American Inventions - Game 17, Houston

In 1962, Timmie Jean Lindsey went to her local clinic with a little problem. In a moment of poor judgment, she had two roses tattooed on her chest, and wanted them removed. At the old Jefferson Davis Hospital in Houston, the removal was done by a young plastic surgeon named Frank Gerow.

Gerow had been working with another doctor, Thomas Cronin, on a radical new surgical procedure, and were searching for a candidate to try it on. They must have been persuasive gents, because the woman who was embarrassed about having tattoos on her chest would later agree to become the first recipient of silicone breast implants.

Of course, Gerow and Cronin weren't the first doctors to try breast augmentation surgery. As far back as 1895, pioneering surgeon Vincenz Czerny, while removing a malignant tumor from a patient's breast, repositioned a benign tumor so as to "avoid asymmetry" in the patient.

In the intervening years, all manner of substances were used in breast implants. This was usually done by injecting the substance directly into the breasts, often with horrible side effects. (Those with sensitive stomachs may wish to skip the next paragraph. I'm not kidding.)

Some of the substances tried before 1962 were: sponges, ivory, ground rubber, ox cartilage, glass balls, the subject's own fatty tissue (the idea was to strategically shift it around, as Dr. Czerny did), olive oil, paraffin, polyethylene tape, petroleum jelly, and of course, silicone. Side effects include hematoma, infection, inflammation, capsular contracture (an adverse reaction of the immune system to foreign substance), and worse. Not to mention hardening, lumpiness, and shifting of the breasts, which would seem to defeat the purpose of cosmetic surgery. Injecting silicone directly into the body can lead to "silicone rot", which results in blindness, strokes, gangrene, and death. This still goes on today, with back alley butt injections causing several deaths in recent years.

Gerow and Cronin's innovation was enclosing the silicone in a container, rather than injecting the substance directly into the body. Inspired by a plastic blood bag, they designed a container of the proper shape for the task at hand. They even borrowed ideas from another Houston industry: rocketry. "A rocket achieves lift off with lift and thrust - same thing in breast augmentation," said their assistant Thomas Biggs.

The doctors installed a prototype implant into a dog named Esmeralda. It went well, until the dog tried to chew the stitches off. Satisfied with this result, they approached young Timmie Jean. She was self-conscious, but about her ears rather than her chest. She agreed to do the surgery if the plastic surgeons would also make her ears less prominent.

At first, the procedure was a smashing success. Upgraded from a B cup to a C, the freshly divorced Timmie Jean suddenly found herself the subject of much male attention, and no side effects to speak of. "When they took off the bandages after ten days, my breasts looked beautiful. All the young doctors were standing around to look at 'the masterpiece," she said at the time. The new procedure was the talk of the 1963 International Society of Plastic Surgeons. Any readers interested in judging for themselves can see this BBC article for before-and-after pics. (NSFW due to other images in the article.)

Dow Corning soon began manufacturing the Cronin-Gerow Implant, and a new era had begun.

The first generation of implants were relatively problem-free. But as we shall see, that's not a high standard. As early as 1977, silicone breast implants were being blamed for health problems in women who had them. Houston-based attorney Richard Mithoff won a $170,000 settlement from Dow Corning for a woman whose implants had ruptured. The lawsuits continued through the 1980s, with recipients reporting autoimmune problems, ruptured implants, nasty substances leaking into the bloodstream, and other problems.

While the FDA hemmed and hawed about how to classify breast implants, the implant makers continued to lose in court. Another Houston lawyer, John O'Quinn won a $25 million judgment. This is the same John O'Quinn for whom the University of Houston's former football field is named. Word about the dangers of breast implants began to circulate in the media. At the height of this health scare, Dr. Cronin asked Timmie Jean -- who was getting along fine for the most part -- to appear on a Houston TV show to defend the procedure.

In 1992 alone, 3,500 lawsuits were filed against Dow Corning. In 1993, there would be another 9,000 lawsuits. Dow Corning finally had to settle a class action lawsuit for $3.2 billion, an amount that sent them into bankruptcy for awhile.

The FDA pulled silicone breast implants from the U.S. market in 1992. But the scientific community struggled to find a conclusive link between breast implants and the kind of health problems the plaintiffs reported. A 1994 Mayo Clinic study failed to show a connection. In 1999, a huge Institute of Medicine study concluded that:

Local complications were the primary safety issue with silicone breast implants. These local complications, which included rupture, pain, capsular contracture, disfigurement, and serious infection, lead to medical interventions and repeat surgeries. Importantly, the IOM report concluded that there was no evidence that silicone breast implants caused systemic health effects such as cancer or autoimmune disease.

Those are still some pretty scary side effects, mind you. Nevertheless, in 2006, the FDA approved two new types of silicone breast implant, and Gerow and Cronin's invention was back on the U.S. market. But the horror stories would continue: in 2010, the French-made PIP silicone implant was pulled from the market for using substandard silicone, which greatly increased health risks in recipients.

Despite all the dangers, the procedure is more popular is ever. Breast enhancement is the second-most popular cosmetic surgery procedure, after liposuction. About 300,000 American women had them in 2010, and millions worldwide have had the procedure over the years. The vast majority of these surgeries are elective; women subject themselves to these risks for no reason other than to have larger breasts. What that says about our society, sexuality, and values is a much weightier subject than I could tackle here.

So how did things work out for patient #1, Timmie Jean Lindsey? It's been a mixed blessing. During an interview when she was 75, she complained of hardening, acute pain like that of broken ribs, and other "local complications" as the Institute of Medicine called them. But the prototype implants never ruptured or leaked. In more recent interviews, she was more positive, taking pride in being a pioneer of a sort. Especially since one of her granddaughters had to get implants after a double mastectomy. She's in her early 80s, and still lives in the Houston area.