The Silicone Breast Implant Controversy

In 1992, the Food and Drug Administration officially banned the use of silicone breast implants in most cosmetic surgeries, citing concerns over the dangers of silicone leakage in the body.

Today reputable surgeons use saline-filled implants which are less harmful when leakage occurs but may still elicit an immune response if the silicone shell the saline is housed in breaks down in the body. I've performed numerous breast surgeries in the past 12 years and I myself have had silicone gel breast implants since 1985, -- so I can understand women's concern on this issue. Ongoing studies may not produce conclusive results for many years, but here is what we know so far:

1. All Implants Can Rupture or Leak.
Most silicone gel implants, especially those manufactured prior to 1985, were known to have small amounts of silicone gel "bleed" or leak through the shell. In the early 1980's, Dow Corning developed a "low bleed" gel implant with a silicone shell that was less likely to bleed, although this leakage occurs to some extent in all silicone gel implants-even those that have not ruptured.

Since silicone-gel implants were banned for use in most surgeries in 1992, plastic surgeons today generally use either smooth-wall saline-filled implants (which are felt to have fewer problems with wrinkling) or textured saline-filled implants (which have a lower incidence of capsular contracture, a tightening or hardening of the scar tissue around the implant).

2. Silicone Leakage in the Body Can Require Additional Surgery.
When saline-filled implants leak out of the silicone shell, the salt water is usually reabsorbed by surrounding tissue without much difficulty. But when silicone bleeds through the shell, it usually requires surgical removal of the material. Fortunately, the body tends to isolate the majority of the silicone within the scar capsule, making this removal much easier. It is important that the explanting surgeon use a technique that minimizes the risk of free silicone coming into contact with bodily tissues and that all of the scar capsule be removed, since it contains silicone particles.

3. Silicone Leakage May Cause Complications or Disease Elsewhere in the Body.
In the past three years, I've seen more than 120 patients with silicone breast implants who have suffered a variety of chronic ailments. Their symptoms range in severity from mild chronic fatigue and occasional joint and muscles aches to more debilitating illnesses, such as fibromyalgia, Lupus, and rheumatoid arthritis. Some plastic surgeons speculate that a low-grade chronic infection around a silicone gel implant may lead to a chronic illness, in which the immune system is unable to eradicate the infection or dispose of the foreign body.

The good news is that we have seen an improvement of symptoms after surgeons remove the scar capsule and implants. Patients often report return of their normal energy levels, sometimes within several weeks following surgery. Some patients only experience a partial improvement, but to date most have not had their symptoms progress unless large amounts of silicone gel still remain in the body.

4. If You Experience Symptoms of Rupture, Consult Your Surgeon as soon as Possible.
Any woman with silicone gel breast implants who experiences a sudden change in shape and/or contour of her breast, or develops burning pain or numbness and tingling in the arm should be evaluated by a plastic surgeon for the possibility of implant rupture. If you experience generalized symptoms such as chronic fatigue and muscle and joint aches-and especially if these symptoms are progressive-you may wish to consider removal of the scar capsule and implant, even if tests do not show a ruptured implant. If the symptoms are severe, I would not advise replacement of the implants with saline implants-recovery is often delayed if the saline implants are replaced at the time of implant removal.