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The "Dark" side of silicone breast implants.

Frank Vasey, MD

Thinking about getting silicone breast implants or encouraging the woman in your life to get them…

You already know or think you know the benefits of these implants? As I am not an expert in the "bright side" of silicone breast implants, I will not comment. The "dark side" is another story. I have learned a lot from the 2000 sick women with mostly, but not exclusively, gel-filled silicone breast implants. The outside of a saline-filled implant is still silicone, but much less than a gel-filled implant. If as predicted the saline-filled implant fails in 10-15 years, you know it. The implant goes flat as an airless tire. On the other hand, the outside "envelope" of the gel-filled implant can disintegrate and there could be no obvious indication of this rupture. The silicone/silica debris could be spreading into your lymph system or through connective tissue planes down your arms or under the axilla (arm pit). One lady expressed silicone gel from below her knee in my office.


Figure 1.
This is a breast capsular biopsy demonstrating particles of silicone/silica debris being attacked by macrophages. Similar debris has been described in regional lymph nodes. Macrophages are cells of the immune system that circulate throughout the body and play a key role in an immune reaction. Also, the element silicon has been shown to be increased in peripheral blood in women with silicone implants in comparison to contrasts without implants (work done at UC Davis California)

From my perspective…

The immune system activation from silicone/silica causes a unique fibromyalgia syndrome. Based on an FDA MRI-based study of almost 400 women with gel-filled implants, 13 years after they were placed, the risk of systemic illness is 10-25%. The 25% (about 75 women) was the extra-capsular rupture group. (Brown et al. 2001)

The good news is the syndrome tends to stabilize and improve when you remove and do not replace the implants. I believe the systemic illness is a function of the degree of excitability of the woman's immune system to silicone/silica (implants are about 20% silica) coupled with the amount of the material exposed to the immune system.

Here is what to look for if you have them…

Usually local problems under the muscle occur first. The breast hardens and feels like a grapefruit or even a baseball (capsule formation). That is your macrophages in action. The immune system is responsible for wound healing and making scar tissue. The pain spreads into the muscles in the anterior chest, upper back and neck. Exercise tends to spread the silicone/silica debris making you feel worse. On the other hand, exercise makes psychologically-driven fibromyalgia better.

Bladder irritability with the urge to empty your bladder or even gross blood has rarely been noted. This is interstitial cystitis, which I suspect comes from urinary excretion of the silicone/silica debris. No one has proven this. Neuropathy is a malfunction of peripheral nerves. You feel a "blowtorch", an "insect crawling", or "numbness with nothing on your skin".

If you are concerned…

See your doctor, what else! But don't expect him to know much about silicone. You want him to be certain you don't have something else. Such things as under active thyroid, hepatitis, lupus, HIV, and polymyalgia rheumatica can all make you tired, achy, and sick. Check your temperature. With "silicone related disorders" you probably won't have a fever, but I have seen about 10 women who did. All fevers I have seen went away when the implants were removed, but you may want a blood culture and a TB skin test, or chest x-ray to try to be sure there is no other explanation for the fever.

Everyone is waiting for a syndrome definition that can be tested…

Evidently, manufacturers, plastic surgeons and even the federal government do not want to do it. I'd like to do it, but I have no funding and I did ask years ago.

So the status quo continues as I approach retirement…

We let people smoke and we know that kills them. I don't think silicone kills people, but it can make you feel like the flu every day, which is a pretty miserable way to live. If you are sick and your doctor can only diagnose fibromyalgia, you steadily worsen with activity, feel like you need to urinate all the time and have in apparent insects crawling on your burning skin, consider removing and not replacing your silicone breast implants. This is a tough decision, but perhaps important for your health. Good luck.

If I am so smart why isn't your plastic surgeon telling you about this…

If your surgery was recent or you are thinking about surgery, my advice is to read your informed consent and keep it for future reference. Most plastic surgeons do not honestly believe there is a systemic syndrome to silicone because that is the "party line".

Why is that…

Basically, because a definitive study has not been done despite the fact that silicone breast implants have been placed since 1964. That is over 40 years. A 20-year prospective (into the future, not looking back) study of silicone patients and their similar best friends without implants would answer the question of the existence of the syndrome. The fact that a large number of typical symptoms (chronic fatigue, muscle & joint pain, etc.) were statistically worse in women with silicone breast implants over controls who had a breast reduction operation (Fryzeck et al. 2001) does not convince plastic surgeons. Neither does the improvement in symptomatic women post implant removal (Rohrich et al. 2000 & Vasey et al. 1996).