Talk:Breast implant/Archive 2

From Wikipedia, the free encyclopedia

 This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.
← Archive 1 Archive 2 Archive 3 →

Contents

Responses to request for comment

I'm by no far cry an expert on this subject, but following David's RfC I had a look over this article. I feel that the contributions made by both users are indeed relevent, and should in some way be included. However, this article is becoming quite lengthy and if the table is included, it will (in my view) reduce the readability further. I suggest that the article should be split, as proposed above, into an article which deals will both sides of the issue (which I don't feel was covered in the table). Perhaps the new article could be further split to include more specific facts pertaining to auto-immune diseases, including the table.

One thing I strongly recommend is that both Droliver and Jgwlaw, when the 3RR block expires, should reach consensus before any further changes are made to this article. Further edits aren't going to solve this, and will simply result in further blocks. I must also applaud David Ruben for his patience and mediation in this situation. Scott 18:59, 12 April 2006 (UTC)


Judging by the section above, both User:Jgwlaw and User:Droliver would be well advised to read and follow Wikipedia:Civility. Jgwlaw, if you have not already started doing so, please sign and date your posts to talk pages, unless you have some excellent reasons not to do so. If you have started doing this, thanks!

Can I just be clear on what the two participants in this edit war are looking for? Looking at the recent diffs, I assume this diff represents the differences - that is, Jgwlaw believes the table should be this one while Droliver believes the table should look like this. Is this right? Is this what the argument is about? Mike1024 (t/c) 00:01, 13 April 2006 (UTC)

If that is the locus of this dispute, I think that the tables could be summarised in a paragraph, pro and con, and then both linked to in a daughter article (BTW, the tables are lovely, David, and good work mediating). IronDuke 01:19, 14 April 2006 (UTC)
What I added to the tables was the full finding - both the findings that were supportive of implants, and the concerns. That did not go over well. I also asked that Oliver provide a citation for a study and a conclusion (not just 'same as above'). I did not delete it because it was 'irrelevant' as he alleged. There have been studies funded by Dow Corning that are very supportive of implants. Even in (most) of those studies, there have been concerns cited. Surely those should be included. As to a 'pro' and 'con' - a complete description of a study's findings would be sufficient; eg do not leave out that which one party does not like. Also, do not include duplicative reviews of the same studies. molly bloom is jgwlaw molly bloom 21:34, 14 April 2006 (UTC)
Can anyone tell me where to find information on how to format? I tried to italicize and obviously was not successful.molly bloom 18:28, 15 April 2006 (UTC)
You can find a detailed guide here. For italics, 2 apostrophes: ''content'' --Scott 19:18, 15 April 2006 (UTC)
Thanks!!molly bloom 19:43, 15 April 2006 (UTC)

risk/controversy section

I propose a signifigant consolidation of the controversial area of this entry. I've refrained from restoring what I feel is the proper context for this to play nice, but we're left with a disjointed and rambling entry that isn't reflective of most of the literature. What is stretched out over multiple paragraphs is easily summarized in several sentences with attached references for those wishing to examine the various reviews and articles. I would like some 3rd party participation to act as the editors here. Droliver 15:22, 17 April 2006 (UTC)

Risks & Controversy Section

The article on BI needs to be balanced. That means one section is not expanded at the expense of another. I am glad the previous editor 'refrained' from further POV comments. However, this time the edit was done in another section - local complications. The section on 'local complications' was simply collapsed into one disjointed sentence. The complication of necrosis was entirely deleted, which rendered the photo meaningless. Yet another section describing types of implants was expanded and a chart added, which was merely redundant. This is a detailed article, but it needs to be NPOV. Expanding one section while deleting one that does not serve the editor's purpose, is POV. It is my understanding that anyone is free to edit Wikopedia -- interested parties, researchers, experts of various types and even doctors. Finally, Dr. Henry Jenny was the first to develop saline implants. I have included references to this, and I will cite them in the 'proper format' as soon as I can figure out how to do this. I am still new to Wiki. molly bloom 21:24, 17 April 2006 (UTC)

RESTORING

First and above all, before some 'monitor' (he is not an administrator) starts crtiticizing an editor and making implicit threats, it would be helpful if he would read what he is 'reverting'. In this case, he clearly did not. Also, to editors: please reference with citations that actually support what is written. I have noticed a number of alleged references that have nothing to do with the edit being made. One such statement was the erroneous comment about the inventor of saline implants. I changed that statement, and provided a citation that relates directly to my edit. Also, before someone starts making wholesale changes, please discuss here. I think that is a reasonable request. The complications page should stay as it is now. This is a complete list of the local complications, which are not in any dispute at all, and should stay. The photo I included directly references this list. There is no more need to 'summarize' this than there is a need to shorten the type of implants or techniques used. To collapse it to a disjointed sentence while leaving or expanding with redundancies is POV.molly bloom 00:34, 18 April 2006 (UTC)

1.In re. to the saline device: This is cited in the reference you deleted as well in the recently published 2006 Mathes Plastic Surgery series Vol 6 pg 2, quoting "The inflatable saline-filled implant was first reported by Arion in France in 1965. The impetus for its development was to allow smaller incisions through which a non-inflatable device could be inserted and then inflated with its liquid filler material". Dr. Jenny was involved in later incarnations in the 1970's. See also similar citations on the web[1], [2],[3]

Droliver 01:41, 18 April 2006 (UTC)

Your original citation said nothing about the invention of saline implants. However, I looked up what you had here, and there is indeed a reference. This is most interesting and I have done more research. It appears that the New York Times article misstated facts, as did some articles that claimed only that Arion was the first reported inventor of saline implants.

