| Ilena Rose 2005-01-27, 8:50 am |
| http://www.drmyhill.co.uk/article.cfm?id=86
Silicone Breast Implants and Injections
I have now been consulted by over 100 patients with chronic ill health
following silicone breast implants or injections. Silicone leaks (so
called "gel bleed") out of the implant where it is picked up by the
reticulo-endothelial cells and distributed widely throughout the whole
body. The government body responsible for licensing silicone, the
Medical Devices Agency, claims that silicone is inert and does no harm
despite this gel bleed. My clinical experience and the scientific
literature suggests otherwise.
There are many problems with implants, of which the most obvious is
infection at the time of insertion. 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 autoimmune disorders. This
means that these patients suffer from multisystem autoimmune disease.
In particular, clinically one sees:
mixed connective tissue disease, demyelinating conditions such as MS
autoimmune endocrinopathies, vasculitis, myopathies,
- all of which eventually leads to a chronic fatigue syndrome often
including multiple chemical sensitivity My clinical impression is that
the silicone poisoned patients suffer more from pain than the 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.
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 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 recent 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.
Generalised effects of silicone are caused by silicone migrating via
the reticulo-endothelial system to the rest of the body and causing
inflammatory reactions wherever silicone ends up. In the brain this
causes a multiple sclerosis-like syndrome, in the body it can cause a
range of autoimmune disorders, chronic fatigue syndrome, chronic pain
and multiple chemical sensitivity.
Tests For Silicone Poisoning Prof Robert Garry's lab in the USA offers
antibody testing. He measures the anti-polymer antibody levels.
However, this is expensive and is not specific for siliconosis. So I
rarely do this test nowadays. His address is Dept of Microbiology and
Immunology, Tulane university School of Medicine, New Orleans, LA
70112 tel 001 504 587 2027 fax 001 504 584 1994. I can arrange the
test if this is easier - I can post the kit to the patient for the
blood to be taken locally and make arrangements to dispatch the sample
to America via a courier. The cost is ?150 for the test and ?20 for
the transport.
I have just had an extract of silicone made up for skin testing and am
getting interesting results! This test is designed to look at the
body's immune response to silicone. The extract is a very dilute
solution (1:100) which is injected intradermally to bring up a weal of
about 7 by 7mm. Ten minutes later this is measured. A complete
non-reactor would have no growth and flattening of the weal. Reactors
show a growth in the size of the weal. A positive reaction supports
the idea that the body is reacting positively to silicone. Again I
don't know the medico-legal aspects of this test until I have done a
reasonable number including controls (i.e people who have never been
exposed to silicone). I don't see why it should not be possible to try
a desensitisation technique called neutralisation from the test
extract.For a list of practitioners, visit www.bsaenm.org
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 Biolab in London. My clinical impression of tests done
so far is that the worst affected women have the highest levels of
sensitivity.
Treatment 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 90 days before surgery and
believes this damps down the T cell activity and prevents this post
operative flare. Plaquenil is a standard immunosuppressive drug 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
prudetn 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 make up an excuse. 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 ysu!
The CFS side of things I treat in exactly the same way as I treat all
my other CFS patients with fatigue caused by viral infection or
pesticide poisoning or whatever. Namely rest, nutritional supplements,
elimination dieting, magnesium injections where appropriate (blood
test needed), B12 injections, avoiding chemicals, etc.
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. However, I would like to repeat this research in all my
patients and hope to attract some modest funds to allow me to do this.
I would do it myself if I had the time, but I don't. I would need to
employ somebody short term to contact women. Any volunteers?
See also: Neutralisation in FOOD ALLERGY section
Related Test[s]
Lymphocyte Sensitivity to Silicone
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