict 180-day deadline, thwarting a lawsuit by Lilly M. Ledbetter, a longtime supervisor at the Goodyear tire plant in Gadsden, Ala. Three Republicans voted for the bill.

The other bill — passed 256 to 163, with support from 10 Republicans — would make it easier for women to prove violations of the Equal Pay Act of 1963, which generally requires equal pay for equal work.

President Bush threatened to veto both bills, saying they would “invite a surge of litigation” and “impose a tremendous burden on employers.”

The sentence that follows the Bush quote is the best: “Congress will not give him the opportunity.”

That’s because in less than two weeks there will be a new president in town who is enthusiastic about signing both bills.

Plus: Jill Miller Zimon has a good wrap-up and points to this NWLC page, from which you can contact your senator and urge support for these bills.

Health Issues at the Top of the List: Women’s eNews looks at the to-do list of the Congressional Caucus for Women’s Issues. In addition to reintroducing a bill to address heart disease in women, the Caucus intends to focus on human trafficking, sexual and domestic violence against women, women in the military and the backlog of DNA evidence in rape cases.

Lesbian Health Day & Summit: Jan. 5 was Blog for Lesbian Health Day. In response, Jane, a community health nurse and nurse practitioner student who blogs at Fallacy Findings, wrote an excellent post that includes discussion of “lesbian neglect” — which “refers to the fact that many lesbians fail to get Pap smears, do not get them regularly, and/or do not think they need to get them” — and lesbian health as a much-needed topic in nursing and medical schools.

The blogging event was organized as a lead-up to the National Lesbian Health Summit 2009 taking place March 6-8. Organized by the Lesbian Health & Research Center at the University of California, San Francisco, among other groups, the summit “approaches health issues from the perspective of those who face disparities and discrimination and who also generate health and resilience everyday. We will engage in deep thinking and extended discussion to create new responses and innovative programming that reflect our lives.”

Should a TV Doctor be Surgeon General?: Well looks at what health and science blog are saying in response to the news that Sanjay Gupta, a neurosurgeon and CNN’s chief medical correspondent, is Obama’s pic for U.S. surgeon general. Rachel weighs in with some concerns. Here are more links from Shakesville.

The Easy-Bake Oven in My Vagina: Over at Womanist Musings, a reflection on motherhood, race and class includes this gem:

How many of you have run across the vagina equals Betty Crocker syndrome? If you have not, then you probably soon will.  The education system seems to think that this is still 1950 and that mothers are at home with tons of time on their hands to participate in bake sales.  This request is never gender neutral, even though Daddy has two perfectly good hands himself.  Why is this still the norm when most women work a double day?  Even if a woman is a stay at home mother how does a vagina translate into the ability to bake? Do I have an easy bake oven stashed somewhere in my vaginal opening that I was not aware of?

Pull Up a Chair: On my to-do list was to write about the blog The Kitchen Table, a dialog between Princeton University professors Melissa Harris-Lacewell and Yolanda Pierce. Miriam beat me to it and sums up why it’s an essential read.

In this post, Harris-Lacewell discusses violence against gays and lesbians, in the context of the movie “Milk” and the brutal gang rape of a woman who may have been targeted because she is openly lesbian. She writes:

As much as I appreciated Milk, the story has the unfortunate effect of reinscribing an image of gay identity as primarily white, male, urban, and childless. The American imagination of “gay people” as childless, white, men living in cities can render invisible lesbian mothers of color like the woman attacked in Richmond. [...]

Harvey Milk understood that “straight folks” needed to feel our interconnections with gay men and lesbians. We have to know that our destinies our intertwined. We cannot be a great and free country while we sanction violence against and degradation of our neighbors. I consider it a sacred and politically necessary task to speak out for the rights and equalities of others, because they are not truly other. We are all one.

Information on sending contributions or cards of sympathy and solidarity is also provided. Four suspects in the case were arrested last week.

Eye-Rolling Quote of the Week: Ann Coulter refers to single motherhood as “a recipe to create criminals, strippers, rapists, murderers.” Remind me again why she is considered a suitable interviewee?

