He Got a Silicone Implant in the 1990s. Thirty Years Later, His Body Started Sending the Bill

⏱ 13 min read

The Man’s Case Files · #4 — Health

The numbers behind one man’s penile implant removal in Korea — and why so few American surgeons still do this work.

Jake’s first phone call was to the urology clinic closest to his house. The voice on the other end was polite but careful. When he mentioned the silicone implant that had been in his body for more than thirty years, the answers got shorter. Get a referral from your primary care physician first. Then we can begin a workup.

He asked about cost. They didn’t know. Type of procedure, insurance coverage, surgeon experience — all of that would have to wait until an in-person consultation. The next available appointment was six weeks out.

Jake is self-employed. The business was in a busy stretch, and stepping away wasn’t a matter of taking time off — it was a matter of revenue going somewhere else. Money wasn’t the problem. The system kept asking for time.

This was about a year ago.

The implant Jake doesn’t talk about much

Jake had the procedure done when he was in his twenties. Late 1980s, early 1990s — somewhere in that window. A few of his friends had it done around the same time. The mood at the time wasn’t quite “everyone’s doing it,” but it wasn’t strange either. Ads ran in newspaper sports sections. Doctors advertised their own work on infomercials. The Howard Stern Show talked about it.

Something started shifting last year. First a faint redness. Then occasional bleeding. Now there’s pain.

What kind of device exactly was placed inside him, and what technique was used — Jake doesn’t remember in detail. The doctor who did the work retired long ago, and the medical records aren’t easy to track down anymore. What he knows is that silicone went in. It wasn’t something he was going to ask his friends about either.

What was happening in America in the 1990s

To understand Jake’s case, you have to look at the era his procedure came out of.

Between 1990 and 1996, a single physician in Culver City, California essentially defined the American cosmetic penile enhancement market. According to Phoenix New Times reporting from 1994, he was performing 125 enhancement surgeries per month, charging $3,500 for a basic lengthening and $5,900 for the deluxe package. The main clinic was in Los Angeles, but he ran screening centers in nine American cities — Phoenix, Detroit, San Francisco, San Diego, and others. Medical assistants gave twenty-minute briefings to walk-in prospects, complete with charts, graphs, and before-and-after picture books.

The advertising copy was direct. A box ad in the San Jose Mercury News read: “For Men Only: Be All the Man You Want to Be!” A November 17 ad in the Arizona Republic emphasized “Totally Natural! No Implants!” The campaigns ran in newspaper sports pages, on the Howard Stern Show, in television infomercials, on early websites — almost every channel that could reach an American man in the early-to-mid 1990s. The monthly advertising spend was $200,000. Multiplying surgical fees by patient volume, the practice’s estimated annual revenue was $13 million, and that one physician’s cumulative earnings during the early 1990s ran close to $6 million.

Between 1990 and 1996, his practice performed somewhere between 3,000 and 7,000 enhancement procedures. That was just one surgeon. The Seattle Times estimated in 1996 that at least thirty doctors across the country were performing the same kind of work, and that more than 10,000 American men had undergone cosmetic penile enlargements in total. Most of these procedures took place in private operating rooms with no hospital affiliation.

The dominant techniques were two. For length, suspensory ligament release. For girth, fat injection or insertion of a silicone block or sleeve. Some practitioners used liquid injectable silicone, which the medical literature describes as historically associated with poor outcomes requiring later surgical correction.

The market collapsed in 1996. Salon’s 1999 reporting cited a post-operative infection rate of 90 to 95 percent at the lead surgeon’s clinic during late 1994. Patient testimony recorded in CNN, Seattle Times, and Phoenix New Times coverage describes the outcomes in concrete terms: scarring, hair growth on the shaft, lumps, asymmetry, sometimes a smaller result than what the patient started with, sometimes loss of function entirely.

More than 30 malpractice suits were filed. The California Medical Board called the surgeon “an immediate danger to the public health, safety and welfare.” A ten-page Findings of Fact from the administrative law judge documented false advertising — the ads had claimed “most patients appear as if they have doubled in size.” On July 12, 1996, he surrendered his medical license.

In Miami, the surgeon credited as the original developer of the fat-injection technique was incarcerated on manslaughter charges after a patient died during one of his procedures.

The American Urological Association declined to endorse cosmetic penile enhancement throughout this period. A UCLA urologist quoted in CNN coverage at the time put it directly: the procedure was experimental and had no backing from the AUA.

The problem now is that thirty years have passed

If this were just a historical episode, the article would end here. It isn’t. By the time the market collapsed in 1996, more than 10,000 American men had undergone these procedures. The men who had it done in their twenties and thirties are now in their late fifties and early sixties. Jake’s age.

