Silicone Breast Implants and Injections
I have now been consulted by over 300 patients with chronic ill health following silicone breast implants or injections. Silicone leaks out of the implant from the day it is implanted (so called "gel bleed"). Some leaked silicone is found immediately round the implant where a pseudo-capsule forms - this may be full of silicone granulomas. Some silicone is picked up by the reticulo-endothelial cells and distributed widely throughout the whole body. Silicone is tough molecule which cannot be broken down by any biological enzyme system. It is a plastic - plastic bags do not even rot down in a compost heap! However, in some patients the immune system tries to break down the silicone. This causes inflammation wherever the silicone ends up. Because the largest part of our body is made up of muscle, connective tissue and skin, I commonly see symptoms here. It is very common to hear patients complaining of "burning" pain. However, any part of the body may be affected.
The government body responsible for licensing silicone, the Medical Devices Agency, claims that silicone is inert and does no harm despite this gel bleed. However, silicone injections are now banned. My clinical experience and the scientific literature suggests otherwise.
With silicone I am not just looking for the obvious breast implant or silicone injections (siliconosis) - many other prostheses have biologically active materials. Examples include:
- other breast implants - all breast implants, including saline ones, have silicone in them,
- testicular implants,
- lens implants,
- Norplant contraceptive device (silicone rods),
- TMJ work,
- facial contouring - chin implants etc,
- meshes for hernia repairs or wound repairs
- "sting" injection of teflon for treating urinary reflux in children
- and many others
There are many problems with implants, of which the most obvious is reaction at the time of insertion. The majority of women who have silicone implants do not seem to react to the silicone - the immune system ignores it. However, for an unfortunate few the immune system is activated against the silicone. This can cause problems immediately after implantation when the body tries to get rid of the silicone. It does this by throwing up a fibrous capsule around the implant which then contracts, trying to squeeze the implant out. This is akin to the mechanism by which the body gets rid of any foreign body that gets into it, such as a thorn. In this event the implant goes hard and becomes painful. Surgeons often treat this by crushing the breast between their hands, either to rupture the implant or break the pseudo-capsule. However, this often creates just more problems. This technique is called external capsulotomy.
However, the long term effects are far more malign. This stems from the fact that silicone cannot be broken down by any enzyme system in the body, is engulfed by macrophages, carried to distant sites by embolisation and there it acts as an immune adjuvant, stimulating immune activity. This means that these patients may suffer from multisystem disease.
Therefore, we see disregulation of the immune system with:
- Autoimmunity, eg mixed connective tissue disease,demyelinating conditions such as MS, autoimmune endocrinopathies, vasculitis and myopathies;
- Chronic fatigue syndromes;
- Disregulation of the immune system leading to multiple allergies which may be to foods, to chemicals, to inhalants, or to micro organisms.
My clinical impression is that the silicone poisoned patients suffer more from pain (typically described as a burning pain) than those suffering from virally or OP induced CFS. I have concluded from my own observations that silicone causes a new disease unique to silicone but resembling other diseases.
All of these cases I have reported to the MDA. None of these cases were reported to the MDA by either their plastic surgeon or rheumatologist or oncologist. This simply reflects the level of gross under-reporting of side effects.
Mechanism of damage by silicone
It is well recognised that the silicone bleeds out of the implants very readily and is widely distributed throughout the body by the reticulo-endothelial system. Silicone leaks out as soon as the implants are put in. I know this because the Medical Devices Agency, which is the government body responsible for licensing these products, tells me so. However, where we disagree is about what happens to the silicone then. The MDA maintains that it is inert, but actually silicone is well recognised as being an immune adjuvant and I suspect in susceptible individuals we get an inflammatory reaction against the silicone which results in multi-system disease. The Louisiana ruling on 19.8.97 showed that Dow Corning was developing silicone for use as an active pharmaceutical agent at the same time as when it was being declared "inert".