The Deeper Truth: A new study that looked at the five most popular women’s magazines in Canada found that articles commonly portray cosmetic surgery as an empowering option that improves women’s emotional health, even though there’s no scientific consensus that it does anything of the sort. Here’s Reuters’ take, and the abstract:

Content analyses show the articles tend to present readers with detailed physical health risk information. However, 48% of articles discuss the impact that cosmetic surgery has on emotional health, most often linking cosmetic surgery with enhanced emotional well-being regardless of the patient’s pre-existing state of emotional health. The articles also tend to use accounts given by males to provide defining standards of female attractiveness.

Inside the Medicine Cabinet: Chicago Tribune health writer Julie Deardorff lists essential items to keep in your medicine cabinet (courtesy of the American College of Emergency Physicians) and chemicals found in personal care products that you might want to consider keeping out.

Look Your Best in the New Year: Writing in The New Yorker, Amy Ozol reveals her secrets to “a trim and attractive physique” in just nine easy steps. She spent years perfecting this system, as you can tell. A sampling:

Step 5: Surround yourself with thin people. This will naturally encourage you to emulate their healthy habits. Weigh your friends on a regular basis, then weigh yourself. Do you have a friend who weighs less than you? If so, consider gastric bypass surgery.

First, An Important Announcement: Don’t burn the gift-wrapping paper. In case you didn’t know, it’s bad for you. And remember to check new toys for lead.

New Reconstructive Surgery Options Not Discussed: Women undergoing reconstructive breast surgery are often not told about the full range of options available to them, reports The New York Times.

For instance, there is a new procedure that involves transplanting a wedge of fat and blood vessels from the abdomen or buttocks, which would be refashioned to form new breasts. This procedure is more complex and less profitable for doctors than breast implants.

The story also mentions this language appropriation:

To raise awareness of breast reconstruction and to market it to patients, the American Society of Plastic Surgeons has adopted the vocabulary of the movement to support a woman’s freedom to choose an abortion, adjusting it for women with breast cancer. Although women “don’t choose their diagnosis, they can choose to go ahead with reconstruction or not, and with the aid of a knowledgeable plastic surgeon they can choose what their options might be,” Dr. Linda G. Phillips, a plastic surgeon in Galveston, Tex., said in a telephone news conference organized by the plastic surgery society to mark Breast Cancer Awareness Month in October. “Then they have that much more power over their lives if they have that power to choose.”

But for many patients, the options may be limited because their doctors are not proficient in the latest procedures. Dr. Michael F. McGuire, the president-elect of the American Society of Plastic Surgeons, said it is not unusual for surgeons to omit telling patients about operations they do not perform.

Single-Payer Health Care Unlikely: “President-elect Barack Obama said at a town-hall meeting in August that he would ‘probably go ahead with a single-payer system’ if he were designing a system from scratch. But that’s not anywhere close to what he’s been advocating,” reports NPR. Congress seems to feel the same way.

That frustrates single-payer health plan advocates like David Himmelstein, an associate professor at the Harvard Medical School and co-founder of Physicians for a National Health Program, which has been advocating for a single-payer model since the late 1980s.

HHS Rule Could Override Plan B Protections: “New federal regulations, set to take effect Jan. 18, could override Connecticut’s law requiring all hospitals to offer rape victims emergency contraception, according to Attorney General Richard Blumenthal,” reports the New Haven Register. “Blumenthal said he plans to fight the federal rule, issued by the U.S. Department of Health and Human Services. It reinforces protections for health care workers and institutions that refuse to provide certain services, such as abortions, for personal reasons.”

Plus: Read more about the new “conscience” rule here. Its one of several Bush-era regulations women’s health activists expect the new Obama administration to overturn.

FDA to Reconsider Plastic Bottle Risk: In August, the FDA concluded that bisphenol-A, a chemical found in numerous plastic products, including baby bottles, water bottles and metal can linings, is safe, despite the fact that many scientific studies have found otherwise.

