male body


In the past, cosmetic surgery was associated with women, but statistics show that more and more men are going under the knife in the name of looking good.


There are many reasons why more men are considering surgery, from increased pressure to look good and a more intense focus on male beauty in the media, to increased access to male cosmetic treatment and a change in societal attitudes to male cosmetic surgery.


Figures show that the most popular cosmetic surgical procedures for men in 2013 are likely to be:


Nose reshaping (rhinoplasty)


Rhinoplasty, commonly known as a nose job, is a very popular procedure with both men and women. The aim of the surgery is to improve the aesthetic of the nose by re-shaping it, making it bigger or smaller and smoothing out any bumps. According to the American Society of Plastic Surgeons (ASPS), 62,000 procedures were carried out on men in 2011. Rhinoplasty is a very common procedure because many people are unhappy with the shape of their nose and think their nose is too big, some think it is too small and others believe it is wonky, bent or uneven. A nose job can help to balance the other facial features, as well as improving the look of the nose.


Eyelid surgery


Eyelid surgery is a popular procedure for middle-aged and older people, who have developed bags around their eyes. The aim of eyelid surgery is to remove excess fat and skin from around the eyes to create a more youthful look. According to the ASPS, 29,000 eyelid procedures were carried out on men last year.


Liposuction and body contouring


Liposuction has become more popular among men in the last five years, as more and more men look for a perfect, toned physique. Liposuction removes excess fat from the body and it can be performed on several areas of the body, including the stomach, buttocks, thighs and arms. Body contouring is designed to create more definition and a sleek, toned physique, which has become very popular in the media. Men’s magazines often feature muscular athletes and models and advertising campaigns use models with clear muscular definition. Last year, 23,000 procedures were carried out on men in the USA.


Breast reduction


Breast reduction has become much more popular in the last few years and a growing number of men are choosing to have surgery to tackle the problem of ‘moobs’, a name given to male breasts. The procedure removes excess tissue from the chest to give a flatter, more masculine look. There has been a great deal of media focus on ‘moobs’ of late and this has undoubtedly influenced the figures for male breast reduction surgery. Last year, 20,000 procedures were performed on men, which represent an increase of 8 per cent since 2010.




A facelift is designed to combat the signs of ageing, such as lines and wrinkles, to produce a smoother, younger complexion. Male surgery has become much more acceptable in society than it used to be and most men are no longer afraid to admit to having surgery to make them look better. In 2011, 11,000 male facelift procedures were performed in America. Many men are also opting for smile makeovers such as veneers, tooth whitening and other cosmetic treatments to improve the aesthetics of the face at smile makeovers London.


Male cosmetic surgery has become increasingly popular over the last five years and this trend looks set to continue in 2013.




Form stable cohesive gel breast implants differ from the round breast implants that the FDA approved in 2006.  These implants, which have been given the nickname “Gummy Bear” implants over the years, are the newest generation of silicone gel breast implants. In March of 2012, Sientra became the first US manufacturer to obtain FDA approval for the sale of their version of the shaped form stable breast implant.  Form stable breast implants, manufactured by Mentor and Allergan are currently considered investigational devices in New Jersey and the US and are not yet FDA approved. Developed in the early 90’s, and used widely throughout the rest of the world, the Style 410 manufactured by Allergan, and the CPG manufactured by Mentor,  remain in clinical trials in the United States until their anticipated FDA approval.  Although each of these manufacturers has developed a form stable cohesive gel implant, they differ from each other with respect to the consistency of their fill (cohesivity), their shape, and the percentage of gel that they are each filled with.

I am presently continuing to enroll patients in the Allergan style 410 studies, until their anticipated approval by the FDA.  Because the value of these studies is so significant, Allergan encouraged specialized training in the use of their devices, and I underwent extensive training in Sweden before being given the opportunity to enroll patients for study. I have now been enrolling patients since 2005 and have extensive experience with form stable breast implants. In the United States there are presently two groups of patients who may enroll in a clinical trial with the form stable cohesive breast implants. The first group are women who request a revision breast augmentation or breast reconstruction after mastectomy (CARE study), and second, are those women who desire a primary breast augmentation (410 implant study). All patients must agree to return for scheduled follow-up exams for a period of 10 years from the date of their surgery. After their FDA approval, there will still be a need to continue long term follow-up of augmentation, reconstruction, and revision augmentation patients, in order to collect long-term data on surgical outcomes.

Frequently Asked Questions

How are form stable highly cohesive breast implants different from standard round gel implants approved in 2006?

Cohesivity: The more cohesive silicone gel is, the thicker and firmer it becomes. This explains why silicone can come in a liquid form, like in your hair gel, as well as the solid form like your kitchen cutting board. There is a range of firmness within silicone products, and the form stable cohesive gel implants are believed to be just firm enough to resist forming creases and folds, yet soft enough to feel like a natural breast. Each of the different manufacturers, Allergan, Mentor, and Sientra, have designed form stable breast implants with different degrees of cohesivity. The increased form stability of these breast implants may lead to reduced implant visibility and palpability through the overlying breast tissue and skin.

