For Surgeons


Silicone: The Final Word

On June 21, 1999 the Institute of Medicine of the National Academy of Sciences released its long awaited final report on the possible role of silicone gel implants in systemic or connective tissue diseases. They found none! The 440 page report compiled at the request of the United States Congress found that breast implanted women were no more likely to develop cancer, immunologic disease or neurologic problems than the rest of the population. No threat was found to breast feeding or unborn babies, and no new 'autoimmune disease' was associated with breast implants. Hallelujah – unfortunately this vindication is too little, too late!

Being personally involved in this debacle, first as Secretary and later President of the Association of Plastic and Reconstructive Surgeons of Southern Africa, it is clear to me that the “silicone issue” has done irreparable harm to doctor-patient relations, to the medical profession as a whole and ultimately to the public. My statement to the media at the time was that “our Association would not suspend the use of silicone as we reacted to Academic facts and not to emotional hysteria or medico legal blackmail. The facts showed certain problems associated with implants but these did not involve disease processes.” Dow Corning then offered 6 billion dollars to settle accusations that it knew to be unfounded! Shocked, I called the CEO of Dow Corning who told me this was a business decision – although they were adamant that no academic evidence linked silicone to any disease, if they fought and won 75% of cases, it would still cost them more than the global settlement. So much for the truth!

By now the media were having a field day – anecdotal musings of the status of Dolly Parton's breasts were more sought after than Academic fact, so much so that one of our leading newspapers suggested to me to take an advertisement rather than print our scientific response, as it was too dry and not newsworthy! TV played early American tapes over and over, even after most of the facts had been disproved. Even as late as 1999 SABC flighted a movie based on the “silicone tragedy”. Our lobbying before the flighting was totally ignored – even though the movie was made in 1990, before the true facts were publicized. Not moved by the fact that thousands of women (especially mastectomy reconstructed women) would be thrown into panic again, the movie was flighted over and over to “recoup costs”. Local experts , such as Mary Ann Shearer, a healthy living guru, was quoted as saying that silicone definitely caused an immune disease and surgeons were reluctant to admit it, as silicone had allowed them to spend many summers on the beaches! All these events caused extreme strain on doctor-patient relations and plastic surgeons were regarded with great suspicion.

As tough as it was locally, we had a picnic compared to the Americans. New operations with new complications were promoted for reconstruction, silicone implants were suspended for cosmetic operations, new 'explant' surgeons climbed on the money wagon, and of course lawyers basked in their role of saviors of women’s causes. At an American congress I attended in 1993, surgeons complained that they were hampered in their efforts to research silicone as many of their patients had been 'contaminated' – lawyers employed physicians to train patients to convincingly present symptoms of “silicone disease”. Millions of dollars were awarded to women on the basis of subjective symptoms alone – no blood test evidence or true objective criteria were used to assess cases –the result? Thousands of women appeared out of the woodwork to claim their prizes – Silicone Sisters was formed; major courses were held to train lawyers in the art of “tort” litigation and “class action suits”

31 October 2002
Prof Alan D Widgerow