But that wasn’t the end of the story. As The New York Times reports, the FDA’s science board subcommittee on BPA found that the FDA was wrong to disregard research showing health effects even at extremely low doses. The FDA is now reconsidering its position — which it reached after relying on studies funded by the American Plastics Council.

“This was the F.D.A. finally acknowledging that its assertion that BPA is safe may not be correct,” said Dr. Anila Jacob, a physician and senior scientist at the Environmental Working Group. “Still, we don’t think it’s enough. With millions of babies being exposed to this chemical on a daily basis, every day we continue to delay removing this chemical from baby products is another day millions of infants continue to be exposed.”

And now, 2008 top stories …

• RH Reality Check spotlights the top 10 reproductive health stories, as chosen by readers. Amanda Marcotte’s podcast looks at the year’s top 10 major stories in sexual and reproductive health — and good news may actually outweigh the bad.
• International Women’s Health Coalition features the top 10 wins for women’s health and rights.
• Change.org’s Jen Nedeau selects the top 10 moments in feminism, as does Hugo Schwyzer.
• Women’s eNews reveals the top five “cheers” and “jeers” of the year.

*Any other lists or favorite stories you want to share? Add your links in the comments.

Earlier this year we introduced readers to “Absolutely Safe,” a documentary about the safety of breast implants told through the stories of women whose choices intersect with health, money, science and cultural pressures that narrowly define beauty.

Directed by Carol Ciancutti-Leyva, the documentary was screened at a number of film festivals and on college campuses, and it received lots of praise (including from our own Judy Norsigian — Our Bodies Ourselves is one of the film’s main outreach partners).

It is now available on DVD, and the distributor is offering Our Bodies Our Blog readers a 15 percent discount on individual purchases. CLICK HERE and you’ll get $3.75 off the regular DVD price of $24.98. Multiple orders are permitted.

Plus, if you buy the DVD before Jan. 15, Our Bodies Ourselves will receive $3 for every DVD sold. A win-win for everyone.

Check out the trailer below and the “Absolutely Safe” website, which provides excellent background along with information on FDA regulations, statistics on who gets implants, and take-action suggestions — including tips from Our Bodies Ourselves on redefining beauty. The tips are also available at the OBOS website.

Carol Ciancutti-Leyva, director of “Absolutely Safe,” a documentary on the controversy over the safety of breast implants, critiques a recent “Oprah” episode that discussed breast cancer and breast reconstruction surgery without mentioning the health risks associated with implants.

The title refers to something the actress Christina Applegate said during the episode. Applegate, 36, was diagnosed with breast cancer in July and underwent a double mastectomy after also testing positive for the BRCA gene.

Ciancutti-Leyva writes:

I applaud her openness and Oprah’s dedicating her show to this issue. Christina discussed her decision to have a radical mastectomy and her decision to be reconstructed with saline implants. She explained the procedure of getting saline implants after mastectomy, the placement of breast expanders, and the later implantation of saline implants. She then said “I’ll never have to wear a bra again.” That took my breath away for a second.

My mother went to the Mayo Clinic in the early 1970’s and she was told to have a radical mastectomy and have her breasts reconstructed with silicone implants. Her surgeon told her the same thing – “You’ll never have to wear a bra again!” Two years after that surgery her implant ruptured and she had it replaced. Very shortly after that it ruptured again. My mother has suffered a great deal of pain from the several surgeries, complications from the implants, and subsequent health problems. Not having to wear a bra was a very insignificant benefit given the many serious problems she had with her implants.

Now, one might say that this happened years ago and now implants are safer, the surgery has been perfected, and even the FDA has approved both saline and silicone implants. I think this is far from the truth. Somehow, the known risks, the known complications, and unknowns about the long-term safety of both saline and silicone implants are being lost. Don’t forget that the FDA and implant manufacturers fully acknowledge that breast implants carry known risks, like rupture and capsular contracture. The safety dispute emerges regarding the “unknown” risks like severe allergic reaction to the chemicals and platinum salts used in both saline and silicone breast implants.