Shape: The form stable cohesive gels offer plastic surgeons and their patients the opportunity to select shaped breast implants. This means that the breast implants have a variable width, height, and projection. The possible advantage to a shaped device is that it offers plastic surgeons more options in selecting an implant that can fit your individual body shape and size, as well as the quality of your breast tissue. Shaped form stable breast implants are especially useful for patients with breast or chest wall asymmetries, or patients with tuberous or constricted base breasts. No one breast implant is the right one for all women. Some may still prefer the fuller look of a round implant while others may prefer a more proportionate breast augmentation.

Rupture Rates and Capsular Contracture: The 7 year data collected from the United States, as well as the data collected from Europe and Canada, shows very low rupture rates with the form stable cohesive gel devices. More data will continue to be collected over the next 10 years.

Will I need a larger incision if I choose form stable gel implants?

Because these implants cannot be folded on themselves, the surgeon must use a slightly larger incision to place these implants into the body without damaging the implant shell or the cohesive gel. Incision sites should be discussed with the surgeon.

Do I need to have an up-to-date mammogram prior to undergoing this procedure and what screening techniques are used after?

Mammography and MRI: Your breast health should be your primary concern. Pre-operative mammography is strongly suggested on all patients over 35 and as indicated by the American Cancer Society guidelines thereafter. After breast augmentation, specialized views may be necessary for women with breast implants. Presently, an MRI is the best technique routinely available for evaluating the integrity of breast implants, but newer High Resolution ultrasound techniques are on the horizon.

How can I enroll in a form stable highly cohesive gel breast implant study?

Until their FDA approval in the United States, patients must enroll in a FDA approved long-term study to obtain the form stable implants manufactured by Allergan and Mentor. The Sientra form stable breast implants are presently available with voluntary long-term study enrollment. As a requirement of these studies, patients are encouraged to return for scheduled visits over a ten year period. Patients interested in enrollment can visit www.drglicksman.com or www.cohesivebreastimplants.com and click on “find a cohesive breast implant surgeon” to locate a highly experienced board certified plastic surgeon in your region of the country.

Are form stable breast implants ideal for all patients?

There are advantages and disadvantages to all breast implants. A careful breast exam and lengthy consultation are necessary to determine the best breast implant for you. Additional assessment of your breasts can also be performed with the Vectra 3D simulation. This gives women the opportunity to visualize several different breast implant options and creates a better educated patient.


Source Caroline Glicksman, MD


In 2012, the French based company PIP (Poly Implant Prothèse) had their implants banned because it was discovered that they were utilizing a non-medical grade silicone as the filler for their gel implants. In addition, the recent reported death of a French woman from the rare form of cancer ALCL, who had PIP breast implants has led to a tremendous amount of media concern about a company recognized by few American women. Inspections in France as early as 2001 had revealed numerous non-conformities surrounding the manufacture of PIP implants. In 2009, it was reported that there were high rupture rates with their implants in France, leading to allegations of implant shell problems. In 2010 distribution was suspended and the company filed for bankruptcy.

PIP appears to have used two types of silicone gel within their breast implants; the “Medical Grade” silicone manufactured by Nusil, (made in US and France), and a less expensive formula that they claimed was chemically identical. When implant manufacturers describe their silicone gel, they often uses terms such as “Industrial Grade”, “Medical Grade”, “Health Care Grade” and even “Implant Grade.” These terms can differ around the world. There are multiple tests for silicones including mechanical, chemical, animal, biochemical, cell culture tests and clinical evaluations that are required to determine what silicone formulations are safe for long term human implantation.1 Summing it up, “Medical Grade” silicones are those that have passed extensive, strict biological testing, and in the United States the manufacturers must formally submit their data to the FDA for approval.

The fallout from this discovery has left women worldwide confused and worried. It appears that various European and South American Health Ministry’s are offering different options to women who have these devices. While France is offering to pay for the removal and replacement of PIP implants used in breast reconstruction, Venezuela will pay for explantation only. Other European nations, such as the Netherlands, Ireland, Austria, and Denmark, to name a few, are suggesting only close follow-up of women who have these devices. Each health ministry, as well as the FDA, has repeated their conclusion on breast implants that although there may be a very low but increased risk of developing ALCL adjacent to breast implants, with less than 70 cases reported in the world literature to date, these represent a very small fraction of the 5-10 million women who have received breast implants worldwide. In addition, PIP implants have not played a significant role in the US market since the company’s 2000 request to market saline implants in the US was denied. The silicone implants that are presently used in the United States are manufactured by Allergan, Mentor and Silimed/Sientra, and must all meet the strict requirements of our FDA.

Finally, as with all silicone gel breast implants, there is no exact expiration date. No implant will last a life-time, and all silicone implants, regardless of their manufacturer, should be followed and imaged as they age.

1 Allistar Winn, Manufacturing and FDA Compliance Support, date accessed 12-29-11, date modified October 10, 2011.

Source Caroline Glicksman M.D.