I have read a number of academic articles now on this, and am still not entirely sure. In fact, there are contradictory statements. So it may not be you or I at 'fault' here. Because of this, I have asked a plastic surgeon whom I know to be an expert in this field. He has many many years of experience, and is quoted in a number of academic articles. I incorporated what you wrote and what I wrote, and it may still not be correct. Let's wait until we get input on this from some more renowned experts.molly bloom 03:29, 18 April 2006 (UTC)

I have restored a little of what I previously wrote that Droliver deleted, but most of my changes were intended to simplify the language. This article should not use medical jargon. It should be aimed at a lay audience.

Since there seems to be concern about the length, I took out the section on techniques, which seemsd to be aimed at plastic surgeons. It is much too technical, and other articles on medical procedures don't include that kind of information.

There are too many references that are not linked to text, but rather than start an editing war I just removed the oldest, weakest studies. What remains are most (but not all) of the government funded studies and many studies funded by Dow Corning or plastic surgery societies. I will try to link some of the studies to text when I have more time.

Any citations of FDA analyses of Inamed or Mentor Corp research is available on the FDA website, www.fda.gov. Unfortunately, the implant makers have never published it. Drzuckerman Dr Zuckerman

Too long and beyond encyclopaedic

One benefit of splitting it up is that you can layer the infroamtion - presenting first what people who ask the encyclopaedia "what is a breast implant" with a small amount of useful information, and then rather more detail to those who are considering whether they are a good thing, or whether public discussion of them is credible. The level of infromation being argued over recently seems more that of a product insert, which is prbably better left to product inserts, IE by reference ratehr than even linking in WP. As far as complications of plastic/implant/augmentative/cosmetic surgery go, which is a superset of compliations of surgery, both of those would be better handled by articls just on them, which might be briefly referenced from anywhere. I note that WP is not a hierarchical collection of information, but it does not make for a readable article to have such information in such quantity. The article could do with more focus on why, rather than the minutiae of what. Midgley 04:01, 18 April 2006 (UTC)

bad layout of list, and mammography twice

" 12. Interference with Mammography'

Interference with mammography due to breast implants may delay or hinder the early detection of breast cancer. Implants increase the difficulty of both taking and reading mammograms. Mammography requires breast compression (hard pressure) that could contribute to implant rupture.

" There are ways to wikify that list, but mammography shouldn't be in it... the complication if it is one is "delayed recognition" not "interference with", and the following section covers mammography. The whole list is excessive detail at that point. Midgley 04:12, 18 April 2006 (UTC)

Edit-war again ?

(Edit conflicts with Midgley - sorry, but too late for we to totally rework this response - we're both highlighting similar problems with the article at the same time, but I include below a wider point about editing behaviour in this content dispute). Hooray - at last some dialogue in talk pages without prior edits to the article - I was considering referring this edit war for further administrator action, but shall continue to observe for another day or two. I had avoided making any significant changes to Breast Implants or this talk page until the recent blocks on 2 editors expired. I had hoped to then help the various editors engage in some discussion over editing (I'm still willing to help mediate). Unfortunately the article has returned to an edit war with some 53 edits in the last 24hours alone - quite ridiculous.

Please note the comments of the RfC above, it is generally sensible for editors involved with a contested article to engage in talk-page discussion and consensus agreement prior to making further edits to the article itself, which may just inflame an edit-war further.

As is present at the bottom of the wikipedia window "If you don't want your writing to be edited mercilessly or redistributed by others, do not submit it.", so editors need to be relaxed about their contributions and their interaction with other editors. Wikipedia is an encyclopaedia, and as such summarises information. If another editor decides to change one’s own contributions then one should seriously give thought before reverting back to a previous version, if a re-revert occurs then doubly so. Many editors in this situation do not continually revert until limited by the Three Revert Rule, but rather choose to follow a One Revert Rule. This means that if one’s edit is reverted, then rather than immediately revert back one instead initiates discussion on the talk page. Wikipedia has no deadline for completion, so there is no hurry to "correct" an article - if it is a great article in one month’s time it is immaterial if it reaches that stage in a day, a week or 29 days. Likewise there is not hurry to complete discussion over a point - allow the other editor time to respond and also allow time for other editors to contribute, thus allowing a consensus to form (so don't post a talk-page message and then edit article a few minutes or hours later).

Currently the article is in a poor state (I'm not referring to any one edit version here) - it lacks clear progressive expansion of information, is too long (too verbose), and is repetitive & duplicates. It needs rewriting, better summarisation or splitting (but there was not consensus for the later recently) - I note Midgely's comments above. As an example, the complications list. I don't think any editor is disputing any of the items included, in so far as whether they occur or not, but there is a styling issue within an encyclopaedia - namely do they need mentioning in each and every article on surgical procedures ? Complications should be included if peculiar to a particular procedure (i.e. implant rupture clearly pertinent to BIs), or if risks especially high (e.g. risk of death in emergency aortic aneurysm repair compared to planned procedure), but any operation can cause pain, bleeding, infection, scaring. This article on BI is not attempting (I hope) to list every possible complication - if so, then it needs be quadrupled the length to also include risks of anaesthesia, analgesia medication given, intubation, prolonged immobility causing DVTs etc etc etc. So what we currently have is a selective list, and the question is what criteria are to be used as to those we include ? To mention at length complications that are not unduly specific to this procedure, may be viewed as a general POV push at discrediting. Yet the article already mentions clearly the FDA's concerns and banning of the products, so care needs be taken not to "over play" a position.

