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INTERVIEW – After the publication of the investigation into the lack of control of medical implants, the Professor, head of the department of plastic surgery at the Saint-Louis Hospital in Paris, protests against textured bad implants.
Since 2011, 53 women with textured-coat bad implants have developed a very rare tumor: anaplastic large cell lymphoma.
LE FIGARO. – The French Agency for Medicines (ANSM) must decide early next year on their reliability. Is this decision eagerly awaited?
Pr Maurice Mimoun. – Yes, since 500,000 women currently wear bad implants in France. Textured implants, implicated in the occurrence of this rare cancer, represent the majority of the French market: 85%, against 15% for implants with a smooth envelope.
"When we introduce a foreign body such as an implant into the body, the body starts to produce a membrane that can become very thick and distorts the prosthesis, making the bad hard and painful."
Why are you angry?
Because all of this could have been avoided. Textured implants do not make sense. Let me explain. There are two types of bad prostheses: smooth-walled prostheses and textured (or rough) walled prostheses. If the manufacturers started to make different types of implants, it is supposed to avoid a phenomenon called "capsulitis retractile" or "shell", but I do not know whose advice. This is sometimes the case when a foreign body such as an implant is introduced into the body. The body begins to produce a membrane that can become very thick and distorts the prosthesis, making the bad hard and painful.
Textured prostheses do not prevent the formation of hulls?
Labs have said it so often that everyone started to believe it! Yet there was no study that showed it. It is not because things are repeated ten times, a hundred times, a thousand times that they are true. This claim has been so widely spread that it has turned into a truth that Social Security has grown. So much so that for reconstructions of the bad, she only refunded textured prostheses!
Do you question the virality of information?
Yes, the virality of medico-commercial information that has nothing to do with medical information. The medico-commercial information is repeated so many times that we forget the source. And, what was a hypothesis, becomes an affirmation. Novelty does not mean efficiency. We are in the reign of "All beautiful, all new", "Long live the last prosthesis", the one that is fashionable! The news is broadcast on the internet, and it is true. That's the problem. And in this logic, competing laboratories have embarked on the race for the best prosthesis … And we have multiplied the types of textures. And the vicious circle was still packed when everyone said: "Since social security only reimburses textured prostheses, it's better."
»READ ALSO – Medical implants: the lack of control denounced by a consortium of journalists
What about studies then?
Gradually – and this was the height – studies were published even stating that textured prostheses often caused more shells than smooth dentures, but I was amazed that the attitude did not change. The benefit of textured prostheses was null or unproven. In desperation, they were found to have an anti-rotatory role in anatomical prostheses as well as to give themselves a good conscience.
"I just did not give in to the pressure of the laboratories, the novelty and the patients who were unfortunately misinformed"
In your service at the Saint-Louis Hospital in Paris, have you never implanted them?
No never. I held fast! I repeat it did not make sense. I have always banned them in the service. Despite my arguments, my ban went bad. I simply did not succumb to the pressure of laboratories, novelty and patients who were unfortunately misinformed.
The patients are asking you?
Naturally. They claim them since they read it in this or that article or on this site. It takes a lot of energy not to be dragged by the wave that sometimes borders on the tsunami. "How, you do not want to use this prosthesis?", I am told. I say, "No, ma'am, we do not have enough perspective!" But I often hear back: "But this is the last one." And I have to re-explain everything I just told you.
Moreover, when the laboratories come to see me each year by proposing a new prosthesis, I am amused to ask them: "Why? The one you proposed to me last year no longer work? What should I tell my patients? "
"Today, I am irritated because things could have been avoided. This unfortunate story must serve as a model from which we must learn. (…) We have a duty of caution and information "
And today?
Today, I am irritated because things could have been avoided. This unfortunate story must serve as a model from which we must learn. Certainly, the attraction of the new is normal, it is the curiosity and the desire to improve things. But we have a duty of caution and information. By what right can we use a new prosthesis that does not have several years of hindsight without telling our patients?
The story of the texture seemed very innocent. The labs were saying, "It does not matter, it's just a texture after all, if it does not work, it can not hurt." Well no, we can never think so for the human! Health authorities agree that texture, in a very rare number of cases, leads to a very particular cancer: anaplastic large cell lymphoma. The result is that many patients with this type of prosthesis are in a state of panic.
That's why I'm irritated. Today, cases are rare and it seems that the removal of prostheses would involve more operating risks than keeping them. All of this has yet to be evaluated. But anyway the anxiety will persist. It's a shame, we have such a beautiful specialty that makes so many services.
"My opinion is that you have to stop the texture completely"
A word to conclude?
Yes, sadly, I see another false statement. We're starting to say that microtexturing is not dangerous. First of all, we forget that right now, "microtexturing" means nothing. While the laboratories have clbadified the texturations in micro and macrotexturation, but these rankings are completely arbitrary. Microtexturations of some laboratories correspond to macrotexturations for others. There is no standard. It is without considering either the process of manufacturing the texture that can weaken the prostheses. Especially what threshold should we choose between macro and micro? There will always be an uncertain end point. My opinion is that you have to stop the texture completely.
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