The 1990s began on a high note of growth, cooperation and continued innovations in the field of plastic surgery. More than 5,000 board-certified plastic surgeons were active in the United States. Many were engaged in research or volunteered in their communities or overseas.
In 1995, ASPRS unveiled "Plastic Surgeons Online," a subscription-Web service where plastic surgeons were able to post questions about difficult cases and receive responses from their peers around the world. It also hosted its first cyberspace surgical conference (on rhinoplasty). These tools were nothing short of revolutionary at the time, but merely the tip of the iceberg of what was to come.
In 1996, the Society launched its first public Web site www.plasticsurgery.org, while the world wide web was still in its infancy. The Society offered the largest library of plastic surgery procedural information on the Internet, and included listings of its members in the ASPS "Find a Plastic Surgeon" online referral service.
Public Perceptions Need Improvement
Despite the contributions plastic surgeons make both in their own communities and the world community, the profession suffered from an identity problem as consumers didn't recognize the broad spectrum of work plastic surgeons perform. A survey conducted by ASPS in the early '90s indicated that the American people did not realize plastic surgeons perform reconstructive work, instead equating "plastic surgeon" with "cosmetic surgeon."
In 1994, ASPS President Elvin G. Zook, MD, of Springfield, IL, made changing this perception one of the top priorities of his tenure. He promoted changing the name of the Society from American Society of Plastic and Reconstructive Surgeons (ASPRS) to American Society of Plastic Surgeons (ASPS) in an effort to convince people that plastic surgeons and reconstructive surgeons are one and the same, not two different types of surgeon, as the old name of the society seemed to imply.
His initiative took five years to win enough support to pass, but in 1999, the society officially became the American Society of Plastic Surgeons.
Silicone Implants Come to Crisis in the '90s
In 1976 the Food and Drug Administration (FDA) was given the authority by Congress to regulate medical devices. That same year, the FDA's General and Plastic Surgery Devices Panel recommended that breast implants be classified as class II medical devices, requiring general controls and performance standards.
Throughout the 1980s, the issue went largely unnoticed by the public. However, in 1988, the FDA announced classification of breast implants as class III devices and indicated that the agency could require manufacturers to submit studies on implant safety and effectiveness.
In early 1989, an unpublished study on polyurethane foam-covered implants raised FDA concern about the product's safety, and the manufacturer removed the device from the market.
In December 1990, the questions of implant safety exploded nationally when "Face-to-Face with Connie Chung" detailed the "horrors" of breast implants. Her report sparked a wave of concern among women with breast implants and increased pressure on government officials to act.
Plastic surgeons sought to reassure breast implant patients and the public. ASPS and PSF provided the FDA with much information on the positive clinical experience of plastic surgeons and their patients, including a survey that indicated more than 90 percent of implant patients were satisfied with their devices. ASPS set up a toll-free hotline for physicians and patients with questions about implants.
Despite the efforts of the Society and Foundation to address growing fears scientifically, the FDA called for a temporary moratorium on the use of silicone gel breast implants in January 1992. In April of that year, the agency announced that silicone gel implants would only be available to women for reconstruction under clinical studies, in essence removing them from the open market.
While ASPS and PSF continued to fund research to provide patients with the answers they deserved on the safety and efficacy of their implants, a $4 billion plus global litigation settlement was unveiled in September 1993. The settlement was created by the manufacturers of silicone breast implants to address a class action suit brought by women plaintiffs who alleged the implants caused them illness.
The Federal Court gave approval to the settlement in September 1994. By the fall of 1995, however, the settlement, as originally proposed, had collapsed due to underfunding following the bankruptcy filing of Dow Corning Corp.
Despite a growing volume of studies published in the scientific literature, an extensive government-funded study conducted by the prestigious Institute of Medicine on the safety of breast implants released in June 1999, and a late 1998 report from the federal court-appointed National Science Panel, all of which found no connection between the implants and illness in women, a revised settlement was eventually agreed upon.
In 2000, the fund began issuing checks to women who had registered for the settlement alleging sickness as a result of their implants.
Health Care Reform
The other great challenge of the 1990s was health care reform. Plastic surgeons were active in advocating for coverage for reconstructive procedures in any new health plan and ensuring patient choice and access to specialists.
In 1998, after an extensive lobbying effort, President Clinton signed a budget bill which included a long sought-after provision requiring insurance companies to cover the cost of reconstructive breast surgery for women who have undergone a mastectomy.