San José, Costa Rica, since 1956

Health officials order breast implant swap

Lucía Castiglioni left her house at 4 a.m. Tuesday carrying only a bag with an extra change of clothing. She traveled from the Southern Zone canton of Pérez Zeledón to San José’s San Juan de Dios Hospital for elective surgery after learning that she is one of 130 women who received a potentially defective breast implant at the hospital from the French company Poly Implant Prosthese, or PIP, between 2006 and 2010.

Officials say 372 Costa Rican women received PIP implants at public hospitals and can now have them replaced as part of a plan by the Social Security System (Caja). The plan responds to a worldwide alert about PIP implants, which were manufactured with industrial-grade silicone and other potentially harmful additives instead of medical silicone. In Costa Rica, public and private hospitals stopped using PIP implants in 2010 when the Health Ministry issued a warning about them following notification from French health officials. 

The 372 women with PIP implants from public hospitals received them during treatment of breast cancer and other medical issues.

This week, the Caja issued a preventive alert to all patients who received the PIP implants. Officials from San José’s main public hospitals – Hospital México, San Juan de Dios Hospital and Calderón Guardia Hospital – began  calling patients to explain potential risks of keeping the implants, as well as advising women that replacements are available to patients covered by the Caja.

On Monday, doctors at Hospital Mexico met with a group of seven women. The first replacement surgery took place today. At Hospital Mexico, a total of 37 women were given PIP implants.

Doctors at San Juan de Dios Hospital also met with patients throughout the week. “All the women [we spoke with] were willing to have replacement surgery, and we are already scheduling surgeries in order to start in the next two weeks,” said Gilberto Reyna, a hospital physician. “We invite women [with PIP implants] to the hospital, we explain the situation to them, we tell them to be calm, we address their doubts and make sure they understand that they have the opportunity to have the implants replaced.” 

Castiglioni, 59, was one of five women assessed on Tuesday. She received a PIP implant in 2007, and recently has had high fevers and discomfort. She said she wants a replacement as soon as possible, and on Tuesday she was prepared to stay at the hospital. Doctors told her she would have to wait until next week to schedule her surgery.

At public hospitals, PIP implants will be replaced with Motiva implants manufactured in Costa Rica’s Coyol de Alajuela Free Zone by the company Establishment Labs. 

“I’ve never had problems with my implant, but the hospital has made it clear that this is an important preventive measure. I would rather have surgery sooner than later,” said Isabel Mesén, 27, from Alajuelita, who received a breast implant in 2009. 

According to Reyna, at San Juan de Dios Hospital, 90 percent of patients had breast implants because of breast cancer. The remaining 10 percent either had Poland Syndrome, a birth defect that hinders breast development, or complications like breast necrosis after breast-feeding. 

Officials at Calderón Guardia Hospital are also in the process of establishing a list of patients with PIP implants, and to date they have identified 37 women. 

Women who received PIP implants at private hospitals and are enlisted in the Caja can have the implants removed at public hospitals, but not replaced, officials said. 

Also this week, officials from the Economy Ministry – which operates a consumer advocacy office – and the Health Ministry said that private hospitals that used PIP implants are required to replace them, the daily La Nación reported Wednesday. Health Minister Daisy Corrales sent a letter notifying five private hospitals of the requirement. The notice was sent to Metropolitan Hospital, Clínica Bíblica Hospital, CIMA Hospital, Clínica Santa Rita Hospital and La Católica Hospital, La Nación reported. 

However, directors from Metropolitan Hospital and Clínica Bíblica Hospital said they had not used PIP implants.

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