Silicone: The Past, the Fears and the Future

Past Fears

Remember silicone breast implants? Women loved them and, in my experience as a physician, many female patients preferred them over the saline counterpart. So what happened to silicone?

Well, back in the ‘80s, America's media propaganda machine seized upon unproven but scary-sounding anecdotal reports blaming silicone implants for connective tissue diseases. Even though proof of causality was, and still is, completely absent, the media (which loves a good fear-driven story), made it press-worthy front-page reading. The result was a brainwashing of public perception that quickly caught the attention of droves of personal injury attorneys looking to capitalize.

Ironically, any association whatsoever between silicone and connective tissue diseases was never proven. In fact, the linkage has been completely refuted through both clinical research and independent expert panel review. This conclusion was even supported early on by a study from the Mayo clinic in June,1994, published in The New England Journal of Medicine, as well as a Harvard study published in the same journal in June,1995, both of which concluded there was no association.

Silicone implants were also blamed for cases of breast cancer. But even the landmark study in the September, 1997 issue of the Journal of the National Cancer Institute, which concluded that breast implants did not cause cancer, was not enough to allay premature and unfounded fears the media had recklessly inserted into people's minds. The propaganda machine continued to grow, and so did the pockets of the attorneys. It was too late for the truth to matter. Public perception, shaped by the media, won the day. Soon after, in June, 1999, a National Academy of Science independent committee of 13 scientists concluded in their 400-page report submitted to Congress that implants do not cause any major diseases. But that wasn't enough to stop the feeding frenzy. Even more recently, in March, 2000, a New England Journal of Medicine report showed no association between silicone breast implants and connective tissue diseases, or any other autoimmune diseases.

Though no proven causation between silicone breast implants and any major disease, including connective tissue disorders and breast cancer, was ever found, the unstoppable fear juggernaut had started and lawsuits swept across the nation. Under the weight of massive jury awards, the health care and insurance industries got crushed.

 Present Practice

Now, years later, we have yet to find a shred of proof that these early allegations had any basis in science. That the public did not realize what was going on should come as no surprise. The media's loves of fear- and controversy-driven stories is often greater than its thirst for truth. What makes some editors put a story on the front page is frequently that which will seduce the reader rather than the most important news. Take all the front-page headlines about the Kobe Bryant sexual assault story, for example. Regardless of how curious you might be about Kobe's situation, I'm quite sure there were far more important life and death news stories and factually confirmed updates from our soldiers being killed in Iraq at the same time.  

 At any rate, since the 1992 ban, silicone implants have returned, albeit confined to specific guidelines, according to the American Society of Plastic Surgeons. I think of all those women robbed of the choice. Many women were breast cancer beaters who had the old Halstead radical mastectomy and so desperately wanted their reconstruction done with silicone implants, but silicone was either unavailable to them or they were dissuaded by the swirling fears. I think of all those medical supply companies, physicians and insurance companies who got the shit sued out of them. Dow Corning alone paid out $3.2 billion dollars and was forced into bankruptcy for cases which had absolutely no conclusive scientific proof!

Despite all this crap, silicone survives. Though still seeking FDA approval in this country, silicone is much more widely used throughout the world. Its use by physicians was never banned in the UK. The latest silicone use is through injection. Liquid silicone is even being injected in France for minor facial cosmetic purposes. The procedure is becoming quite popular compared to Botox®, which can sometimes lead to paralysis of the nerves, and fat injections, which can cause considerable inflammation.

So it begs the question, though regulatory approval might never happen, could silicone injections ever be used in other parts of the body to electively augment and improve areas with which someone may not be satisfied? The answers are only theoretical, but the thought is compelling.

Future Fantasy?

Back in medical school, I recall reading about the bizarre practice of Japanese prostitutes injecting their breasts with silicone to satisfy war-time servicemen in the 1940s. The first I ever heard of injecting silicone to enhance muscle was from the late "underground steroid guru" himself, Dan Duchaine. Most would agree that Dan was sort of a brilliant nut-job, always seemingly on the fringe with his ideas. Yet, in some ways, he was an innovator who perpetually thought outside the box in which everyone else was trapped. Though many of his ideas were completely off the wall (I considered them "ideas for entertainment purposes only"), others were sort of profound and made me think.

One of his ideas was to take a liquid-gel silicone and inject it in long lines along areas of muscle. Unlike a stiff implant, the advantage would be that an injectable gel would mold to the surface of the muscle, thus naturally preserving contours and striations. The movement, like the Hollywood face makeup in the recent re-make of "Planet of the Apes," would be natural. His theory was to have an experienced plastic surgeon insert a needle between the muscle and the overlying fascia. In much the same way as a silicone or saline implant is currently used to augment a muscle (i.e., a calf or glute) by being inserted under or over the fascia to raise and shape the surface of the skin, the injected silicone could do the same.

This technology would not just have an application for the obsessive body-shaper or narcissistic bodybuilder, but might also have real medical applications for patients who suffer disfiguring muscle disease, cancer and surgical disfigurement. In fact, I wonder if such a technology could be used to help even out facial asymmetry in such patients, thus dramatically improving the quality of their lives in ways current plastic surgery methods fail to do.

