Two days before her surgery to receive saline breast implants, a Tampa woman grappled with some last-minute thoughts.
She wanted well-rounded breasts again; hers sagged after her daughter was born 10 months ago, she said. But she wondered about all those thousands of women, including one of her sisters, who blame an array of health problems on breast implants. Then again, the woman's other sister has had no problems with her silicone implants.
"I'm still a lot confused. I want it done," said the 26-year-old, who asked not to be identified. "There isn't a whole lot of information out there as to whether it's safe or not, when it comes down to it. I feel it's really a shame what happened to the women with silicone implants.
"I wouldn't be doing it with silicone. And who knows? I may be faced with the same thing in 20 years. I don't know. But I'm going to take that risk."
So did her 23-year-old niece, who wanted to enhance what doctors called "underdeveloped" breasts. In fact, because the two women were scheduled to have surgery the same day, they got a discount rate for the procedure.
All of this makes Marian Amparo cringe.
Amparo, a 45-year-old woman who leads a support group called Silicone Survivors Action for Education (SAFE), doesn't trust the safety of saline implants any more than silicone. Both are at the heart of thousands of lawsuits filed by women seeking damages for health problems they believe were caused by breast implants.
The Tampa woman and her niece have spoken to numerous medical professionals about the implants, including a doctor who told the woman she could safely plan to have and nurse children after breast enhancement.
Last week, the two women contacted Amparo for literature on breast implants. Amparo said they were unaware of the risks associated with saline implants, and she wanted to give them the information she had.
"Their (doctors) are telling them it's okay. They had no idea until she talked to me that the FDA is going to make a decision this spring, supposedly, on what to do about these saline implants," Amparo said.
Amparo's serious health problems have been linked by doctors to the silicone breast implants she got in 1980 to replace tissue that atrophied from fibrocystic disease. With the information available today, Amparo has trouble understanding the decision to have implant surgery.
"It boils down to vanity," Amparo said. "It's beauty before life."
Like life and beauty, the breast implant issue is not simple.
Untold numbers of women have suffered no ill effects from implants, and many doctors do not think they cause problems.
Others attribute a host of ailments to implants _ silicone and saline _ including chronic fatigue syndrome, asthma, seizures, enlarged lymph nodes and immune disorders.
Meanwhile, the proposed $4.75-billion global settlement that would be paid by implant makers and raw-materials suppliers to women who qualify remains in limbo as various companies hash out what part of the agreed-upon settlement each will pay, and when.
Though a conclusion to the settlement had been expected last week, new snags have stalled the process.
"The important thing to remember is that as of the present moment, there is no settlement. We remain optimistic there will be one, but things could happen to make it fall completely apart," said Tampa attorney Scott Charlton, who represents several area breast-implant patients and who serves on an advisory committee for the global settlement.
"The problem was, up until approximately a couple of weeks ago, the defendants were having arguments among themselves allocating the money, who was going to pay how much. Apparently the money has been committed to by the defendants, but they want to change the terms of the settlements to delay (their deadline to pay victims).
"The net effect," said Charlton, "would be to reduce (to companies being sued) real costs, since they could hold onto their money later. But most importantly, it would delay the time in which we could get the money to the victims by more than a year. That simply wasn't acceptable to us."
More than unacceptable such a delay could be lethal, Amparo said.
"Women are dying," she said. "They're losing their insurance. They're on expensive treatments. You just die."
Like Amparo, Jackie Clark, founder of The Silicone Connection, is flooded with calls every week from women who are sick, frightened and unsure what to do next. Many don't know how the global settlement would work or whether to pursue separate legal action.
Clark, a private investigator who was misdiagnosed with a host of sicknesses _ including AIDS _ before doctors linked her illnesses to silicone, frantically sought help for her problems.
"I went to 13 different doctors," she said. "None of them told me it could possibly be related to my implants. For one week, I thought I had AIDS. After that, the doctor said, "The good news is, you don't have AIDS. I think you have lupus.' In a year and a half, I was diagnosed with AIDS, lupus, neuromuscular disease, early signs of lung disease.
"No one would help me make the connection," Clark said. "I was very, very ill."
After her diagnosis, Clark applied her professional skills to help change the law in Virginia _ where she lived at the time _ that governed the statute of limitations for implant litigation.
She brought her support group to her native Florida when she returned in August, and she continues to operate the non-profit organization while also working for the St. Petersburg law firm of Yanchuck, Berman and Kasaris.
Her mission now is to urge women with implants to educate themselves. She also directs them to lawyers and doctors who specialize in cases involving breast implants.
"My biggest concern at this point is with the global settlement and what's happening with the multidistrict litigation," she said. "These women are not going to be acting quickly enough and are going to be left out in the cold."
Experts can only generalize about which women would benefit most from participating in the proposed global settlement _ assuming it occurs _ and who should pursue individual claims.
Bob Hummer, an attorney who specializes in breast implant litigation and injury law for Yanchuck, Berman and Kasaris, said women who don't meet statute-of-limitations deadlines or who don't have clear, direct links between their problems and their implants would be more likely to opt into the global settlement.
Women must consider other variables, as well. "There's a certain number of women this settlement is not for, based on the severity of their illness or their loss. A woman with enormous medical bills or a very lucrative career she lost _ someone like that may wish to opt out of the settlement," said Tampa attorney Charlton.
It's hard to know how many women eventually will divide the money from a group settlement.
"Nobody knows how many women were implanted. No one knows how many women have developed problems. And nobody knows how many of those will come forward," Charlton said. "I know it's hard to believe there are no hard and fast numbers out there that tell you how many women received implants."
Clark says it's imperative for the women concerned to get proper medical and legal guidance.
"What I tell (women who contact her) is to interview with four or five different attorneys, and you make the decision for yourself. What I want to try to bring to their attention is there is a difference (in attorneys' specialties and personalities). In pursuing a claim against manufacturers, you need someonewho's experienced with product liability. It has to be a silicone-educated attorney. This is all very new.
"One of the other things I want to make women aware of is it's going to be absolutely necessary that these cases are prepared and filed in accordance with the global settlement protocol and presented to the multidistrict litigation claims committee within a limited but designated time period. It means that once the (global settlement is approved), they're going to give you a specific time to opt in and opt out.
"If you miss it, you might jeopardize your case."
Moreover, Clark said, a delay could be life threatening.
"I met a woman today who can't get her implants out. She has no money. Her insurance denied her to get her implants out. She sat here and cried for an hour. She's in severe pain. She has four doctors saying it's medically necessary for her to get her implants removed," said Clark.
"I don't know how this is allowed to happen. If they would do something with the global settlement and let's start settling some claims for the women who are sick or need funds to have their implants removed, these women could get on the road to recovery. The women are just getting sicker by the day."
Clark, with the Silicone Connection, can be reached at (407) 454-4394. The hotline for SAFE is (813) 254-8258.