Q:  Breast Implant Studies Participation

Dr. Phelps,

I am bipolar and interested in the new cohesive gel silicone breast implants. There are liquid gel silicone breast implant studies in the US where patients with psychological problems are automatically excluded. I would like to know why this is so. I would also like to know if there is a drug interaction of some sort between the silicone and the psychiatric. The saline (alternative) implants also have a silicone shell and they are safe to use. Is this precaution about traveling silicone in the case of a rupture ? If so, the new cohesive gel does not rupture, it stays in place because it is cohesive. Thank you for all of your  help Dr. Phelps. The answer to this question is really important to me.

Sincerely,
Lorraine

Dear Lorraine -- 
Taking your two questions separately, and starting with the "is there a silicon/drug interaction problem?"  Not that I can find.  There are some reviews on risk that to my ear don't make the total "risk/benefit ratio" look too good, such as (the abstracts are in English): 

    Risk of silicone implants in general

    A woman who had eyelid inflammation which was discovered to be likely due to       
    silicon having traveled there

    Silicon exposure and autoimmune diseases

Therefore your close attention to the potential for silicon migration is clearly warranted.  On the basis of just this much information about risk, which is definitely not an exhaustive search for information on the topic, one would think there should be a lot of benefit, a whole lot of benefit, to be had from implants.  And that brings us to the other part of your question. 

Perhaps our society has come to a place where women do indeed get "a whole lot of benefit" from implants.  That's a pretty sad state of affairs, if that's true.  But as a woman in such a society, I suppose it's your right to decide how you want to interact with that societal tendency.  A woman's mental health ought not necessarily have anything to do with it.  

On the other hand, a woman's mental health might indeed have something to do with it if she had something that made sexual attractiveness have even more importance to her than "average" (whatever that is).  Bipolar disorder is clearly associated, in manic phases, with an increase in sexual interest (this is not talking about you personally, mind you; just trying to address your question in theoretical terms that might, if there is any relationship at all, have something to do with you -- because otherwise I would basically find myself agreeing with you that the decision about implants is independent of whatever mental health condition you've been diagnosed with, if any).  So theoretically, there could be in interest in implants that arose from or was increased by bipolar disorder. 

To make matters a little worse, another condition we psychiatrists treat is the adult effects of childhood sexual abuse.  This childhood experience can also affect a woman's thoughts about the importance of her own physical attractiveness, though in this case it's pretty complicated how that can happen (and it does not always happen).  And, it looks like childhood sexual abuse is one of the things that can make bipolar disorder worse (also complicated).  

So, to finally answer your question, "patients with psychological problems are automatically excluded" in some studies because the study authors must make absolutely sure that they are not somehow potentially harming someone who is not fully in a position to make a decision about risk entirely on her own; and some mental health conditions, as described above, might in some complex ways influence that decision in a way that could be regarded as decreasing the complete "on her own" nature of the decision.  

Dr. Phelps