The summary paragraph seemed a better editorial choice, problems with the current list being:

  • Pain- is this particularly severe compared to other surgical operations, or is persisting chronic pain any more likely ? If not, then this does not deserve a whole paragraph.
  • Infection - the current version notes "Most infections appear within a few days to weeks", so is this any different from other operations, particularly those involving foreign body insertion (e.g. pins, screws & plates in orthopaedic surgery, dacron tubes used in artery bypassing, intra-ocular lenses in cataract removal) ? Again if not peculiarly special to BI, then needs only brief mentioning.
  • Haematomas - again special to or peculiar in BI's ?
  • Interference with mammography - this is duplication, as a whole section is already devoted to this.

The article probably reads better for the absence of the list of BI-supportive studies re Rheumatological disorders, by which I mean that it was heavy going reading through the multiple paragraphs, and another user has commented that my attempt at summarisation into a table did not seems that great a summarisation/reduction. However, the current version cites none of the studies. To have "A number of existing studies internationally" seems a little skewed given the large number of entries the table included at various points. I'm not insisting on the data/table re-introduction (I'm just one editor and consensus applies), but at least a few of the studies should be cited at this point at least (i.e. footnote references, not necessarily description in the text). David Ruben Talk 04:17, 18 April 2006 (UTC)

Point taken about the length of the list of local complications. I object to reducing it to one sentence, however. Necrosis is a serious complication with breast implants. While not unique to implants, hematoma/seroma is too often a complication with implants and can cause contracture which is unique to implants. Also important is the shifting/undesirable outcome, and loss of nipple sensation (which is very common and a real problem for many women). I have shortened this section considerably. However, it is not valid to say this highlights already discussed issues re the banning of silicone implants. The banning of silicone implants was not because of local complications. Local complications are simply a fact with implants and should be discussed, more than one sentence. Hopefully what I have edited now will eliminate redundancies and normal complications of any surgery (that do not cause other problems unique to implants.)molly bloom 06:07, 18 April 2006 (UTC)
The 'chart' that was introduced in 'generations of implants' was redundant, since the text already discussed this. Also, I do not think that the 'generations' of implants is correct. A plastic surgeon I consulted tonight agreed, and he said he would help edit that section. I left it as Oliver had it (with the exception of a chart that was redundant). molly bloom 05:40, 18 April 2006 (UTC)
I agree that some of the other studies need to be included. I am not sure it even should be a footnote. There could be a sentence or a paragraph, with footnotes. The chart had many entries because many of those were reviews of the same studies. As another editor observed, this is not appropriate. molly bloom 05:49, 18 April 2006 (UTC)
I have not changed that, because I knew it would start yet another edit war. I welcome another editor's suggestion - preferably here in discussion first, since it was so contentious. Perhaps the plastic surgeon I talked with tonight might be amenable to helping in this area.molly bloom 06:14, 18 April 2006 (UTC)
My goal has never been to show only one side. I do not want the article to read like an advertisement for breast implants, which it did originally.molly bloom 06:14, 18 April 2006 (UTC)

Last picture edit

I removed the last picture added because the article already seems to have pics of women who have had breast augmentation, and that picture (and the caption under it which was a bit too titillating vfor an encyclopedia) added nothing new other than a picture of another woman with large breasts. Pat Payne 21:05, 19 April 2006 (UTC)

Good move, Pat. I wonder if there is really a need for any photo of a 'woman with breast implants'.

Don't you think people know what women with breast implants look like?molly bloom 21:41, 19 April 2006 (UTC)

Probably not, but I was giving the other one the benefit of the doubt because it was clearly a clinical "after" photo, and didn't look like it had been ripped from a fetish mag. But you're right, having a picture of a bare-chested woman, especially if you can;t verify that the woman in question has had augmentation is a bit needless to the topic. Pat Payne 14:55, 20 April 2006 (UTC)

I'm not allergic to breasts, but I would like such illustrations to serve some instructional purpose here. It would be nice if we had a before & after set, to show the effects of such surgery. Alienus 17:26, 20 April 2006 (UTC)

I'm not allergic to breasts either and I agree illustrations should serve some instructional purpose. I just don't think before and after sets serve an instructional purpose. Anyone with eyes knows the difference between large and small breasts. It doesn't illustrate anything we don't already know. A before and after set would merely be advertising for the plastic surgeon industry and/or titillation and there is already plenty of that on the web already. Gfwesq 02:32, 21 April 2006 (UTC)gfwesq
I disagree. It's not the same as the difference between "large and small breasts". Breast implants - at least, the more common, less expensive ones - have a very distinctive shape which is pretty easy to distinguish from real breasts. (The more expensive ones used by more wealthy clients are much harder to distinguish.) This is notable because it speaks to the fact that implants are generally not as well-concealed as their makers and owners would prefer. For instance, after trawling through the page history, I see nothing titillating at all about this image, which was formerly included in the article. It is presented in unflattering lighting from a simple frontal angle, there are no sexual paraphernalia or costumes or lingerie, there are no suggestive looks, there are no sexual activities taking place in the photo, there isn't even a background, and the genitals are not visible. There is nothing in the image but a female torso with false breasts. It serves to illustrate the subject matter of the article. If people think that image is titillating, then it would be literally impossible to find a photo of implants that wasn't "titillating", unless it were a photo of implants on a cadaver. Removing notable images on a subjective decision that they're "titillating" simply doesn't hold water. Respectfully, Kasreyn 06:20, 25 May 2006 (UTC)
I am glad the photo is off. There is nothing notable about that photo. Nothing. And, besides that, we dont' even know for sure if it is legitimate. It really IS the difference between small and large breasts.MollyBloom 01:07, 31 May 2006 (UTC)

Breast implant: editing conventions, important conduct policies, and a proposal for progress.