It still sounded a bit like science fiction to me up until a recent conversation with my good friend and colleague, Bruce Nadler, MD an innovative plastic surgeon. He had some interesting commentary. Bruce confirmed that the late Dan's theories, though extreme, certainly could one day fall into the realm of possibility.

The limitations might be as follows:

• 1. Restriction to small muscles. The procedure, if ever done, would simply not seem to work well on big muscles due to the fact that you probably could not inject enough silicone lines to make an appreciable difference in a large muscle. Small muscles like shoulders, triceps, biceps and calves might end up being the best targets, whereas a procedure on the chest, back and quads would likely be unnoticeable and fruitless.
• 2. Sub-fascial only. Injections could not likely take place above the fascia of the muscle, simply because an injectable gel form would need an overlying fascia to keep it in place. Traditional implants look and function better below the fascia but require more recovery time; the same might hold true for these injections.
• 3. Surgeon skill. Heaven knows how plastic surgeons would get skilled in this area. Perhaps they would work on cadavers for a while. Beyond that, they would have to be skilled beyond the already attuned skills of the average plastic surgeon. In other words, because they would have to manipulate a needle into the delicate space of the sub-fascial plain, they would need the fine skills of a neurosurgeon in addition to the aesthetic sensitivity of a plastic surgeon. Though implants have the versatility to be placed either above or below the fascia, an injection might only be properly done below the fascia.
• 4. Cost. The cost of the procedure might end up being rather high, simply because of the technical work involved. In addition, though creating a liquid-gel silicone for injection is not an issue because such products are already in existence, the volume used in this procedure might be the determining factor. In other words, for some procedures, you might use a lot of it.

One Sad Story

Over many years in the gym and in medical practice, I've seen bodybuilders who have done just about every conceivable thing to their bodies, including one guy who supposedly injected silicone. Gary was what you would call one of those career gym rats. While never having actually stepped on stage and competed, he seemed to always be "planning for a show next year."  You know- he was one of those guys you always see in the gym no matter when you decide to show up. You look at them and say to yourself, "Do these guys work?"

Gary was one of these guys. He was not one of the heaviest juicers in the gym, but certainly did his share. One day, poof! He was gone. Nearly three months later he finally surfaced again with about 30 pounds less muscle and with his arm in a compression-bandage from shoulder to wrist. The story was that he had injected silicone directly and blindly into his biceps to make them bigger, but hit a vein. Apparently, he almost died from a near-fatal embolic event (sounds a little like what happened to a famous pro bodybuilder you might have heard of who messed with Synthol®, but it's not him I'm talking about). In addition, he managed the lacerate a blood vessel and almost lost the use of his arm.

To this day, I'm not sure of the truthfulness of the story since I can't imagine how three years ago he was able to get his grubby paws on liquid gel silicone. Of course, if he did find some, he certainly was twisted enough to inject it! What I am sure of is that he injected something. Whether it was silicone or not, I'll never know. Either way, the lesson is that the bottom line is the same- you play, you pay. But warning self-abusing bodybuilders not to stupidly experiment on themselves and instead wait for medical science to reach proper breakthroughs is hopelessly akin to telling the media to just stick to the facts and tell a balanced story. Or convincing the personal injury attorneys to not exploit unfounded fears.

Of course, if the safety of such a procedure were ever to be approved, I can't imagine that it would not suffer the same fate as silicone implants. Some collection of nuts would decide they didn't want to take responsibility for their own lives and would instead blame silicone for everything from the plaque in their arteries, a heart attack or a brain tumor to their love handles, genital warts or a pimple on their asses!

Again, I go back to thinking of the billions paid out without a basis in fact, and it makes me wonder. Even if elective silicone injection by a qualified plastic surgeon for purposes of muscle shaping and augmentation ever gets approved, I doubt such a procedure could survive in the current climate. That is, unless of course, someone like Arnold makes sits in the governor's office in California. Maybe the Terminator can make a difference. That's one guy who, if he wants to be, is truly immune to all the special-interest bull-crap! Maybe he'll be the one to pioneer legal tort reform.

I mean, let's not forget that in the name of public interest, some people are actually trying to sue McDonald's® because too many Americans have a fat ass. I understand that the company that makes Oreo® is also being attacked for trans-fatty acid content. Can you imagine? Well, you don't have to, because this is now America's reality.

Hey! I just had an evil thought. Maybe that's what happened to me. I distinctly remember my mom buying me McDonald's® and giving me an Oreo® cookie for dessert back in June, 1975. According to their thinking, I could join in the carnage; maybe sue her as well! Of course, then I could use the pilfered money on injectible silicone, and it doesn't have to stop there! If things don't change, I could sue the company that made the silicone for causing my hemorrhoids when I'm 60! Hey! I could make a living at this! Don't laugh. Some actually do.

I think I'll call Washington, find out the name of my representative and voice my opinion (202-224-3121). Care to join in?