Ciancutti-Leyva’s post also includes a statement from Our Bodies Ourselves Executive Director Judy Norsigian: “We know breast cancer patients want to make informed decisions, but that just isn’t possible when the necessary long-term research has not been done.”

What’s the most empowering action you’ve taken recently? Did you ask for a raise? Stand up for a cause? Run for president?

If you answered “Got breast implants!” well, Allergan’s marketing is working.

Allergan is a global pharmaceutical company perhaps best known for producing Botox. In late 2005, Allergan merged with Inamed, maker of silicone breast implants — just before silicone breast implants received FDA approval.

Earlier this summer, Orange County Register columnist Colin Stewart, who is admittedly no fan of elective cosmetic surgery but who remains “dazzled by the ways Allergan makes the idea” of “injecting, slicing and rearranging body parts” seem appealing, devoted a column to Allergan’s marketing scheme, which is all about empowering you:

In its new breast-implant campaign, for example, Allergan’s marketers imply that implants are artful, like designer clothing. Even though implants are basically plastic bags filled with silicone or saline solution, Allergan portrays them as sources of power, freedom, individuality and self-confidence.

That’s a big change from last year, when Allergan bought Santa Barbara-based Inamed and its breast implants for $3.2 billion. Then, the implants were labeled “Style 68,” “Style 101,” etc.

The old labels were cold and clinical, so Allergan is giving them a new identity that sounds natural, feminine and artful. In a new marketing campaign, they’re the “Natrelle collection of breast implants.”

Breast implants can seem crudely sexual, but Allergan combats that impression too, ingeniously presenting them almost as a feminist issue. The company says it’s “empowering” women with information about their options.

The tag line for the Natrelle collection: “To each her own.”

Studies of breast-implant users reveal that women “aren’t getting them to attract men, but to feel greater confidence in their femininity,” says Robert Grant, president of the Allergan Medical division.

Presumably, women whose natural attributes have Natrelle enhancements will gain self-confidence from each masculine head that turns when they walk past.

“Nearly 400,000 women did something fabulous for themselves last year,” is Allergan’s message about Inamed’s breast implants. But to Grant that number isn’t fabulous enough.

“The $3.2 billion price for Inamed isn’t worth it for us” at that rate, Grant says. “We can grow (the rate of annual implants) to in excess of one million procedures.”

How else is Allergan making a show of empowering women? Let’s consider the research. Last November, a review of studies on the safety of breast implants appeared in the journal Annals of Plastic Surgery. The authors concluded that “the weight of the epidemiologic evidence does not support a causal association between breast implants and breast or any other type of cancer, definite or atypical connective tissue disease, adverse offspring effects, or neurologic disease. Women with breast implants do not present with more advanced stages of breast cancer or suffer impaired survival after breast cancer diagnosis.”

In fact, the only caution the authors registered concerned the observed higher incidence of suicide among with women with implants. On this point, they recommended future studies “to determine whether the consistently observed excess of suicide among women with implants reflects underlying psychiatric illness prior to breast augmentation surgery or other factors.”

But if that sounds, well, mostly reassuring, there’s more.

After the study was published, Diane Zuckerman, president of the National Research Center for Women & Families notified health activists that the journal article’s four authors all have financial ties to the breast implant industry. The lead author, Joseph McLaughlin, has been a consultant to Inamed/Allergan.

“In fact, McLaughlin is an author of almost every study on breast implants of the last 10 years, all funded by Dow, all concluding that implants are safe,” wrote Zuckerman. “With a couple of exceptions, the only studies he hasn’t co-authored are ones by NCI and FDA, which found significant increases in several illnesses among women with implants.”

“This isn’t a new study, it’s a review of all the old studies that McLaughlin co-authored. So, he’s summarizing his own work (without admitting it is his) and once again concluding that implants are safe.”

Makes you want to replace the guards at the hen house, no?

Despite the increasing popularity of breast implants — breast augmentation was the most popular plastic surgery procedure in 2007, with close to 350,000 procedures done — the safety debate rarely breaks through the marketing noise.

