The Illicit, Perilous World Of 'Pumping'

The American Society of Plastic Surgeons is launching a public safety campaign Monday. It follows many cases of procedures gone wrong at the hands of unqualified surgeons, including 'pumpers' who illegally inject industrial-grade silicone into patients. The practice leads to dire health problems, even death. Guest host Jacki Lyden learns more with Laura Rena Murray, who recently reported this issue for the New York Times, and Dr. Malcolm Roth, the new president of the American Society of Plastic Surgeons.

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JACKI LYDEN, host: This is TELL ME MORE from NPR News. I'm Jacki Lyden. Michel Martin is away. Coming up, we remember Nobel Prize winner Wangari Maathai, the Kenyan activist. Her efforts to link poverty and environmental degradation made one of Africa's made her one of Africa's most important reformed voices.

But first, we go behind closed doors, as we often do on Mondays, where we discuss issues people usually keep private and plastic surgery is something that many patients don't want to talk about, especially if that surgery is illegal, dangerous or invites fatality.

Today, we'll hear about a troubling trend called pumping, a procedure sought out by people who sometimes want a gender change, other times those who want more curves, but who can't afford to visit a licensed, board certified plastic surgeon.

Pumpers often use industrial grade silicone or loose silicone or other substances for the effect, only the damage they cause is permanent.

Joining us now is Laura Rena Murray, who reported this story for the New York Times, and we also have with us Dr. Malcolm Roth. Starting today, he's the new president of the American Society of Plastic Surgeons. And today, that organization launches a new public safety campaign about the danger of unsafe cosmetic procedures.

Welcome to you both. Thanks for being with us.

LAURA RENA MURRAY: Thank you for having me.

MALCOLM ROTH: Thank you for having us.

LYDEN: Dr. Roth, let's start with you. I know that you're concerned and that the professional society, the ASPS, the American Society of Plastic Surgeons, is concerned about illegal procedures. Tell me what's going on and why you issued the warning.

ROTH: Well, Jacki, as you've already pointed out, this deadly trend is increasing in popularity. Pumping, in particular, which is the trendy word for illegally injecting silicone into the body to alter somebody's appearance, we're hearing more and more about complications, in some case, as minor as an infection, but unfortunately, we're also hearing about deaths. Two extreme and serious examples come to mind. There was a woman last year who died following a buttock injection done in a Philadelphia hotel room and not long after that, another woman died from a similar procedure in a Las Vegas warehouse.

So the American Society of Plastic Surgeons is launching this patient safety campaign to remind patients of the important of selecting the most qualified doctor they can, a board certified plastic surgeon.

LYDEN: Laura Rena Murray, you bring us a riveting and tragic story from the New York Times. You saw how someone in the transgender community who had this illegal pumping procedure done. Introduce us, if you would please, to Zaira Quispe and what happened to her.

MURRAY: When I met Zaira, it was right before she ended up going into the hospital for an extended period of time. She is currently 42 and started pumping when she was in her early 20s and pumped throughout her 20s.

Ten years after she began the procedures is when she started noticing that the silicone was turning hard and then eventually began to migrate down her legs. She had had her injections primarily in her buttocks and hips and she first started doing the injections because she wanted to fully transition, but did not have the money to afford a licensed surgeon.

LYDEN: So this was one way that she saw of making, basically - cosmetically, at least - what amounts to a sex change?

MURRAY: Yes.

LYDEN: Dr. Roth, what is a pumping party? Could you describe that for us?

ROTH: What happens, typically, is a group of patients get together, they pool their money and often, for just a few hundred dollars, they meet with somebody in typically not a physician's office, but something like a hotel room and they have injections of industrial grade silicone to enhance, perhaps, their breasts, their lips, their buttocks.

Aside from being illegal, it's clearly unsafe and these practitioners are not licensed physicians and they're certainly not board certified plastic surgeons.

LYDEN: Laura, take us back to the story of Zaira Quispe. We had invited her to be part of our discussion today, but she was too ill. Who supplied her with this substance and what was it?

MURRAY: Well, the problem with pumping is that you never actually know what's being injected and each pumper can promise you that they are injecting medical grade silicone, but in fact it is industrial grade silicone or worse. Sometimes, what someone is injecting is industrial grade silicone mixed with baby oil or Crisco to try and loosen it up and make it stretch a little bit longer. Zaira was injected by three different people. And the last series of injections that she received, one of her surgeons told her, ended up being industrial grade silicone, and that was...

LYDEN: When you say surgeon, you mean someone she saw afterward.

MURRAY: Yes. When she started having problems she ended up going to see a provider who then referred her to a plastic surgeon at Beth Israel and then she was told that (unintelligible) had been injected was not at all what she thought it was.

LYDEN: And when you met her what were her symptoms? And not to be ghoulish about it, but how did she look?

MURRAY: Well, she appeared fine from - I mean you can't really tell from an outward appearance, if somebody is sort of walking around with poison traveling through their body. But she had a lot of health problems as a result of it. She wasn't able to sit for very long periods of time because it caused her too much pain. Likewise, she also had difficulty sleeping because she had to keep maneuvering. She couldn't walk for very long stretches because she would get dizzy quickly. So those are some of the things that plague her on a daily basis. And she was just chronically in pain from the waist down.