Stem cell treatment
The search for the Fountain of Youth and eternal life has been present in humanity since mythological times. For centuries men tried in vain to reach immortality. It might be that we have finally given our first step towards that direction.In order to prolong life the first step would be to make people healthier longer enabling them to fight off diseases arising from advanced age, such as Alzheimer and cardiovascular diseases. Pragmatically the goal to reach eternity can be better attained simply be fighting old age.In mapping human DNA, scientists came to many propositions of how to fight old age, among them, the ones gaining more importance due to results, are fat ingestion reduction and stem cells treatment. It is on this last resource, allied to cosmiatry, in which that Dr. Magno Lott Caldeira acts and focuses.Over the last ten years, various researches were developed seeking the use of stem cells on the correction of flaws and deformities, and regression of pathological process, promoting wellness and even healing.Aiming at the reversal of this series of physiological processes, currently stem cells can be used to heal deformities of cardiac muscles and correct many conditions regarding the skin aging process. Among these is the regression or reversal of facial alterations related to degenerative or traumatic processes. Treatment with stem cells works like a replacement set. Old tissue, which has been spoiled trough time, is regenerated by new cells.Lab tests around the world are proving that stem cell treatment is more efficient and promising. Experiments in humans have already repaired vital organs such as the heart which, on top of regeneration, gained benefits such as an increase in blood flow and reduction of dead tissue areas in patients with chronic heart failure.The use of stem cells is based on their withdrawal, mainly from the adipose tissue, where there are plenty of mesenchymal cells. To treat body aesthetics, many evaluations were performed over the last years in order to estimate the performance of mesenchymal cells on the reversal of skin aging process with very promising results. These stem cells can be introduced on the patient’s subcutaneous tissue aiming to improve general conditions of the skin. When filtered, these mesenchymal cells promote an aging reversal. There are two major positive aspects on the utilization of these cells: the first is the fact that they are from the patient’s own body and the second, in that they promote the reversal of the skin aging process with extremely natural results; dissociated of any artificial cosmetic procedure.


The main tissue used for this process is the abdominal adipose tissue, due to its richness in stem cells. Such tissue serves as filling for other areas, especially the ones devoid of such a large quantity of stem cells.

This fat can either be used for skin filling or in cryopreservation, a technique which preserves stem cells present in the fat. In cryopreservation, there is a proliferation of these stem cells so they can be used on the target-organs needing treatment. I.e., after the fat preparation, it is possible to reutilize the stem cell on the cardiac muscle, for instance, or on skin regions which need restructuring, either because of severe skin aging or traumatic destructuring processes regarding skin structure.

Is plastic surgery superfluous?


It’s very common having people complain about a small detail in their body that causes discomfort. It may be just a tiny issue, caused by genetics, natural aging, weight alteration, pregnancy, or other factors that can end up affecting a patient’s psychological or social well being.

It may happen to you and not always be well accepted or understood by the people surrounding you. Friends and family tend to think everything is perfect the way it is. You, and only you, know how much that tiny detail may be disturbing. What you may not know is that the UN, the United Nations, through the World Health Organization, agrees with this premise.

This is how they define perfect health: “Perfect health is defined by humans physical and psychological well being”

And that’s exactly where Plastic Surgery may help, integrating mind and body, giving your self esteem a well desired boost. Searching for solutions to fix an aesthetic physical discomfort is an absolutely normal well being pursuit as well as an accomplishment for the best possible integration with your social environment.


It doesn’t matter if you love your bra or not, or if your bras are cheap or expensive. Here are some tips to care for them so they’re in a good shape – which means you’re comfortable and happy.

Switch up bras every day
Avoid wearing your bra for two consecutive days. Your body exudes heat and heat makes the Lycra in the bra stretch when it is warm. Wearing your bra for more than one day in a row will cause it to deteriorate faster. Lycra needs at least 24 hours to cool off — so alternating bras each day will go a long way towards good bra care.

Store your bras properly
It is best if you have a dedicated lingerie drawer. If you place lingerie with other clothing items, or toss them into a chest in an unorganized manner, it will cause early wear and tear on your bras. Hooks snaps, and some other clothing items or objects can snare fabric. So it is best if you make room specifically for your fine lingerie. Furthermore, you might want to organize your lingerie collection by type (e.g. all bras in one drawer, all panties in another drawer, etc.) Or you can put matching sets of lingerie together.

[mk_fancy_title tag_name=”h2″ style=”false” color=”#393836″ size=”22″ font_weight=”inhert” margin_top=”0″ margin_bottom=”18″ font_family=”Arvo” font_type=”google” align=”center”]This weeks Featured Surgeon is Dr Paul Belt from Brisbane Australia.[/mk_fancy_title]

Dr Paul Belt has completed an extensive training in Plastic, Reconstructive and Cosmetic Surgery over a period of more than seven years. This training was in addition to his basic medical and surgical degrees and tertiary postgraduate qualifications in General Surgery. He has also completed a Fellowship in Oxford after obtaining his Plastic Surgical qualification from the Royal Australasian College of Surgeons (FRACS Plast).