The following pertains to the recent activity of two contributors to this article, and contains some suggestions for improving both the text and the editing environment. I make these remarks in the hope that the ongoing troubles over this article will be addressed in a spirit of cooperation and mutual respect.

On April 12th, 2006 I temporarily blocked the accounts Droliver (talk · contribs) and Jgwlaw (talk · contribs) and the IP 65.89.98.20 (talk · contribs) for their involvement in an 'edit war' over this article. User:Droliver has edited from the IP 65.89.98.20; I believe, but am not certain, that User:Jgwlaw edits from the IP 67.35.126.14 (talk · contribs). In neither case have the IPs been employed to circumvent or infringe Wikipedia editing policies; I will therefore make little reference to them in what follows.

'Revert warring' is a practice that is especially frowned upon in Wikipedia. It goes against the collaborative spirit central to the project, and suggests a disinclination on the part of involved editors to discuss their differences of opinion respectfully on the Talk page. Although it may seem unlikely, most content disputes can be brought to a satisfactory resolution; the critical ingredient is sincere, thoughtful discussion amongst involved parties with the goal of producing a fair, neutral and informative article. This cannot occur if a revert war is going on—it is the Wiki equivalent of yelling at each other. Furthermore, aggressive revert wars make it difficult for people to read the article: the text keeps changing very rapidly, often with large chunks appearing and disappearing in quick succession. This can also make it impossible for other editors to contribute to the article. The following series of reverts (edit summaries in italics) occured over just two days at Breast implant.

Reverts to Breast implant, 23:04, 2006 April 11—04:09, 2006 April 12

by Jgwlaw (talk · contribs)

by IP 65.89.98.20 (talk · contribs)/Droliver (talk · contribs)

Reverts to Breast implant, 04:43, 2006 April 9—23:50, 2006 April 10

by Jgwlaw (talk · contribs)

by Droliver (talk · contribs)

Please do not do this again. It is not productive, as must be apparent by now. As both of you, Droliver and Jgwlaw, are very new, I do not for a moment doubt that you had good intentions but were not familiar with the editing norms of Wikipedia. I trust that henceforth you will not edit in this manner. Please read very carefully Wikipedia:Revert only when necessary and Wikipedia:Three-revert rule.

I would like to make a few suggestions concerning your editing activity in Wikipedia.

Some important editing conventions

  • When posting a message on any talk page (i.e., the discussion page of an article or a Wikiproject page or an editor's userpage), it is customary to sign and date your posts. This is done by typing four tildes at the end of your posts, like so: ~~~~.
  • When replying to another's post, make sure to properly indent yours. Please read Wikipedia:How to edit a page, in particular the Wiki markup section. If your reply contains paragraphs, you will accordingly have to indent each paragraph with the same number of colons/asterisks.
  • Please do not ever delete another editor's comments or alter them. If you are concerned about incivility or personal attacks, politely point out precisely what you find objectionable and ask the other editor to cease making those remarks. If the behavior continues, report it to an administrator (Wikipedia:Administrator's noticeboard).

Important conduct rules

  • Wikipedia is inherently a very forgiving place. Newbies are warmly welcomed and encouraged to edit full articles from the get go. Indeed, it is thought that one of the better things about creating a reference work via the wiki process is that mistakes are continually corrected; editors are told not to be afraid to write, edit and modify. If you make a mistake, it is easily undone. If you do not know how to use a complicated template, that's fine—ask for help or even just give it a shot and see; if it doesn't work a hundred more experienced editors will gladly come to your aid, with a smile. If you do not know how to reference an article like David Ruben, no worries—put your reference next to the text you're writing, or leave on the talk page, or ask someone who's been around a bit longer: we're all glad to help (and if you make a mistake, we'll be glad to clean it up too). If you can't write prose like a seasoned Brittanica editor, that's no problem either: some day someone will improve it for you.

    But there are some things Wikipedians have rather less tolerance for. We do not take sustained incivility, baseless assumptions of bad faith, and personal attacks lightly. Virtually all editors who have been brought before the Arbitration Committee and permanently banned were folks who did not quite get this (or who got it and sadly didn't care). Please know that on Wikipedia, we value politeness, we value those who write thoughtfully even when they disagree with those to whom they write, we value those who do not return incivility with more incivility, we value those who work to raise the level of discourse, we value those who always try to see the best in others and politely help them where they falter, we value grace and temperance, we value the forgiving smile over the biting retort.

    Over the course of editing this article both of you have been rather less civil than I'm sure you usually are; much of this can be attributed to your newness to the project and the very human habit of losing one's temper.This is understandable. But now, I'd really like both of you to shake hands, put this behind you, and work together like the great folks I know you are. You both mean well; what's happening is that you each place a different level of importance on different aspects of breast implants. But it is resolvable—a good article is in the making, if we give it the chance.

