A complicating view of breast implants.

Although fears about breast implants have focused on autoimmune disease, scientists have yet to prove a link between an autoimmune syndrome and the implants. A new study now takes a different tack, showing that one-quarter of women who get implants will develop other significant medical problems.

Sherine E. Gabriel of the Mayo Clinic in Rochester, Minn., and her colleagues studied 749 women who had received a silicone or saline breast implant between 1964 and 1991.

The team discovered that 5 years after the procedure, 178 of the women had developed at least one complication that required a surgical follow-up. The most frequent problem was capsular contraction, a painful condition in which scar tissue forms around the implant, sometimes distorting the shape of the breast. The report in the March 6 New England Journal of Medicine notes that 131 women had an operation to remove such disfiguring scar tissue. The researchers also found that 43 women had experienced a ruptured implant. Other problems included blood blisters and infection, the team noted.

Women who had implants for cosmetic reasons reported fewer such problems than women who got the implants to reconstruct a breast after a mastectomy.

The study applies to both silicone and saline implants. In 1992, the Food and Drug Administration banned the use of silicone implants in cosmetic surgery, but some breast cancer patients still receive silicone implants as part of research studies.

An accompanying editorial by Stephen J. Mathes of the University of California, San Francisco points out that most women who get breast implants are satisfied with the result.