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The recent “patient-oriented” article by Sieber and Adams1 compares the risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) with daily activities such as driving a car or flying an airplane using micromort calculations. One micromort represents a 1:1,000,000 chance of death. Sieber and Adams1,2 explain to patients that traveling 8 hours by car carries a 40× higher risk (ie, 16 micromorts) than the lifetime risk of two textured implants (0.4 micromorts). These authors simultaneously report that driving a car 230 miles represents 1 micromort,1 which is the correct figure according to a Wikipedia reference cited by the authors. Regardless of the risk of BIA-ALCL compared with driving a car, is the micromort calculation a useful benchmark for allowable risk?

The coauthors of this letter, question why plastic surgeons are not already recommending against the continued use of a product that is known to be dangerous. Mackay compares the response of two companies to a crisis.3 In 1982, seven individuals in Chicago died after taking Tylenol poisoned with cyanide. The manufacturer immediately canceled Tylenol advertising and recalled all Tylenol capsules, at a cost of $100 million. Johnson & Johnson (New Brunswick, NJ) introduced tamper-resistant packaging and regained a 30% market share within 1 year.4 A micromort calculation comparing 7 deaths with 50 million Americans who use acetaminophen each week5 would be 0.14.

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