    I would like both of you to read the following:

  • Wikipedia:Civility
  • Wikipedia:No personal attacks
  • Wikipedia:Assume good faith (of particular relevance and importance here)
  • Wikipedia:Staying cool when the editing gets hot
  • Wikipedia:No angry mastodons
  • A very good rule of thumb is: Comment on content, not on the contributor. Do not comment on the other person's intelligence, competence, or motivations (e.g., do not assume that the other person is writing with an agenda to turn the piece into anti-implant propaganda, or can only speak as a patient who has had a poor personal experience with implants, or is a conniving surgeon who can't wait to get greedy hands on FDA-approved silicone implants). No personal remarks, please; no insinuations on other editors' talk pages about how awful so-and-so is. This approach is completely antithetical to the collaborative spirit of Wikipedia. If you disagree with an edit, politely state why you think it is suboptimal, and try to work out a fair solution.

The article

  • Finally, some thoughts on the article itself. The major dispute over the controversial issue of implant risks seems to have distracted editors somewhat from the rest of the article.
    1. The lead section can be greatly improved. Wikipedia:Lead section provides the basic details of how to write a good lead. Essentially, the lead section must be a clear, uncluttered, well-written summary of the rest of the article. (Medical professionals will recognize the obvious analogy to the abstract of a paper). It must touch upon each major theme that is addressed in greater detail in the full article. Here however the lead section is just two sentences long. For examples of a good lead section, see Evolution (which incidentally is an excellent example of how a subject with controversial aspects can nevertheless be well-written), Barbara McClintock, S. A. Andrée's Arctic balloon expedition of 1897 (which, despite the quaint title, is an outstanding example of an encyclopedia entry, written in the main by one of Wikipedia's finest editors), and Military history of France, among many others.
    2. This entry is about breast implants. An encyclopedia article on this subject should clearly (and neutrally) address the following topics: What is a breast implant? What are they made of and how are they made? How widely are they used (and related epidemiologic issues)? What is their history? What problems are they used for? How do doctors decide on good candidates for implants? What preparations/tests must a patient undergo before surgery? What are the available operative approaches and techniques? What are the outcomes like? What are the risks of implant placement? How are complications managed? What is the controversy over implants about, what happened, who were/are the parties involved, what is the status now? Because of the dispute over one (albeit important) aspect of the article, other aspects appear not to have received the attention they deserve.

      The issue about the controversy also appears to have distorted other sections. Under the heading Types of implants, which begins just two sentences from the start of the article, we have a paragraph that states, quite suddenly, that "The General and Plastic Surgery advisory panel recommended FDA approval of Mentor and against Inamed silicone gel breast implants. Despite the panel's recommendation that Inamed's implants not be approved, the FDA sent Inamed a letter..." Why is this here? The reader has been given no indication of what Inamed and Mentor are, the silicone implant controversy has not been alluded to prior to this, and the average reader will be quite puzzled with this segment. It is also in the wrong place: a section on types of implants should spend three or four well-referenced neutral paragraphs explaining the types of implants. There is a place for the above information, but it is not in the middle of this section—an encyclopedia article must be clearly structured. We should not allow enthusiasm for presenting important details about one issue overwhelm other aspects of the article. As Wikipedia editors, our primary concern should be to craft a balanced, neutral, informative, clear, well-referenced article: we should be dissatisfied if the article is not balanced, even if in favor of our personal points-of-view.

    3. The chief problem here appears to be the risks and controversies section. Now, it is important to be clear about this. That many risks are associated with implant surgery is uncontroversial. Like all major surgical procedures, implant surgery can be complicated by anesthetic mishap, infection, bleeding/thrombosis, local neurologic sequelae. Peculiar to breast implant surgery, there is also the risk of implant rupture/leak and capsular contracture. Aside from these known risks, there are also attendent problems such as interference with mammography, calcium deposition in the surrounding tissue, and post-surgical movement of the implant which may cause a poor cosmetic outcome. None of this stuff is controversial, and a good article will address them in plain, neutral language. Four or so well-referenced paragraphs mentioning all these things at the level of detail expected in a general article about implants, in a general encyclopedia, should suffice.

      The controversial bit is whether implants can also cause chronic systemic diseases and autoimmune disorders. The available evidence overwhelmingly suggests that the answer is no (at least with respect to known disorders); there is concern however that the available evidence is not good enough. It should be possible to write one fair, neutral paragraph that summarizes the controversy, always bearing in mind that here on Wikipedia, we do not take sides—we write about the controversy from a neutral point of view. (An aside: it has been said that when a good Wikipedia editor writes on a controversial topic, you should not be able to tell from his writing or comments which side of the issue he personally advocates. That is the standard of neutrality I would like all editors participating here to aim for).

      Now, there is no doubt that the specific subject, silicone breast implant controversy, can be written about at great length: it has a long and involved history, and thousands of pages have been written devoted to it—books, journal reports, court documents, company reports, news reports. It would be inappropriate, however, to reproduce a voluminous account on a general article about breast (including saline) implants, especially at the expense of the other important aspects an article on breast implants should contain as mentioned in 2. On the other hand, the controversy and its history are important, and it is desirable for an encyclopedia to have a good account of it. So what do we do? On Wikipedia this type of problem is resolved by using something known as the Summary style. I urge those of you who haven't read this document to do so. (This should not be confused with a POV fork. A POV fork is a second article on a given subject with an opposing POV; i.e., instead of collaborating to write a single balanced, neutral, article, editors of opposing points-of-view create two biased accounts of the same topic. The impetus to create silicone breast implant controversy however is that this subtopic is sufficiently noteworthy, important and complex that it requires an individual page, itself conforming to NPOV, which the main article breast implant will summarise in a neutral fashion in the relevant subsection).

