An Open Letter
From A Plastic Surgeon

An Open Letter from
Susan E. Kolb, M.D., F.A.C.S.
Certified by The American Board of Holistic Medicine, 2-01

Silicone Studies

March 12, 2001

After watching "Storm in a D Cup" on The Learning Channel, I would like to propose some suggestions to scientists that may help to resolve the still
ongoing breast implant controversy, which in my opinion has not ever been satisfactorily resolved.

1 am a board certified plastic surgeon who is also board certified in
holistic medicine. I have not only had the opportunity to experience the
symptoms of silicone immune and neurological disease in my own body when my silicone gel implants leaked, but also have had the opportunity to treat over five hundred women with similar illnesses. Subsequently I believe I have some insights into this problem that may have been missed by doctors who do not treat these women.

First of all, any study on silicone should only include women who have had implants in at least eight to ten years as it is well documented that in
most cases leakage or rupture usually does not occur before this time,
unless the implant is subject to some form of trauma. There are studies
describing the lipolysis reaction that occurs on the Silastic shell and
this lipolysis reaction takes time. Second, a less strict definition of
connective tissue or autoimmune disease needs to be studied, as the
majority of patients do not have a known connective tissue disease. The
first element of this disease has to do with the development of symptoms of systemic candidiasis due to an immune dysfunction, which I have found to be associated with depressed natural killer T cell levels. We also find at
surgery that approximately half of the patients' breast capsules culture
out pathogenic organisms such as Staph aureus and Enterococcus. I would
propose that once the silicone gel leaks out of the implant, a chronic
immune response occurs that is often associated with local capsular
bacterial infection and with systemic and possibly local fungal infections.
The patients next experience neurological symptoms that can be explained by the silicone gel migrating directly or via the macrophages into the lymphatic and nervous systems. Women with longstanding silicone gel exposure have typical neurological problems, usually beginning in the extremity on the side of the implant that leaks or ruptures first. Some women also have toxicity from platinum and other chemicals that are used in the manufacturing process of the implants. In my experience, the end stage of this disease is an autoimmune condition similar to scleroderma. It may be modulated by intracellular bacterial infections that change the characteristics of the cell wall and lead to autoimmune symptoms that are atypical, in that they do not fall into any known connective tissue disease but are actually very typical for women with silicone immune dysfunction.This does not occur right away and may take ten or more years of silicone exposure.

The clinical picture we see in these women is that of increased level of
cytokines which explains why Plaquenil is effective. I believe this is also
one of the factors, along with the presence of increased silica in the
body, which may protect women with implants against breast cancer. Silica and other mineral deficiencies are known to predispose to cancer.

It is important to study this problem for three reasons. One is that
silicone gel implants are being reintroduced into the market without
understanding what has caused so many women to become ill; and the second is that some patients with saline implants are experiencing similar
problems, especially after trauma, which may disrupt some of the textured
silicone from the capsule into the systemic circulation and/or lymphatics;
and third, is the advent of the exciting research on the potential
protection from breast implants against the development of breast cancer.
This potential advent indicates the necessity of fully understanding the
effects of silicone and its breakdown products in the body as this may
contain the information for an important cancer treatment.

I would propose much more detailed immunological studies of the patients
with problems as well as a study of the HLA type of the same patients. Our
best avenue to serve'our patients is to prevent complications even if they
occur in a minority of our patients, rather than to insist that these
problems do not exist. Many of my patients have been told by their plastic
surgeons and/or rheumatologists that their implants could not have anything to do with their illness, only to discover abnormal bacterial and fungal growth around an implant that when removed and properly treated, leads to the patients' recovery and greatly improved health. I would encourage all of the doctors and scientists in this politically charged issue to focus on the patient to determine what is making them ill, and on the science of silicone, so hopefully we may someday safely use this material in the body.

Sincerely Yours,

Susan E. Kolb, M.D., F.A.C.S. SEK: tam


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