[mk_padding_divider size=”50″]
[mk_fancy_title tag_name=”h2″ style=”false” color=”#393836″ size=”22″ font_weight=”inhert” margin_top=”0″ margin_bottom=”18″ font_family=”Arvo” font_type=”google” align=”center”]Paul is talking to us about Breast Reduction[/mk_fancy_title]

This operation involves the removal of breast tissue and usually some breast skin. The reduction in breast volume will result in smaller, lighter breasts and may lead to improvement in posture and relief of back, neck and shoulder strap pain. The procedure can also reduce the risk of rashes which form under the breasts (intertrigo).
The reduction in breast size and weight can result in a new lease of life allowing greater unrestricted activity. The procedure can also produce an uplift of the breasts so correcting any downward pointing of the nipples. The above all help to increase self confidence and self esteem.

[mk_image src=”http://explantinfo.com/wp-content/uploads/2012/05/Dr-Paul-Belt-.jpg” image_width=”300″ image_height=”350″ crop=”true” lightbox=”false” frame_style=”simple” target=”_self” caption_location=”inside-image” align=”center” margin_bottom=”10″]
[mk_padding_divider size=”50″]
[mk_fancy_title tag_name=”h2″ style=”false” color=”#393836″ size=”22″ font_weight=”inhert” margin_top=”0″ margin_bottom=”18″ font_family=”Arvo” font_type=”google” align=”center”]How do I decide on the size of my new breasts?[/mk_fancy_title]

Dr Belt will discuss the ideal size you want to be during your two pre-operative visits. No guarantee of a specific cup size is made, as this is a relatively unscientific measurement. Different bra manufacturers can differ in the cup size by up to two breast sizes.
Your ideal size is influenced by your wishes, height, and weight and body shape. The best results are obtained when you are as close to your ideal body weight as possible before the operation. Weight gain or loss after the surgery can affect the quality of the result.

[mk_padding_divider size=”50″]
[mk_fancy_title tag_name=”h2″ style=”false” color=”#393836″ size=”22″ font_weight=”inhert” margin_top=”0″ margin_bottom=”18″ font_family=”Arvo” font_type=”google” align=”center”]What are the potential risks?[/mk_fancy_title]

The risks will be discussed with you in detail before you consent to the operation. The risks can be broken down into general risks associated with any operation, and those specific to breast reduction.
General operative risks include anaesthetic complications, bruising, bleeding, infection, wound breakdown and abnormal scarring.
Specific complications include: changes in sensation of the nipple and breast skin, asymmetry, bottoming out of the breast with time, interference with breast feeding, skin, fat or nipple necrosis (loss), and continued back, neck, shoulder and breast pain.

[mk_padding_divider size=”50″]
[mk_fancy_title tag_name=”h2″ style=”false” color=”#393836″ size=”22″ font_weight=”inhert” margin_top=”0″ margin_bottom=”18″ font_family=”Arvo” font_type=”google” align=”center”]How is this surgery performed?[/mk_fancy_title]

This surgery is performed with the skin being removed in a keyhole pattern (“wise” pattern). This produces the “anchor” pattern whereby a scar runs around the nipple in a circular fashion and is connected to a vertical scar running from the nipple to the fold underneath the breast and a small scar runs in the groove underneath the breast.
Smaller reductions may be able to be achieved using only a circular scar around the nipple or alternatively a “lollypop” with a scar running around the nipple and a short vertical scar only. The breast tissue is usually removed and the nipple is preserved on a mound of tissue. This can either be based from below “the inferior pedicle” or from above “using the supero medial pedicle”.
The inferior pedicle technique is more likely to preserve the sensation to the nipple but does potentially produce a more ‘boxy” shape. This also has the possibility of “bottoming out” with time.
The supero medial pedicle technique produces a better shape and a shape that is more likely to last. This is because the most gravity dependent part of the lower breast tissue is removed and this enables the sides (or lateral pillars) of the breast to be coned so producing a more natural rounded shape and restoring the volume to the upper pole of the breast. This also produces a shape that lasts more with time. There is a possibility that greater loss of sensation to the nipple may occur with this technique.

[mk_padding_divider size=”50″]
[mk_fancy_title tag_name=”h2″ style=”false” color=”#393836″ size=”22″ font_weight=”inhert” margin_top=”0″ margin_bottom=”18″ font_family=”Arvo” font_type=”google” align=”center”]What happens after the operation?[/mk_fancy_title]

Most people will stay in a hospital overnight. A drain is usually inserted into each side. You may leave hospital with the drains still in place. You will be given a prescription for strong painkillers upon discharge from the hospital. You will be advised to wear a crop top for the first six weeks (day and night). I recommend that you plan a very quiet week immediately after your surgery and avoid driving for 2 weeks and vigorous exercise for 6 weeks.
The stitches are dissolvable and therefore don’t need removing. You will be seen regularly after the operation at one week, two weeks, six weeks and six and 12 months.

[mk_fancy_title tag_name=”h2″ style=”false” color=”#393836″ size=”22″ font_weight=”inhert” margin_top=”0″ margin_bottom=”18″ font_family=”Arvo” font_type=”google” align=”center”]What costs are involved?[/mk_fancy_title]

Dr Belt’s surgical fee
Assistant’s fee
Theatre fee / day bed, and overnight bed if not a day case
Specialist anaesthetists fee
Costs of sports bra / crop top
Rebates are available through both Medicare and Private Health Funds.
Please contact Dr. Belt’s rooms and his staff can answer any questions you may have. A personalised quote and information can be sent to you regarding your procedure.

