By Peter Berton

LOS ANGELES – Adult performer Elizabeth Starr faces a significant risk of life-threatening blood clots unless she undergoes a double mastectomy to remove her famous and highly marketable O-cup breasts. That’s what doctors have told the 43-year-old porn star, who received polypropylene implants in 1999.

Also called “string” implants, the devices resemble yarn. The material absorbs fluid and irritates breast tissue, causing a pocket around the string to fill with more fluid and resulting in continuous, though slow, post-surgical expansion of the breasts. Polypropylene implants were available in the U.S. for only about two years before being banned by the Food and Drug Administration in 2001. The implants also are banned in the European Union.

“There is so much scar tissue in my breasts, it’s affecting the blood flow to the body and could cause a fatal blood clot,” Starr told The Sun newspaper. “I’m a ticking time bomb, because anything could happen to me. I’m so scared.”

Starr said her experience with the implants was unpleasant from the start. Within days of undergoing the procedure, she developed complications. A painful infection led to the eventual removal of the string from her right breast. Afterward, a gallon of sterile saline was added to that breast so her two sides would match, since her left breast retains its implant.

Now a mother of two, Starr said she has spent thousands of dollars on reconstructive surgery, is in constant pain and finds performing even simple tasks difficult. Yet, she is reluctant to follow the advice of her reconstructive surgeon because of the impact a mastectomy would have on her career.

“I presented her case at the local medical society, and the sentiment was she needed a double mastectomy,” Dr. Alexander Sinclair told The Sun.

Making such a choice, Starr said, represents her own personal Catch-22.

“After 63 procedures on my right breast and fighting to keep my career and my breast, I honestly don’t think that I could [undergo a double mastectomy],” she said. “A mastectomy would take away my livelihood, and I don’t know what else I would do.

“It’s hard when you have been a victim of something, and it’s even harder when you choose a path in life where people might look down on you and think, ‘she deserved it,’” Starr added. “But I wouldn’t wish this on anyone, and I hope my story will act as a warning.”