    4. One more problem with the article is that it is too U.S.-centric. This is a bias many of us Wikipedians have to work at overcoming. Wikipedia is a general encyclopedia with a global audience; indeed, given population and developmental trends, before long the majority of the web's audience will be non-western. When writing articles, always remember the diversity of the audience: it might be a good idea for most of us to picture ourselves trying to explain what breast implants are to a young female college student in China or India. Or even better, perhaps, to a Martian. Should we really write 'FDA' in the second section (nowhere in the entire article is it written 'U.S. Food and Drug Administration')? Should we nonchalantly write "According to a Congressional report..."? Should we only write about surgical practice in the US? Shouldn't we also mention incidence figures from elsewhere (where available)? And so on.
    5. In view of the preceding, I suggest the following:
      • We need to work on a general clean up of the article, from the top down. I suggest the following structure:
        Lead section (untitled by convention)
        Types of implant
        1. Early forms of breast implant
        2. Silicone implants
        3. Saline implants
        Patient evaluation
        Surgical techniques
        Risks and complications
        1. Known risks and complications
        2. Possible risks (can anyone think of a more neutral section title? Should also link to main article See also Silicone breast implant controversy)
        Incidence of breast implant surgery
        References
      • The second article, Silicone breast implant controversy, can be begun on a subpage if so desired. After the basic structure has been agreed upon by all parties, it can go live in the mainspace.

I will be archiving all the old naughty stuff on this page: here's to a new beginning. Throughout, please mind Wikipedia:Civility, Wikipedia:No personal attacks, and Wikipedia:Assume good faith. Do not revert war, please. I regret that I will not myself be able to take a substantial editorial role here, but I will continue to watch it in an administrative capacity. David tells me he will continue to contribute, and I hope that all of you great folks—Jgwlaw, Droliver, Midgley, Will Blake, Ombudsman et al—will likewise work together to produce a fine set of articles we can all be proud of. Very kind regards —Encephalon 12:14, 20 April 2006 (UTC)

Comments/other suggestions

Encephalon, if you look at the most recent research, you will see the evidence is NOT 'overwhelming' about systemic illness. You are wrong. I don't have a problem about most of what you said about the article, but you are wrong about the 'evidence'. It appears that others don't want any discussion about the Risks and Controversies. I don't want to be a participant in an article that did not address the true controversy. molly bloom 00:56, 21 April 2006 (UTC)

Wikipedia is not here to "address" anything, it is not a soapbox, rather it should "reflect" (or "cover") the status of a debate. Hence an article should state the consensus majority opinion, and then any disenting minority viewpoint (but does not need to give equal prominance). In this regard and for this topic, what the consensus opinion is can be debated:
  • Most rheumatologists and plastic surgeons would seem (rightly or wrongly) not to be overly concerned - which forms one real-world consensus.
  • Yet there can be no denying the FDA's concerns (and mirrored at least in UK too) and subsequent revoking of product licence - the FDA forms a very clear "official" consensus opinion. (foolish is any doctor who totally ignores legal licensing body or professional organisations' statements)
  • The article is about breast implants and first and formost this article should cover what they are and their history. A description of their use, insertion technique, accepted specific risks should follow along with (as just another sub-section) any debate/disagreement over them. A long section on the risks is thus disproportionately to the overall article, hence my previous suggestion to split into a separate article (with suitabe cross links).
What has been most disputed is not the significance or 'value' for any one study either for or against, but rather the length given over to discussing that item (other editors' comments have talked about the length of the article rather than any specific fact over a possible risk). Even my attempt at shortening the list of studies disputing any rheumatological disease link was critised for still being too long (and having read that opinion I tend to agree). In essence only a summary of knowledge is required, as this is not a textbook. Over-lengthy subtopics in an article is poor encylopaedic writing and (irrespective of citable accuracy) risks seeming to be POV pushing (i.e. has appearence of seeming to be a POV push rather than necessarily being wrongly POV) even if it is for an uncontested majority opinion fact. I quite agree with you (?this or my talk page) that summarisation of the risks can not be ad absurdum to a single sentance, the balance is somewhere inbetween the current status and a few paragraphs (anything longer deserves/should be in a separate article). David Ruben Talk 02:51, 21 April 2006 (UTC)
Wikopedia most certainly is here to 'address' topics. That is the whole point of Wikopedia. Let's not dispute semantics. One 'addresses' a topic whenever one writes anything about it.
Here is one comment from a plastic surgeon I asked to contribute:
"I looked at the site and it would appear that most aspects are covered. The big gap in understanding is that Plastic Surgeons do not seem to take complications very seriously. For example, capsular contracture and even calcification in capsules is more a "vexing minor problem" and does not seem to worry most PS that this occurs regularly. There seems to be total denial of symptoms and women who complain are labelled as being 'hypochondriacs, malingerers, having a bad marriage, bad job, menopausal" or anything but implant related problems.
I often think that future generations will look back at this era and say "what did they do to women?!!"molly bloom 06:04, 21 April 2006 (UTC)

I would like to add a vote in favor of creating a new page silicone breast implant controversy. First, some disclosure:

I am new to wikipedia. I am a plastic surgeon. I do not perform augmentation mammaplasty, for a variety of reasons. I have some personal familiarity with the dispute over systemic effects of silicone gel implants [4].