[mk_padding_divider size=”40″][mk_mini_callout title=”Contact Dr Paul Belt” button_text=”Dr Belt ” button_url=”http://explantinfo.com/directory/listing/dr-paul-belt”]Dr. Paul J. Belt
Plastic, Reconstructive and Aesthetic Surgeon
M.A., B.M., B.Ch. (Oxon), FRCS (Eng), FRACS (Plast)


Buying a Bra

When you buy a new bra, there are a few pointers to bear in mind, so you can achieve your dream fit:

  • Bras will change in shape and size from brand to brand.
  • Different fabrics may affect the fit, for example some women may find lace detailing restrictive.
  • Different types of bras suit different body shapes

A new bra should fit perfectly when using the first hooks, as the bra is worn and stretches over time, you can then adjust accordingly.

Don’t forget If you’re exercising you MUST wear a sports bra which fits you and is suitable for your chosen activity. Our breasts start growing in puberty and they reach their full size somewhere around 21-22.

Click here for Lingerie Care

The Age-Related Breast Surgery Trends That’ll Keep You Guessing…


“Nobody’s boobs are that perfect! They can’t be real…surely?”


How often have you played that game while people-watching with your mates? But could you guess which breast surgery procedure created the hourglass object of envy?


Here’s a clue: There are distinct age-related trends in cosmetic surgery.


Teens: This age group is unlikely to have had breast surgery because breasts continue to develop into your early twenties. Aurora Clinics gets a lot of enquiries from teens, but any reputable surgeon will suggest you wait and see what nature intends before making a decision.

MARSEILLE, France (Reuters) – In March 2010, a pair of health inspectors acting on a tip paid a three-day visit to a factory in this hilly town on the Mediterranean coast.

The factory was the headquarters of Poly Implant Prothese (PIP), a leading international maker of breast implants founded by French entrepreneur Jean-Claude Mas. The inspectors found something odd: six discarded plastic containers of Silopren, a liquid silicone designed for industrial, not medical use, lined up along the outside wall of the production site.

A week later, gendarmes descended on the plant. Mas skipped out just ahead of them, eluding interrogation for nearly eight months, but his game was up. In the nearly two years since, the cheap silicone used in PIP’s fake breasts has continued to leach into women’s bodies. In France, 1,262 of the roughly 300,000 breast implants the company sold worldwide have split open in the past two years. PIP has been closed down, Mas has been arrested and put under investigation for alleged bodily harm, and French and European safety regulators have been thrust into an uncomfortable spotlight.

Mas, 72, a grocer’s son from the south of France, had no scientific training. Yet for the first decade of this century he was able to manufacture and sell faulty breast implants on international markets that he and some of his employees knew to be substandard, according to testimony given to French police and seen by Reuters.

The history of breast implants is littered with flawed devices, a colourful cast of intertwined players and billion-dollar lawsuits. Reuters reviewed hundreds of pages of police investigation transcripts and financial documents, and interviewed former PIP employees, the company’s suppliers, customers and health experts, to piece together this latest chapter in that history.

It is a tale of a haphazardly run and cash-strapped company that allegedly took desperate and sometimes deceptive steps to shave costs and hide the true ingredients of its devices. PIP’s efforts were made easier by a European regulatory regime that had been essentially outsourced to the very companies that are meant to be regulated.

Among the new details to emerge: PIP was able to save an estimated 1.2 million euros (1.0 million pounds) in one year by using the industrial-grade silicone in its implants, according to figures cited by police investigators. And it relied on crude, unscientific tests of product quality, such as judging silicone gel by sticking a finger in it, according to one former worker. Some 75 percent of its implants used the non-approved, cheaper gel, Mas told police.

“Maybe it’s shameful, but there you go,” Yves Haddad, a lawyer who represents both Mas and his now-defunct company, told Reuters at the end of December. “We live in a capitalist world.”

Mas, who declined to comment for this story, has said his products are harmless. After the health ministry advised Frenchwomen to have the devices removed, he told French radio network RTL last month that the decision was “criminal” and the health minister “needs to be committed.”


Jean-Claude Florent Mas, born in Tarbes, near the Spanish border, was a salesman by temperament. He sold everything from life insurance to wine and dental equipment. He entered health care in the mid-1960s, working for various labs, including one that was bought by Bristol-Myers in the 1970s, where he stayed until 1980 as a salesman in the south of France. Mas’ attorney, Haddad, says his client was one of the firm’s top salesmen, although Bristol-Myers could not confirm that or say why he left.

It was after Bristol-Myers that Mas got involved in breast implants. He began working with a French plastic surgeon, Henri Arion, who had made France’s first breast implant in 1965, and was now selling saline implants under the name Simaplast.

It wasn’t a great start. Simaplast’s implants eventually were found to be prone to rupture, according to a 1999 study by U.S. non-profit Institute of Medicine. Simaplast morphed into a company named MAP – the precursor to PIP – where Mas said he performed every job from production to sweeping the floors. The small group of employees included a woman, Dominique Lucciardi, who would become Mas’ companion and mother of his two children. They would take turns filling the prostheses, he told police.