But thoughtful and personal critiques are carried out each day in blogs like Beauty and the Breast, which covers the impact of breast implants, and in documentaries such as “Absolutely Safe,” which has a terrific website filled with resources, including a section on the data debate.

Another documentary, “America the Beautiful,” which opened (or will be opening) in some theaters this summer, looks at the obsession with plastic surgery in general — and how surgeries can go horribly wrong.

And who knows — perhaps “empowerment” will be reclaimed in the future to mean making choices and taking risks that truly improve, not harm, our well-being. Then again, the FDA could approve the lip implants …

When Chick Flicks Get Knocked Up: “Eventually, your female friends — the ones who married late and retained youthful obsessions with Yo La Tengo and graphic art books until forty — may shock you by having children,” writes Alissa Quart at Mother Jones. “This year, at least, they have cinematic alter egos; those millennium Mary Tyler Moores Sarah Jessica Parker and Helen Hunt have left their cosmos and canned laughter behind and gotten knocked up onscreen too. In the process, they have created a new genre: The Fertility Film. But are the new fertility film stars actually feminists?” (via Feministing)

Silicone Gel Implants May Lose Approval: From our enlightened neighbor to the north … “Health Canada may have to reverse its controversial 2006 decision to allow women to get silicone gel-filled breast implants if it proceeds with a plan to declare key chemicals found in them to be toxic, experts say,” reports The Ottawa Citizen. (via Beauty and the Breast)

South Carolina Supreme Court Overturns Conviction: “A South Carolina woman convicted of homicide by child abuse after her stillborn baby tested positive for cocaine should get a new trial because of several mistakes her attorneys made, the state Supreme Court ruled Monday,” reports the Associated Press. “Attorneys for Regina McKnight did not introduce the baby’s autopsy report into evidence and failed to rebut the prosecution’s medical expert, the court said in the unanimous decision.”

Prosecutors have 15 days to decide whether to appeal. From the Myrtle Beach Online:

Attorneys for the National Advocates for Pregnant Women and the S.C. Civil Liberties Union became involved in McKnight’s case when she asked for post-conviction relief.

“The groups got involved because there is complete consensus that prosecuting pregnant women is bad for mothers and babies,” said Lynn Paltrow, with the National Advocates for Pregnant Women. “Regina McKnight was convicted on junk science and was not fairly represented at trial.”

A Place to Pump: “Washington area women have hooked up electric or manual versions in parked cars, restrooms, a telephone booth and the basement storage room of the National Zoo visitors center, where a box of panda costumes doubled this spring as a table on which one woman set her pump, bottles and other equipment,” writes Rebecca Adams at the Washington Post.

“Not perhaps what the D.C. Council had in mind when it passed a law in December requiring employers to provide female workers a private, clean space, outside a restroom, to express milk. The Child’s Right to Nurse Act also gives a woman the right to breast-feed, covered or not, in any place, public or private, where she has a right to be.”

Maternal Exposure to Persistent Organic Pollutants Linked to Urologic Conditions in Boys: This release from the American Urological Association summarizes studies that confirm existing hypotheses that maternal exposure to endocrine-disrupting chemicals – including total polychlorinated biphenyls (PCBs, such as Arochlor) and organochlorinated pesticides (such as dichlorodiphenyl-trichloroethane, or DDT) may contribute to an increased incidences of congenital anomalies.

Mammograms Coupled with Ultrasounds: Deborah Katz of U.S. News & World Report looks at new research on combining mammography and ultrasounds, which may be better for finding cancers in some women, but it also greatly increases the rate of false-positive results. Plus: Check out our analysis on routine mammograms for premenopausal women.

The Business of Bacteria: The L.A. Times reports on the popularity of probioitics, live "friendly" bacteria that is showing up in more foods, like Dannon’s Activia yogurt. “Companies claim that the daily consumption of probiotics can provide consumers with benefits such as a boost to the immune system and relief from intestinal distress — and researchers think that certain probiotic strains hold promise in a number of areas,” writes Brendan Borrell. “But how significant these benefits are is a matter of debate. And it can be tough to decipher which products offer verifiable health claims and which are piggybacking on the hype of the booming industry.