I agree that my colleagues have minimized the risks of breast implants, and that a more candid discussion of these risks is over-due. However, the discussion as it stands pushes a POV quite aggressively. For example, the photograph showing "necrosis" shows not a simple a augmentation mammaplasty or implant placement, but a mastopexy (breast lift) that must have been performed with the augmentation. The necrosis is most correctly described as a complication of the mastopexy, or the combination of a mastopexy with an augmentation, and not the augmentation alone. Including this illustration in an article on implants would only be appropriate with much more explanation than is given here. The systemic illness section is an excellent essay about the evidence that does not fit with the majority consensus on this issue. Now, I personally think that there is a systemic effect of silicone gel, and that it will eventually be proven, but ignoring the majority consensus in this discussion is no more appropriate than ignoring the evidence supporting a systemic effect. I'm reluctant to start any editing of my own in this article, because it obviously very emotionally charged at this point and quite lengthy already. I think acknowledging that this is a controversy, and splitting this off into new page would allow for more contribution. DLaub 04:20, 23 April 2006 (UTC)

International

Canadian Journal of Plastic surgery -- discusses the 'generations' of implants, and the risk of rupture in older 'second generation' implants. [5] Based on the present study and other recent publications (1,6,9), about 80% of all second generation silicone-gel implants are currently ruptured or leaking. Others are expected to rupture with further time. molly bloom 01:55, 23 April 2006 (UTC)

Third Generation Implants

Cohesive gel are considered by most as 'third generation' implants. [6][7] [8][9]molly bloom 01:55, 23 April 2006 (UTC)

Implants used (and withdrawn) in other countries

The original author of this article clearly was writing from a US perspective. There have been other types of implants, & some recently withdrawn from the market. Hydrogel - Hydrogel filled breast implants are no longer available in the UK. Adverse incidents have been reported involving breast swelling associated with fluid around the implant. MHRA (formerly the Medical Devices Agency) is continuing to monitor the safety of these implants and does not recommend that women with hydrogel-filled breast implants have them removed unless they are experiencing problems. In May 2005 the Committee on Toxicity (COT)1 reviewed two animal studies commissioned by PIP. Although some effects were seen in the kidneys of the tested animals, the Committee concluded that these results suggest that exposure to the hydrogel filter will not lead to clinically significant effects in women with these implants. The Committee did, however, express concern about the lack of long-term follow up of women with breast implants.

Because of continuing concern over the safety of breast implants, MDA carried out a series of planned investigations into the safety of the various filler materials used in the products available in the UK. MDA's investigations into hydrogel-filled breast implants revealed inadequacies in the manufacturers' biological safety assessments and concluded that there was not enough information to fully assess either of the hydrogel filler materials. When they were made aware of the results of MDA's reviews, both manufacturers decided to withdraw their hydrogel-filled breast implants from the market as a precautionary measure, pending further studies to establish the safety of the filler materials. In December 2000, MDA issued two Device Alerts concerning the withdrawal of hydrogel-filled breast implants from the UK market as a precautionary measure. [10]molly bloom 00:38, 24 April 2006 (UTC)

Breast implant safety controls urged as dangers recognised (Brussels article)

Saturday, November 17, 2001 :

By Geoff Meade, Brussels

TOUGH Europe-wide controls on the safety of breast implants have been urged, but there is still no evidence they pose a "general health risk", the European Commission said.After a spate of serious illnesses among women undergoing implant surgery, and years of pressure from MEPs, the Commission says there is a need to improve the quality of implants and to set up advice and follow-up care for patients.

Up to 80% of breast implant surgery in the EU is cosmetic, and no general health dangers have been found, following major research in Madrid on behalf of the European Parliament.

But the Commission said yesterday it is widely recognised specific problems do occur, some triggered by the design and characteristics of silicone implants.

Announcing plans to MEPs in Strasbourg, Enterprise Commissioner Erkki Liikanen said: "Health issues are a major public concern, and it is our task to ensure they are addressed in the best possible way, so as to provide European citizens with the highest possible level of safety. We should be aware that, as with all implants and medical interventions, there may be inconveniences, and that patients may react in different ways.

"That is why patients should know the advantages and the disadvantages of implants and be given all the relevant information that allows them to make a well-informed decision."

The proposals, set out in a formal Commission "communication" for consideration by EU governments and MEPs, include guarantees that women considering breast implant treatment have access to independent counselling before and after surgery.

They would also be able to seek a "second opinion" and such surgery would only be considered for those aged 18 and over.

There would be compulsory national registers of every breast implant operation carried out in all 15 member states, with surveillance and monitoring of those undergoing surgery.

Long-term studies to establish the health risk would also be launched.

Silicone breast implants are already banned in the US, Japan, Canada and France - and a recent US survey revealed 69% of them rupture within 10 years.

Mother-of-two Christine Williams, chairman of Silicone Support UK, says she now regrets having breast implants to boost her figure.

She had an operation in 1979 when she was 30, and within four years began to suffer painful scar tissue.

The corrective surgery which followed was the start of a nightmare which, she claims, led to the end of her marriage and a host of health problems.

Two years later she had a second operation to replace the burst implant, but doctors found silicone leaking everywhere and removed much of her right breast and chest muscle.

molly bloom 00:36, 24 April 2006 (UTC)

Dutch physician

2004. The chance on this danger is endorsed by plastic surgeon Rita Kappel of the dutch University Medical centre St. Radboud in Nijmegen. Thousands of Dutch women with silicone implants have considerable health problems. Kappel treats much of these women. She says: Silicone breasts are for some women unsafe, very unsafe. If I remove the implants frequently all complaints dissappear."molly bloom 00:54, 24 April 2006 (UTC)

Recent Edits

External Links--I left the IRG article, but removed an editorial that is NOT a study, or a review, but merely an editorial ranting about lawyers and the horror of not having implants available for all, under any circumstance.