In 1991, aged 52, Mas launched PIP, a limited liability company and chose as its headquarters the site of the old Simaplast factory. In preparation, he had applied for a patent to sell implants containing silicone covered in polyurethane foam, he told police.

As he launched PIP, a breast implant scandal involving Dow Corning was sweeping across the United States. The American firm was found to have knowingly concealed safety concerns about its implants, and in 1992, the U.S. Food and Drug Administration called for a moratorium on the devices. Four years into PIP’s life, in 1995, France also banned silicone in breast implants, a ban that ended in 2001.

Mas found that by innovating, he could still bring products to market. He switched to implants filled with saline solution and launched a pre-filled version; other brands needed to be filled while the patient was on the operating table. PIP’s new product saved time, and surgeons liked it. PIP moved into the huge U.S. market in 1996, and soon the United States made up 40 percent of its revenue, according to company records.


Opportunities for PIP grew on its home turf in 2001, when France lifted its ban on silicone implants, and the United States slowly began to approve more versions containing silicone gel, for which Mas already had a formula. “When I started PIP I brought this formula that I had kept,” he told police. “Why change it?”

Regulators had never examined nor approved that filler, but Mas insisted to his staff that it was perfectly safe, his ex-employees told Reuters.

Building on his innovations in saline implants, in 2002 Mas brought a new twist to silicone by launching an asymmetrical product that became popular with surgeons and patients, because it gave a more natural look than the “classic” style of implant, which resembled a perfectly round orb.

PIP’s approach to filling these implants was novel. On paper, the company said it used NuSil, a silicone blend made by a California company of the same name, which can be used in medical applications, including implantable devices. NuSil was founded by PIP’s former U.S. distributor, Donald McGhan, who is now in prison in Texas for an unrelated fraud conviction. The company has declined any comment on the PIP affair.

But in reality, PIP was mostly using Mas’ own non-approved PIP gel, which looked and felt exactly like NuSil, but cost a seventh of the price.

A litre of NuSil cost about 35 euros, versus 5 euros for PIP’s version, Thierry Brinon, PIP’s former technology head in charge of research and development, told police. Each implant on average used 330 cubic centimetres of gel. That meant it cost 11.55 euros to fill an implant with NuSil and a mere 1.65 euros to use PIP’s gel, a difference of 9.90 euros on each implant produced.

Claude Couty, the former chief financial officer of PIP, told police it cost an average total of 38 to 42 euros to manufacture an implant filled with PIP gel, versus 52 for an implant filled with NuSil. Investigators in the legal case file estimated that in one year alone, 2009, using PIP gel instead of NuSil saved the company nearly 1.2 million euros.

PIP sold implants to French surgeons for about 300 euros a piece. Abroad, the asking price was about 100 euros, according to former PIP staff and surgeons.

“This formula is perfect,” Mas told police. “It’s better than the formula for making NuSil.”


But because NuSil was a known quantity and his gel recipe was not, Mas concealed the implants’ ingredients from the regulator. Flaws in Europe’s regulatory system gave him a helping hand.

France has a government regulator, the Agence Francaise de Securite Sanitaire des Produits de Sante, or AFSSAPS, which has the power to remove products from the market but does not certify them. But the agency that certified PIP’s implants was actually a private company, based in Germany. TUV Rheinland first approved PIP’s saline implants in 1997. Its officials paid annual visits to the factory in La-Seyne-sur-Mer and announced them 10 days in advance, in accordance with European guidelines.

That gave PIP plenty of time to hide the truth. Ahead of TUV visits, workers would clear away evidence of the cheaper silicones PIP was using and put together a doctored version of documents that included no references to the use of unapproved silicone, Mas and ex-managers told police. All internal communications related to TUV’s visits were oral, said one former worker.

“Since 1997, we automatically hid the products that allowed us to make the PIP gel,” Mas told police, according to notes in the case file, “because I knew they weren’t regulation.” In his second police interview, Mas said he had given “the order to hide the truth from TUV” since 1993.

TUV sued PIP in February 2011, saying PIP had tarnished its reputation by using TUV’s name to market sub-standard products and that it had been systematically misled.


There were other gaps in the regulations that helped PIP keep its products on the market for so long. The system does not require on-site, unannounced checks of the implants’ contents. Nor does it require that the chemical composition of the implants, once approved, be re-tested.

A TUV spokesman said it would only have made an unannounced visit for checks if there were very serious indications that something was amiss. There have been no cases of unannounced checks in Germany in the past 40 years, he added.

Moreover, TUV’s yearly audits are essentially audits of overall processes; they do not perform on-site lab tests. The German company believes PIP deliberately deceived it.

AFSSAPS said it tested the insides of PIP’s implants in 2001 to make sure they were what PIP said they were when silicone breast implants were allowed back onto the French market.

After 2001, however, that job went to two independent French laboratories: LEMI, Laboratoire d’Evaluation des Materiels Implantables and LNE, Laboratoire National de Metrologie et d’Essais. Mas told police the laboratories performed tests in 2002 and 2008.

AFSSAPS’ deputy director general, Francois Hebert, told Reuters these tests were likely ordered by PIP following requests from surgeons, who may have sent back defective implants and asked for further evaluation.