Doctors Start to Say “I’m Sorry” Long Before “See You in Court”: The New York Times reports on a change in hospital policy: full disclosure when a doctor makes a mistake. Kevin Sack writes:

For decades, malpractice lawyers and insurers have counseled doctors and hospitals to “deny and defend.” Many still warn clients that any admission of fault, or even expression of regret, is likely to invite litigation and imperil careers.

But with providers choking on malpractice costs and consumers demanding action against medical errors, a handful of prominent academic medical centers, like Johns Hopkins and Stanford, are trying a disarming approach.

By promptly disclosing medical errors and offering earnest apologies and fair compensation, they hope to restore integrity to dealings with patients, make it easier to learn from mistakes and dilute anger that often fuels lawsuits.

Malpractice lawyers say that what often transforms a reasonable patient into an indignant plaintiff is less an error than its concealment, and the victim’s concern that it will happen again.

Culture Affects How Teen Girls See Harassment: “Teenage girls of all ethnic and socioeconomic backgrounds still experience sexism and sexual harassment – but cultural factors may control whether they perceive sexism as an environmental problem or as evidence of their own shortcomings,” according to this release from the University of Kentucky summarizing a study of 600 girls, ages 12 to 18, in California and Georgia.

Ninety percent of the girls reported experiencing at least one incident of sexual harassment, the researchers from University of Kentucky and University of California Santa Cruz found.

Specifically, 67 percent of girls reported receiving unwanted romantic attention, 62 percent were exposed to demeaning gender-related comments, 58 percent were teased because of their appearance, 52 percent received unwanted physical contact and 25 percent were bullied or threatened with harm by a male. 52 percent of girls also reported receiving discouraging gender-based comments on the math, science and computer abilities, usually from male peers, and 76 percent of girls reported sexist comments on their athletic abilities, again
predominantly from male peers.

The researchers found that girls have different levels of understanding of sexism and sexual harassment, which may affect reporting data. Older girls and those from a lower socioeconomic background reported more sexism than did their peers. Latin and Asian American girls reported less sexual harassment than did girls of other ethnic groups. Girls who had been exposed to feminist ideas, either through the media or an adult such as a mother or teacher, were more likely to identify and report sexist behavior than were girls who had no information about feminism. Girls who reported feeling pressure from their parents to conform to gender stereotypes were also more likely to perceive sexism. Girls who felt atypical for their gender and/or were unhappy with stereotypical gender roles were most likely to report sexism and harassment.

The study appears in the May/June issue of Child Development.

Ethics Worth More Than Financial Payments: “With little fanfare, a small number of prominent academic scientists have made a decision that was until recently all but unheard of. They decided to stop accepting payments from food, drug and medical device companies,” reports The New York Times.

No longer will they be paid for speaking at meetings or for sitting on advisory boards. They may still work with companies. It is important, they say, for knowledgeable scientists to help companies draw up and interpret studies. But the work will be pro bono.

The scientists say their decisions were private and made with mixed emotions. In at least one case, the choice resulted in significant financial sacrifice. While the investigators say they do not want to appear superior to their colleagues, they also express relief. At last, they say, when they offer a heartfelt and scientifically reasoned opinion, no one will silently put an asterisk next to their name.

Blogging Against Disablism Day: Coming May 1. Last year, more than 170 people took part. Diary of a Goldfish has the details: “You can write on any subject, specific or general, personal, social or political. In the previous two BADDs, folks have written about all manner of subjects, from discrimination in education and employment, through health care, parenting, family life and relationships, as well as the interaction of disablism with racism and sexism.”

Plus: Tips on language.

“My Beautiful Mommy”: “Oh I just can’t think of enough bad things to say about this book but for starters…” begins Lucinda Marshall’s critique of a new children’s book written by a plastic surgeon to help kids age 4-7 get with the whole “mommy makeover” (tummy tuck and breast augmentation). It’s emblematic of reactions read ’round the web (though EW surprisingly feels the need to ask, “a practical solution for a well-defined demo, or pure evil?” Hmmm. Let me think.)