There is no known mechanism by which silicone can be excreted from the body. Silicone leakage is accelerated when implants rupture, of which 50% do so by 12 years and 95% by 20 years. Most of these ruptures are spontaneous but some follow closed capsulotomy, road traffic accident or whatever. A Lancet paper (November 1997) recommends that all implants are replaced every 8 years. Silicone leakage can be a problem locally whereby the body throws up a scar capsule against the implant to try to prevent the silicone from leaking. As this scar contracts this causes local hardening of the breast, often with pain. Surgeons treat this by crushing the breast between their hands (often with no anaesthetic!) to rupture the scar capsule (this unproven, extremely painful procedure has been sanitised by giving it a name: closed capsulotomy). The implant may also be ruptured by this procedure. Once ruptured, the silicone may migrate in a lump to the axilla and brachial plexus causing pain and blockage of lymphatics, across the breast causing a mis-shapen breast (one patient had to have her nipples surgically re-sited), or down the chest wall.
Second generation effects
There is every reason to expect silicone to cross the placenta into the unborn child. The effects of this are uncertain. Prof Shanklin has looked at a group of 190 women who had babies before and after their implant. There were 127 pre-implant children of which 100 were in good health, 27 in fair health (minor transient problems) and none sick. This compares to 252 post-implant children, of which 78 were in good health 81 in fair health with 93 WHO WERE MORE SERIOUSLY ILL (compares to none in the pre-implant group!). This experience certainly accords with what I am seeing in my patients.
Tests for silicone poisoning
The most sensitive test available in this country to assess the reaction of white cells to silicone in the body is a lymphocyte chemical sensitivity (silicone) test. This just involves sending a blood sample to ACUMEN. This test does not tell us about the total load of silicone but whether or not the immune system has been activated agasint silicone. My clinical impression of tests done so far is that the worst affected women have the highest levels of sensitivity.
- Explantation. I have been in direct contact with Professor Radford Shanklin from the States who has been most helpful with clinical management. We had a long meeting at the Royal Society of Medicine where I could pick his brains. The priority is to have the silicone removed by a surgeon skilled in explantation. However, the problem with explantation is that it is thought to stir up a reaction against silicone and patients often see a worsening of their symptoms which may last up to 3 years. Prof. Shanklin tells me that reactions against silicone are medicated by T cells and interleukin 2. He has been trying Plaquenil 200mgs twice daily for 30 days before and 60 days after surgery and believes this damps down the T cell activity and prevents this post operative flare. Plaquenil is a standard immunosuppressive drug often used to treat rheumatoid arthritis and systemic lupus erythematosis. It is a fairly benign drug and it is felt that for short term treatment no special monitoring is required although it is probably medically prudent to check a white cell count and eye test before and during treatment. Explantation needs to be done by a skilled surgeon aware of the need not to rupture the capsule inadvertently. Furthermore, the scar capsule also needs removing because it will be impregnated with silicone. Insist on being given the implant after surgery and don't allow the surgeon to refuse to show you your implant! I had one patient who was told the implant was removed intact, but it was "scrubbed" to make it look better and ruptured in that process, therefore it was not available to be seen! Let's face it - you've paid for it - it belongs to you!
Here is a list of Recommended UK Explant surgeons from the UK Breast Implant Illness and Healing Support Group:
- Reducing the autoimmunity. See page on treating autoimmunity: Autoimmune diseases - the environmental approach to treating
- Detoxing. Unfortunately, there is no mechanism by which silicones can be excreted from the body. I am not aware of any method of detoxing to facilitate this. One simply has to put in place all of the above measures and hope that the immune system eventually loses interest in silicone and "burns itself out". This is my experience treating women who are able to hold the above regimes in place.
- CFS Checklist
- CFS/ME - my book Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis
- CFS - The Central Cause: Mitochondrial Failure
- Autoimmune diseases - the environmental approach to treating
- Chemical poisoning - general principles of diagnosis and treatment
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