PIP breast implants - TGA update, 13 April 2012

PIP breast implants - background

PIP breast implants are medical devices manufactured by a French company, Poly Implant Prothèse (PIP).

PIP breast implants are known to have been used in Australia from September 1999 until April 2010, when non-implanted PIP breast implants were recalled from the market following advice from the French regulator (AFSSAPS) that in making these devices the manufacturer had used unapproved materials which may affect their safety and performance.

An updated Australian perspective was published by the TGA on 23 March 2012.

Testing undertaken by TGA to date has not found evidence that the risks involved with the use of PIP breast implants are any greater than those for any other brand of silicone gel-filled breast implants.

Information for consumers

The Australian Government's advice remains that removal of PIP breast implants in the absence of evidence of rupture is not routinely required.

It is important that decisions made by patients and their treating doctors about the need for further surgery are fully informed by the best available evidence, and take each individual patient's circumstances fully into account.

People with PIP implants, and those who are unsure about the brand of their breast implants, are strongly encouraged to consult their general practitioner (GP) or surgeon for individual clinical assessment and advice.

Medicare rebates

The Medicare rebate for MRI services for patients with PIP breast implants has been extended to 12 March 2015.

Normal Medicare arrangements apply to reimbursing patients for the usual cost of medical services related to dealing with health concerns about their PIP implants, including ultrasound examinations and any consultations with their GP or surgeon.

Women who know that they have PIP breast implants, or where clinical advice is that they might have PIP implants, are now able to access Medicare rebates for MRI services examinations to accurately assess the state of their implants.

Medicare rebates are also available for the removal and replacement of breast implants where the treating clinician (surgeon) believes there are physical (e.g. rupture) and/or psychological (e.g. significant anxiety) indications for such surgery. Medicare rebates contribute to the fees charged by doctors, including those of the surgeon, anaesthetist and any surgical assistants, but Medicare rebates do not cover the cost of replacement breast implants. Patients with private health insurance should contact their insurer to ascertain if their policy would cover the cost of the implant.

Medicare also does not cover private hospital accommodation and hospital theatre costs, which may also be subsidised by private health insurance.

Patients may elect to be referred by their medical practitioner to the nearest appropriate public hospital. The hospital specialist can then advise the patient about the best course of action which may include surgical treatment.

Reports of problems with PIP breast implants

Approximately 13,000 PIP silicone gel breast implants were supplied in Australia between 1998 and 2010. The table below shows the number of instances of ruptured PIP breast implants notified to the TGA as of 12 April 2012.

Reporter	Confirmedi ruptures	Unconfirmedii ruptures
surgeons	161	29
patients	65	9
supplier	24	0
All reporters	250	38

1. The The TGA categorises ruptures as 'confirmed' if there is sufficient information to uniquely identify:
   1. the patient
   2. the implant used
   3. that an X-Ray or other diagnostic image showed that the device was ruptured; or the implant was found to be ruptured when it was removed.
2. The TGA has sought further information but as yet has not received sufficient information to uniquely identify the rupture.

Reporting problems with breast implants

Patients and healthcare professionals are strongly encouraged to report problems with medical devices including breast implants to the TGA.

In reporting adverse events associated with your breast implants, contact with your treating doctor is important to ensure that the TGA receives all the information that is required to officially confirm reported ruptures (or other problems) with these devices and to conduct further enquiries where necessary.