LNE said its tests were mechanical – how likely PIP’s implants were to resist pressure, for instance – but declined to provide further information. LEMI said its tests related to toxicity, but also declined to provide further information.

The first random test by AFSSAPS would not come until mid-2010 by which time PIP was under investigation by police. That was when AFSSAPS issued a report which said, “this one does not reach the degree of quality of a silicone gel intended for breast implants.”

This week, France’s health department and AFSSAPS submitted a report to the country’s health minister acknowledging gaps in the French and European regulatory system. The report cited the lack of unannounced visits and on-site testing of implants but said that PIP’s alleged fraud was so sophisticated that “it’s not evident that an inspection, even an unannounced one, could have been effective.”


The raw silicone materials for the PIP-formula gel included different products: Silopren – which was kept in the containers that had been spotted by inspectors – and Baysilone. PIP bought these silicone oils from a German distributor, Brenntag. It turned to a French distributor, Gaches Chimie, for a third oil, Rhodorsil 47V1000.

Brenntag confirmed it sold silicone oils to PIP from 2001 to 2010, but said it stopped when it was made aware PIP was under investigation. A Brenntag spokesman, Hubertus Spethmann, said that as far as Brenntag knew, PIP was a diversified supplier whose products included wound dressing pads and other padding products that could be filled with silicones such as the oils it produced. Brenntag would not comment on the orders PIP made or any payment problems with the French company.

Reuters could not independently confirm that these items were sold by PIP.

Representatives from Brenntag periodically asked to visit PIP’s headquarters, according to one ex-PIP employee, a request that caused much worry within PIP. Brenntag would not comment on the visits.

On at least two occasions, Brenntag sales representatives paid a visit, but were welcomed by Mas in his office and did not visit the production labs, the former worker said this month.

“Mas would tell them we used the silicone oil for creams, certainly not breast implants,” said the ex-worker. “We were very uncomfortable and let Mas do all the talking.”

Gaches Chimie also confirmed it occasionally sold its silicone oil to PIP from the early 2000s until 2009, when the orders stopped. CEO Pierre Gaches said he did not believe his company was PIP’s main supplier and never had concerns about the ultimate use of the oil, because it is used in many industrial applications.


Even as PIP used unapproved materials for its silicone implants, its innovative saline products were running into problems in the United States. Lawsuits from hundreds of patients alleged they deflated, sometimes within months of surgery. The FDA was never to approve PIP’s silicone products, instead posting a warning about the firm’s practices on its website.

Mas made a reverse takeover to try to open PIP to U.S. capital and prepare the way for a re-launch.

In 2003, his Luxembourg holding company Milo Finance bought a majority stake in U.S.-listed Heritage Worldwide, and handed to Heritage the control of PIP. In its first annual filing with the U.S. Securities and Exchange Commission after the merger, Heritage disclosed that for the financial year ended June 23, 2003, PIP had a loss of $693,336. That loss grew to $5.6 million in 2004.

PIP also turned to markets where regulation was not as stringent. It found distributors to open sales in 10 new countries “in which no regulatory problems were anticipated,” Heritage said in its 2003 annual report. Exports were less profitable – foreign sales fetched about a third of the French price – but there was volume in South America, which soon became PIP’s top market with two-thirds of sales, driven by Venezuela and Colombia.

In 2005 and 2006, PIP showed a profit. One former employee said these were the “glory days” for the company, which employed about 120 workers. Operating margins reached 20 percent, the sort of level an early cellphone maker could expect. “We’d see a smile on the face of Mr. Couty,” said a former manager. One of those years, the company bought new BMWs for Couty and Mas, Couty told police. He did not respond to requests for an interview.

Mas, now at France’s retirement age of 65, took on a chairman’s “supervisory and advice-giving” role in 2004, for which he received 360,000 euros per year, a five-fold rise over his 2003 salary.

Finance chief Couty became CEO, but PIP’s liquidator, Xavier Huertas, wrote in a March 2010 report that Mas continued to control production, R&D and sales, and “in fact, to lead the company at the side of Mr. Couty.”

However, crisis was around the corner. Litigation and the financial shocks of 2008 were to send Mas back into PIP’s labs, to try to improve on his “perfect” gel formula.


Mas was never trained as a scientist. He was a tinkerer, an experimenter who relied on his gut. But even he was to realise that PIP gel had a problem: it leaked too much silicone oil.

Of seven former PIP staff interviewed by Reuters, only two said they had no idea that the company was using a homemade gel. Three others suggested they kept quiet because they were worried about their jobs.

After 2005, PIP staff became more vocal. That year, the heads of production, quality control and research and development together asked Mas to fill all PIP’s implants with NuSil, Hannelore Font, the company’s quality control director, told police. Mas replied this would be “economically impossible”. Font did not return calls requesting an interview.

For 2008, PIP set aside 1.4 million euros to cover potential lawsuits, according to liquidation documents. It had underestimated. A British court ordered the company to pay 1.6 million euros to plaintiffs who alleged the envelopes covering PIP’s implants were not strong enough and leaked gel. U.S. litigation cost another 160,000 euros.