LYDEN: Dr. Roth, surely this kind of injection of these substances, whether it's industrial silicone or something else, what is happening? It must cause everything from disease to disfigurement.

ROTH: Sure. Well, first off, I think it's important to point out that plastic surgeons typically do not inject silicone, they inject other things. We have many safer, better options at our disposal. But silicone, we know, when it's injected in such a way can cause patients who have these unfortunate results and complications, hardening of the tissue, chronic pain and tenderness, draining infections. They're embarrassed. They often don't have the money to seek out solutions. And often, if they do seek out the solutions and finally do go to a plastic surgeon, the plastic surgeon is often not able to give them a reasonable solution to their problems and they can never get back to normalcy.

LYDEN: If you're just joining us, this is TELL ME MORE from NPR News. I'm Jacki Lyden. Today in our Behind Close Doors conversation, we're talking about illegal silicone injections, a process called pumping. And we're speaking with Dr. Malcolm Roth, the new president of the American Society of Plastic Surgeons. And we also have with us, Laura Rena Murray, who recently covered this issue for The New York Times.

Laura, you actually interviewed someone who performed these procedures a pumper and she that she can make $10,000 a week doing this. Tell us a little bit more about her.

MURRAY: So the pumper that I interviewed for the piece was a member of the transgender community herself. She was a transgendered woman and she considered what she was doing to be a necessity for her community, which often didn't have access to the money that it cost to do these surgical procedures.

LYDEN: When you talked to the pumper, did you talk to her about procedures that had gone awry and the health problems that people face later?

I asked her if she knew of any of her patients - for lack of a better word if anyone had had any problems after being injected by her, and she claimed that that was not the case. However, I interviewed dozens of transgendered women in New York for this article, and one of the first women that I interviewed, had been injected by this pumper and at that point, in her early 30s, was already experiencing some problems.

MURRAY: Typically, if there isn't an adverse effect right away - unfortunately sometimes it can result in an immediate death - then the problem will come 10 years down the line and you just have to wait and see.

Dr. Roth, when you hear something like that, what are you thinking? And where do we see this the most in the country?

ROTH: Well, I practiced in Brooklyn, until recently, for 23 years - so it's clearly a trend, it's been out there for many years and sometimes the complications don't occur 'til later. But because it's illegal, and the patients themselves don't really want to blow the whistle, so it's really difficult to track where it's getting done and who's doing it.

I think that we have to applaud patients like Zaira, who has the courage to stand out there and have her story told to other patients in order to try to help them avoid making that mistake and thinking that this is a reasonable way to get the aesthetic enhancement that they might like.

LYDEN: Mm-hmm. When something goes wrong in a medical procedure with a board-certified physician, there's always, of course, recourse. But for these people, these pumpers, who operate secretly and then disappear, are there any consequences if they are caught and how many are?

ROTH: Well, legally, those involved do face criminal charges if they are caught, because it is against the law. But finding out who they are and where they are has been, I think, extremely difficult.

LYDEN: Hmm. Laura, how many procedures, over the course of the last 10 or 15 years, did Zaira say that she'd had, and how much that she spent in total?

MURRAY: So she ended up spending close to $70,000 over the course of a decade, I think. Usually spending a couple thousand each time to have a liter, or a cup or two, injected into her hips and buttocks.

LYDEN: You know, Dr. Roth, I can't imagine for a second and I suppose I share that with a lot of people listening to this the thought that someone would inject something I wasn't absolutely certain of into my body. And I don't know that I'd be very happy with it even if I did think I knew what it was. Why are there so many people out there willing to do this? What is it say about us as a society?

ROTH: Well, I think that the public needs to be better informed. And that's why we are launching this safety campaign. Our message is very clear and very easy to remember: Do your homework. Consumers need to investigate their medical provider's background. Beware of the white coat confusion. Anyone can wear a white coat and claim to be a plastic surgeon, but not everyone is a plastic surgeon and not everybody is qualified to perform cosmetic procedures.

I think the important thing to keep in mind when you're looking for a plastic surgeon, is if you do go to a member of the American Society of Plastic Surgeons, in addition to having all of the training - six years of surgical training, passing written and oral examinations, continuing medical education requirements, operating in safe accredited facilities - all of our members also have to adhere to a strict code of ethics. And we joke, but it is no joke, we answer to a higher authority. And so when a patient comes in looking for an improvement in their appearance, the risk factors specific to that procedure in that particular patient need to be carefully considered.

And what are the options? It very well be that the patient has refused what they would like, maybe offered something else that might be safer, but having all of the tools in the toolbox and a safe environment in safe hands is the best formula for success.

LYDEN: Well, Dr. Malcolm Roth, new president of the American Society of Plastic Surgeons, he begins his position today, thank you.

ROTH: Thank you for doing this piece. I think it's critical we get the word out.

LYDEN: Dr. Roth joined us from Denver, Colorado. And Laura Rena Murray, who recently covered this story for The New York Times, and joined us from San Francisco's KQED, thank you very much, Laura.

MURRAY: Thank you for having me.

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