I agree with the edit of the 'Local Complications'. It looks good now. Thanks, David.molly bloom 15:37, 25 April 2006 (UTC)

  • Molly, you commented on my talk page "I left the UK report, but why do we need to have it listed twice? It already is in the source citations. Do we want to link to every single report?".
  • I agree the long list of references at one point also included duplication of citations already given in the footnotes. However I did have a v.quick look at the footnote list and did not see the www.silicone-review.gov.uk UK report included there - I still don't see it, but perhaps I need to look at the link addresses rather than the displayed text. (yes if duplicated then not needed in the reference list too)
  • As for links all studies - no, but a selection would help high;ight that the literature contains a variety of views.
  • Re User:DLaub, was this the surgeon you previously mentioned? I thought DLaub comments good - yes I think the article sets out well the range of complications, but could do with some mention that some research suggests other wise (operative word is some, no no need list all studies or at huge length), and likewise mention of that reserach as being subject to comments of FDA & others as to methodology (or conflicts of interest - although conflict of interest does not mean that a report is wrong, a personal assessment, but just that care is required in its critical reading).

Sub-pages for article split

In the last week or so, a number of editors (DLaub, Encephalon, Midgeley, Mike1024) have suggested a split. I think if the currently trimmed complications sections are to be edited much further (they describe the risks but now fail to mention any of the counter-arguing studies) or expanded to give a wider, less US-centric, tone then this will be beyond what one article should cover. Of course a summary of risks needs be included in the main article and an article on risks needs refer back to the description of what breast implants are. I was thinking of being bold and doing the rewrite/edit in one go, but I take note of Encephalons thoughtful suggestion of trialing out in sub-pages first (away from the "live" page). My first drafts at this break the article down into about 35kb lengths - what is considered the rule-of-thumb maximum length for a single article !

Please see therefore the non-live, subpages of Breast implant/Revised and the propossed new article of Breast implant/Risks and debate.

  • Obviously the wording needs tidying up - in particuler I needed to quickly create an introduction to the risks article which I tried to obtain by aggressive summarising the main article.
  • Also unlinked references need be removed from one or other article where they nolonger apply.
  • The main article listing of risks needs be kept very small (ie list a concern and summary of view on this as already well done), any fuller explanatipon then is in the sparate risks article. Note I chose 'Risks and Debate' as 'controversy' suggests that risks have not been suggested - they cearly have in some of the research, there is a debate though as other studies are done as to the significance of any single report or critical reading of a single report. Dlaub's comments re likely risks, evidence perhaps not conclusively confirming thi syet, surgeons aparent lack of concern for issues or uncertainty well voiced. Can we suggest ways to take the parts of this topic (i.e. the editing sub-pages) to reflect this ? Remember whilst currently well written as an essay on the topic, it is perhaps not the best example (yet) of an encyclopaedic entry in wikipedia - hence the creaion of subpages for collaborative work by editors, as per Encephalons comments above. David Ruben Talk 17:42, 25 April 2006 (UTC)
If you remove the "Risks and Controversy" section, you should still leave the 'local complications' with the main article, since it is not controversial. Nobody disputes that these occur. Secondly, upon separation, you should add 'rupture' and the problem with implants & mammography in the 'local compllication' section since the fact that these occur is not controversial. Further discussion about the problems involved could be in the "Risks and Controversy" section.molly bloom 18:16, 25 April 2006 (UTC)
Indeed - I so moved the local complications to remain within the main article. I mention rupture, but not at length - the fact that it occurs is given, but with quite a lot of info on the rates of rupture and with how this is then responsible (via the leaked silicone) for the local/systemic effects given in the risks article, I did not wish to over duplicate - don't think balance is quite right yet though. David Ruben Talk 21:56, 25 April 2006 (UTC)
Your summarizing and 'tidying up' for an intro paragraph is excellent. Very good intro.molly bloom 18:19, 25 April 2006 (UTC)


Copied from User:Encephalon's talk page by David Ruben Talk 00:31, 5 May 2006 (UTC)
Looking over Breast implant/Revised and the main Talk page, I see grounds for hope, David. The beginnings of a neutral Risks section are forming: that quick edit of yours was good, and Molly has been making excellent contributions to the types of implant section. Don't worry about the article's size now, once we've more or less gotten the content in place we can begin the copy editing (I perceive that stage to be some way off). If I may make the suggestion, the headings should probably be of the format here. The current "History" section should probably be rewritten to form "Early forms of breast implant" (if we had a separate history section on the development of of implants, much of it will be redundant with "Types of implant"; if we restricted the history section to just silicone injections, "History" would be an unsuitable title). "Patient evaluation" (+contraindications) and "Surgical techniques" should be straightforward. And then of course we have "Risks and complications". I think some rearrangement in /Revised would be a good idea, David. It's probably best to split the section in two, like I said earlier. The first subsection should be on known risks and complications: op and post op issues, rupture/leak, contracture, mammography issues, etc. (In /Revised some of these bits are currently under "controversy"). The second section should summarize the history and current conclusions re: silicone implants and 1. CTD/autoimmune disorders, 2. cancers, 3. neuro, 4. miscellaneous (the platinum issue, the suicide issue), and then lead of to the subarticle. The "known" section (which we can split into individual subsections if preferred) will probably be around 4-5 paras; the controversy 1-2. Writing the second article is probably going to be the greater challenge, both because of the sheer amount of ground that will have to be covered, as well as the need to maintain dispassionate neutrality. —Encephalon 19:22, 25 April 2006 (UTC)