“All this litigation weakened the health of the company,” said Haddad, the attorney for PIP and Mas.

Complaints rose, and PIP’s customers paid more slowly. The liquidator noted that PIP’s export clients on average took nearly nine months to settle.

Suppliers balked, too. NuSil held up a shipment destined for PIP due to non-payment, PIP’s purchasing manager, Nadine Carrodano, told police. Couty wrote to Mas describing what he called his “fears for the future.”

By June 30, 2009, PIP’s debts reached 8.5 million euros. “In every area the company was crumbling,” Carrodano told police. She declined to comment.


In 2008, PIP invested 300,000 euros on a new machine to make the implants’ shells, hoping more uniformity would cut leakage, according to Couty.

Brinon, PIP’s technical director, said Mas came to him in early 2008 and told him to start developing a new gel, PIP 2. Brinon refused, and the task went instead to another worker who had never worked on implants before coming to PIP. The goal, he said, was to create a gel that would not leak so much oil. This was crucial: silicone gel that seeps out may cause irritation and inflammation in women’s bodies.

That worker told Reuters that Mas relied on trial and error, adding a bit of this and a bit of that in the lab: “He didn’t do scientific tests,” the former worker said. “He’d look and say, ‘that’s good, that’s bad.'”

To judge whether more or less oil was seeping out of the gel, the worker said, “you would look and then put your finger in the gel and you’d see if there was oil or not on your finger.”

Finally, midway through 2008, PIP 2 was ready.

Brinon was sceptical. His own mother, who had once had cancer, had a PIP implant and he was worried, he told police. He began doing his own tests on PIP gel and NuSil. He told police that PIP 1 gel excreted more oil than PIP 2, and much more than NuSil, which leaked oil in “infinitessimal amounts.”


Mas threw himself into export sales. His passport, a copy of which is included in police documents, shows visits to Panama, Venezuela, Colombia, Brazil, Uruguay, Ecuador, China, Singapore and the Philippines in 2008 and 2009.

Back at home, staff morale was low.

On May 4, 2009, a commerce court in the city of Toulon ordered PIP into the French equivalent of Chapter 11 proceedings.

About a dozen employees were laid off, month-to-month workers’ contracts were cut and evening shifts scaled back, according to liquidation documents.

Font, the quality-control staffer, told police she delivered an ultimatum to Mas at a meeting with other managers, saying she would no longer sign off on implants ready to be shipped. Instead, Couty took that on.

TUV performed an audit in early 2010. Purchasing manager Carrodano told police she was “close to tears” after TUV gave PIP the thumbs-up. Font got a doctor to sign a medical release to keep her away from work. Unpaid suppliers stopped sending raw materials; production ground to a halt.


On March 16, 2010, AFSSAPS officials came calling, a visit that had been arranged five days in advance. AFSSAPS had recently received letters from a Marseille surgeon signalling his concerns with PIP rupture rates. The regulator also received in the mail photos sent anonymously of empty containers of non-approved raw materials at PIP’s plant.

On the first day of their visit, inspectors noticed nothing abnormal. The following morning, without telling PIP, they visited PIP’s production facility. It was then they spotted the empty containers labelled “Silop,” for Silopren. The lead inspector estimated they had contained nearly 9 tonnes of the liquid silicone.

Days later, when police visited the site, Mas slipped out quickly. When French police finally managed to question him in November, they asked why he had left in such a hurry. According to a police transcript of the interview, he said he was no longer in charge of the company – he had handed the reins to his finance director years back. “I thought it wasn’t me you were coming to see…”

Within two weeks of the regulators’ visit, PIP was shut down and AFSSAPS pulled its implants from the market. Some 29,000 products were seized. Laid-off staff burned tyres and hurled discarded implants into the car park.

Mas went abroad again. Costa Rica, Nicaragua, Columbia, Spain and Venezuela are among visits his passport records in 2010. In Costa Rica, he was pulled over and charged with drunk driving.

On September 27, 2010, Mas transferred his ownership of a real estate holding company to his partner Lucciardi and their son, according to Luxembourg filing documents. That company holds the title to a four-bedroom villa with a pool not far from PIP’s headquarters.

It was here police arrested Mas in January. The home, according to estate agents, is currently listed for sale at about 1.6 million euros.

In their questioning of Mas in October 2011, he told police that over the years, 75 percent of PIP’s implants were filled with his homemade formula. The French regulator says there are so far 1,262 cases of the devices rupturing in France. Health experts say no concrete link has been shown between PIP implants and breast cancer, but the French government has advised women to have their PIP implants removed.

Mas, who is out on bail, was asked by police what he thought of the women who issued complaints about the failed devices. “It’s about fragile people, or people who are doing it for the money,” he said, according to the interview transcript.



(Alexandria Sage reported from Paris, Natalie Huet from La-Seyne-sur-Mer and Jean-Francois Rosnoblet from Marseille; additional reporting by Marc Joanny in La-Seyne-sur-Mer, Elena Berton in Paris, and Ludwig Burger and Maria Sheahan in Frankfurt; writing by Alexandria Sage; Editing by Sara Ledwith and Simon Robinson)

(Created by Simon Robinson)