The book got a lot of attention this week after this Newsweek story came out. Making Light has good info on how a self-published vanity-press book made major league headlines … including a mention on Wait, Wait …. Don’t Tell Me” this morning.

Plastic Surgery on TV: When Botox, face lifts and reconstructive surgery gets in the way of acting, is it appropriate for a critic to call it out? Mary McNamara at the L.A. Times writes:

People should be free to look as they choose, and this town is tough on women — don’t talk to me about Judi Dench and Helen Mirren, they’re British. Would an American woman ever get away with anything approaching Nicolas Cage’s hair or James Spader’s increasing portliness? Of course not.

But television is a visual art, and if people are going to significantly alter the way they look in ways not directly connected with the roles they are playing, it can affect not only their performance but the whole tone of the show.

So you tell me, what is a critic supposed to say when part of the problem with a show is that the leading lady’s face seems incapable of movement or her eyes appear to be moving toward the sides of her head or her lips just look weird?

Plus: Maureen Ryan on women keeping it real: “In future, I’ll not only attempt to acknowledge when a plastic face impedes the enjoyment of a show, but I’ll also make it my business to congratulate the women who look like they’ve lived, for hanging on to what’s made them distinctive individuals.”

Remember the Controversy Over Contraceptives in Portland, Maine?: “For all the firestorm surrounding the decision to make prescription contraceptives available at King Middle School, only one girl has used the service in the six months since the program began, officials say,” reports the AP.

As of Thursday, the only student to obtain a prescription for contraceptives was a 14-year-old girl, the city reported in response to a Freedom of Access request from The Associated Press.

“If it helps one student who otherwise might be in a position of being at risk, then it’s worth it,” said Lisa Belanger, who oversees Portland’s student health centers.

Falling Breast Cancer Rates Prevalent Only Among White Women: “New research shows a sharp drop in U.S. breast cancer cases in recent years was limited to white women, possibly because they abandoned hormone replacement therapy in greater numbers than minority groups,” reports Reuters.

White women had been more likely to use hormone therapy, and were also the most likely to abandon the drugs after U.S. regulators warned about the cancer link in 2003, according to Dr. Dezheng Huo of the University of Chicago and the study’s lead investigator.

“The sharp reductions seen in Caucasians aged 50 to 69 years were not seen among other ethnic groups,” Hou told the American Association for Cancer Research.

The researchers said the decline has been mainly among women older than 50 with estrogen-receptor positive cancer.

Why We’re Fatter: This Slate article isn’t new — in fact, it was published in 2006 — but it was just brought to my attention and it’s definitely an interesting read. Writer Sydney Spiesel reviews five of the 10 explanations for obesity identified in a study by David Allison and Scott Keith of the University of Alabama at Birmingham.

“In all likelihood, the rise in obesity results from a combination of several of these factors, each making its own contribution and perhaps interacting with other causes in some yet-more-complicated way,” writes Spiesel.

History As Appetizing As Tater Tots: I admit I fall hard for history texts that bring in the social and cultural implications, which is why I’m putting this on my summer reading list: “School Lunch Politics: The Surprising History of America’s Favorite Welfare Program” (Princeton University Press, 2008) by Susan Levine, a University of Illinois at Chicago professor of history.

“The National School Lunch Program has outlasted almost every other 20th century federal welfare initiative and holds a uniquely prominent place in popular imagination,” Levine said in this UIC release. “It suggests the central role food policy plays in shaping American health, welfare and equality.”

Levine, by the way, is also the author of “Degrees of Equality: The American Association of University Women and the Challenge of Twentieth Century Feminism,” and “Labor’s True Woman: Carpet Weavers, Industrialization and Labor Reform in the Gilded Age.”

Strategic Spending on Organic Foods: With the price of organic foods rising, here’s some good advice for shoppers who want to prioritize spending on those organic fruits and vegetables that have a high pesticide residue when grown conventionally. Check out the The Environmental Working Group’s list of 43 fruits and vegetables tested for pesticide residue.