Silicone Gel Breast Implants Turn 50 [Part 1 of 5]

The most studied, and yes, the most litigated device in medical history, is set to turn fifty years of age with the coming of spring 2012. Despite the tempestuous course, breast augmentation and the rise of the silicone gel breast implant has been an exciting story and remains the second most popular cosmetic surgical procedure in the US, and the number one procedure in Europe, with well over two million women wearing breast implants world wide.

The silicone gel breast implant was first conceived by two surgeons in Houston Texas, Thomas Cronin and Frank Gerow. They confronted a demand for a safe means to enlarge and enhance the breast, a challenge with a very long history. We may think that the current youth-oriented society and the fashion industry are responsible for the demand, but the quest for a full and attractive breast is documented in late 1800’s with advertisements for breast creams and suction devices to enhance breast size. Surgical breast augmentation was tried in the 1920’s with glass beads, paraffin, fat grafts (yes, we are back at it), and later a sponge material which was used up until the 1950’s. The hardships from these attempts were well known to Dr.’s Cronin and Gerow, as well as knowledge of the introduction of silicones in the 1940’s during the war. Reports were circulated of a home remedy used by Japanese prostitutes of paraffin and industrial silicone injections to enlarge the breast. Though very many resulted in infection and terrible cysts, some were soft enough to warrant the concept of containing the silicone in a balloon or pillow and thus the idea of the silicone gel implant was born.

It was the spring of 1962 and the first silicone gel implant breast augmentation was performed on Timmie Jean Lindsey in Houston Texas, and later presented at the International Society of Plastic Surgeons in Washington DC in 1963. Mrs. Lindsey is alive today and has been noted to have enjoyed her procedure for decades. The success, fame and fortune of Dr.’s Cronin and Gerow are almost of legend, and were chronicled in a semibiographical film ‘Breast Men’ in 1997 directed by Lawrence O’Neil. Though the movie is not completely factual, it offers a rather comical look into the meteoric success of cosmetic breast enhancement. At last, plastic surgeons had the “prefect” solution to augmentation of the breast in a safe and affordable way.

The rest has been history, though what a history it has been. Dow Corning manufactured and distributed the widely popular silicone gel breast implant enjoyed by many. And though reports of silicone bleed and implant rupture surfaced, the implants had a very good run for the next 20 years.

When I began to enter plastic surgery in 1979 the FDA had just begun collecting “safety and efficacy” data, and as surgeons we knew about eventual leaks and capsular contracture, but patients expected implants to last a lifetime. We had set ourselves on a collision course of public misunderstanding and this is where the story about the silicone gel breast implant really takes off. More in my next blog.