Despite the discovery of a rare lymph node cancer linked to breast implants, experts say women need not be alarmed. They say the chances of developing "ALCL" are low.
Marlies Dingel was 42 when her doctor recommended she have her breast removed.
Though no cancer had been found, doctors said changes in her breast tissue could soon develop and become malignant.
Dingel did not want to push her luck. So she took her doctor's advice.
"The harder question for me was: Do I want my breast reconstructed?" Dingel told DW.
"Back then, in 1992, there was a big discussion going on about possibly dangerous silicones being used in implants. I was very unsure," says Dingel.
But with two young children going through difficult times at school, she wanted to be there as a mother - and look as normal as possible.
Dingel's doctors reassured her, and she decided to have a silicone breast implant.
Definitive correlation between cancer and implants
Twenty years later, the debate around the safety of breast implants has flared up again.
It started with the discovery in 2011 that French PIP implants had been made with low-grade silicone, raising the potential for health risks.
On Tuesday, the French health minister Marisol Touraine said 18 women had been diagnosed with the rare cancer, ALCL, since 2011. All of the women have breast implants. As a result, the French health ministry is looking into a general ban on implants.
"We have found a definitive correlation between breast implants and ALCL," says Professor Lukas Kenner, a Vienna-based cancer expert.
But the risk of developing ALCL is low, he says. "It is a very rare disease."
Depending on the data you look at, Kenner says the risk is between one in 500,000 and one in 3,000,000 women with breast implants may develop ALCL.
Though a little unspecified, symptoms of ALCL include a swelling of the breast. If this happens, women should consult a doctor.
"Chances of curing the cancer are very high if it is discovered early on," says Kenner.
The significance of breast implants has grown in recent years both in cosmetic surgery and medical breast reconstruction. Breast augmentation is the #link:http://www.isaps.org/Media/Default/Current%20News/ISAPS%202013%20Statistic%20Release%20FINAL%20%282%29.pdf:top surgical procedure# worldwide.
In the US, where one in five of the world's cosmetic surgeries are performed, about 300,000 women have their breasts enlarged every year.
From 2000 to 2013, the number of breast reconstructions after mastectomy increased by 21 percent in the US, according to an annual #link:http://www.isaps.org/Media/Default/Current%20News/ISAPS%202013%20Statistic%20Release%20FINAL%20%282%29.pdf:Plastic Surgery Report#.
No clear reasons
But so far, it is unclear how and why ALCL is linked with breast implants.
Kenner is preparing studies to test for different factors, as no other studies on the issue exist.
There are, however, various theories that try to explain the link.
Professor Ernst Magnus Noah, who heads the German Society of Plastic Surgeons, says the cancer seems to mostly develop in patients with textured implants that are widely used today.
"Other than that, there is a theory that says bacteria causes this type of cancer," Noah says.
After an operation a bacterial biofilm can develop inside the breast.
"Some of these bacteria may trigger an immune reaction, which then leads the body to produce atypical cells, known as cancer. We see the same thing with certain stomach lymphomas, caused by helicobacter," Noah says.
If the theory proves to be true, doses of antibiotics before and after cosmetic, or reconstruction surgery may help minimize the risk of developing ALCL.
Marlies Dingel had her implant for almost 20 years - without complications.
But she says, had she known about the risk of developing ALCL, she would have thought twice about having the surgery.
Luckily, everything has gone well for her.
Two years ago, the implant was removed as a precaution due to its age.
She decided then not to have it replaced.