Explosion preventive without urgency

On 23 December, Health Minister Xavier Bertrand recommended the withdrawal of PIP prostheses "preventively and without urgency" from the women who wear them, even in the absence of signs of deterioration The implant.

PIP prostheses: towards a reinforcement of the recommendations of the Afssaps

The Minister of Health confirms in part the confidences collected by the daily Libération as of December 21. In a statement dated 23 December, the Minister and his Secretary of State for Health Nora Berra updated the recommendations for the care of women with PIP prostheses: "As a preventive measure and not urgent, That the explantation of the prostheses, even without clinical sign of deterioration of the implant, is proposed to the women concerned.This proposal could intervene during consultation of their surgeon, already recommended ".
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Removal of PIP prostheses: a controversial reimbursement

This decision follows the request by the ministry of expertise of the various health agencies (Afssaps, whose recommendations were published on December 9, the Institute of Health Watch and the Institute of Cancer). The opinion issued on 22 December, coordinated by INCa, considers that there are no data to date to conclude that there is an increased risk of cancer (large cell anaplastic lymphoma or mammary adenocarcinoma) in women with these PIP prostheses in comparison with other prostheses. In detail, there is no increased risk of breast cancer in women with implants compared to the general population. There is an increased risk of anaplastic large cell lymphoma in women with an implant, regardless of the brand and the content of the implant. But this cancer remains very rare, this risk seems extremely limited.

To date, eight cases of cancer (five breast cancers (adenocarcinomas), rare breast lymphoma, amygdala lymphoma and leukemia) were identified by the follow-up committee created at the request of the government

Preventive withdrawal is therefore not motivated by risks related to the occurrence of cancer but for other reasons. "Nevertheless the well-established risks associated with these prostheses are ruptures and the irritating power of the gel can lead to inflammatory reactions, making explantation difficult," the text continues. If the association for the defense of the prosthesis carriers of the PIP brand welcomes this decision, it remains to specify how to implement ...

According to the information sent on 23 December by the Ministry, the recommendations issued by the Afssaps are therefore strengthened

In addition, the ministers decided to ask the Regional Health Agencies (ARS) to set up a telephone number for patients with PIP breast implants who have difficulty accessing A professional to propose a list of establishments that can receive them for a preventive explantation.

Finally, a prospective epidemiological study on broken prostheses will be launched The concerned healthcare institutions and health professionals are informed in parallel of this decision and of the new recommendations

The issue of repayment related to these explantations, however, continues to be controversial. The health authorities remain in their initial positions. If it is a corrective surgery reimbursed (implantation of a PIP implant after the removal of the breast following a cancer): the Health Insurance will take charge of the diagnostic procedures (consultation, ultrasound). .), Removal of the mammary prosthesis (s) and their possible replacement, hospitalization costs and post-operative care. If it is a cosmetic surgery not reimbursed: the Health Insurance will also take care of the diagnostic procedures, ablation of the prostheses mammaires, the expenses of hospitalization and the postoperative care related to this ablation, But not their possible replacement. A decision that the patient associations denounce, considering that the state is also responsible for leaving a defective and dangerous product on the market. The Afssaps estimates that 80% of the women carrying these prostheses used it for aesthetic purposes and 20% for reconstruction after breast cancer.

Finally, Poly-Implants Prothèses (PIP) sold these defective products (using industrial and non-medical silicone) beyond our borders. In total, some 300,000 women could be affected.

Update on recommendations for women with breast prosthesis Poly Implant Prosthesis (PIP) - Ministry's announcement of December 23, 2011; Proposals for conduct for women with breast prostheses PIP: expert opinion - Coordinated by the National Institute Of Cancer (InCA) - December 23, 2011 (available online) Release of December 20, 2011 "Questions and Answers for Women with PIP Breast Implants", Afssaps, December 8, 2011, (Adenocarcinoma) in a woman with breast implants pre-filled with silicone gel PIP - Information Point ", Afssaps, December 8, 2011, press release available online," Implants mammaires ", Health Insurance, November 28, 2011, Article available online "New death of a PIP prosthesis carrier", La Provence, December 9, 2011, article available online

Women with a breast prosthesis must check the mark of the prosthesis on the card that has been given to them. In the absence of a card, they should contact their surgeon or, failing that, the establishment where the surgery was performed Patients with PIP prostheses should consult their surgeon. On this occasion, a preventive explantation even without clinical sign of deterioration of the implant will be proposed to them. If they do not wish to be explored, they should be monitored by mammary and axillary ultrasound every 6 months. Any rupture, suspicion of rupture or seepage of a prosthesis should lead to its explantation and Before any explantation, whatever its reason, an imaging report (including a mammogram and recent mammogram and axillary ultrasound) must be available.