Silicone starts producing problems decades later.

The clearest synthesis of this is in a published case series of liquid injectable silicone complications. The medical literature documents that silicone granuloma reactions can appear not only one or two years after the original procedure, but decades later. Standard treatment is excision of the affected penile shaft skin followed by reconstruction with split-thickness skin grafting. It isn’t a simple removal — it’s a reconstruction.

For silicone block-style implants — the precursor category to the modern Penuma device — modern data shows long-term erosion rates of 5% and removal rates between 6 and 21 percent. That’s with FDA-approved current-generation devices. Long-term complication rates for the non-FDA implants used in the 1990s aren’t well documented because almost no follow-up studies exist.

One more piece of data worth knowing: once a silicone sleeve has been removed, the same kind of device cannot be reimplanted. Decades of fibrosis prevent the surgical recreation of the subcutaneous compartment. Which means the options after explant are two: leave it as is, or revise with a dermal graft.

When Jake called his local urologist, he didn’t know any of this.

America has very few surgeons who do this work

This is the heart of Jake’s problem.

About 30 million American men have erectile dysfunction. The number who receive an inflatable penile prosthesis each year — the AUA’s own current estimate — is between 20,000 and 25,000. Roughly 1 in 1,200 men with ED ever gets the standard surgical treatment.

The AUA acknowledges the reason directly: there are “a limited number of implanters who can perform the procedure, potentially restricting access for men who may benefit from the treatment.” Specialist supply, by the AUA’s own admission, is the bottleneck for standard ED treatment.

Jake’s case is not standard ED treatment. It’s the explant of a thirty-year-old cosmetic-origin silicone implant, combined with revision. The number of US surgeons who do that routinely can be counted on one hand. A Pennsylvania specialist states on his own clinic page that he has personally removed roughly 50 to 100 silicone implants across more than fifteen years of treating failed silicone implants. Across the whole country, across fifteen years. Other named specialists — in Toronto, in Anaheim — have worked in the same niche, but most of them came up during the 1990s era and are now in their 60s and 70s themselves.

Newer-generation urologists rarely train in this area. There’s no insurance reimbursement, the case volume is low, and the procedure has no AUA endorsement. When the cosmetic enhancement market collapsed in 1996, the specialist pipeline collapsed with it.

The answer Jake got at his local urology clinic — see your primary care physician first, get a referral — wasn’t laziness. It was an honest acknowledgment that this wasn’t something the local clinic could handle.

Penile implant removal cost in the United States

If Jake had pursued the American path anyway, the cost structure would have looked roughly like this.

Penile implant removal combined with dermal graft revision in the United States typically runs $15,000 to $25,000 or more, with complex cases going substantially higher. The medical literature on revision surgery cost is explicit: revision is inherently more complex than primary implantation, requires more perioperative resources, and costs more.

Insurance generally won’t help. If the original procedure was cosmetic, complications from it are usually classified as cosmetic too. Standard ED-indicated penile prostheses are covered by Medicare and roughly 70 percent of commercial insurance, but 1990s-era cosmetic enhancement complications fall outside that category.

So the American path for Jake came down to: $15,000 to $25,000+ self-pay, six to eight weeks before a first specialist consultation, and a specialist pool that could be counted on a few hands nationally. None of that fit his business calendar.

The phone call from someone who knew a different system

Jake has an old friend. American citizen, came to the United States from Korea as a teenager, now runs his own restaurant. They became close over the years partly because they’re both self-employed — they understood each other’s calendar pressure.

One evening Jake mentioned his situation in a sentence or two. The friend’s reply was simple. Doctors do this every day in Korea. There are a lot of them. Just go and look.

The Korean urology prosthetic market is structured differently from the American one. Men’s health clinics are clustered in Seoul districts — Gangnam, Apgujeong, Samseong-dong, Yeongdeungpo — at densities comparable to the cosmetic surgery market in the same areas. In Korea, this category of urological cosmetic procedure is part of an everyday clinical landscape, not a marginal specialty.

Single-surgeon case volume in Korea is not comparable to American norms. A urologist at one Gangnam clinic states in his own clinic literature that he has performed more than 10,000 acellular dermal matrix penile augmentations — a figure he says is verifiable through Korean tax filings, not a marketing number. Compared with the American specialist’s documented 50 to 100 cases over fifteen years, the order of magnitude is different.

Pricing is also different. Korean medical reporting puts cosmetic penile procedures at Gangnam urology clinics in the range of 3 to 7 million won — roughly $2,200 to $5,000, depending on procedure type and graft material. Removal of a silicone implant is described in Korean clinical writing as “a relatively easy procedure because silicone doesn’t get absorbed into surrounding tissue” — in other words, routine. Revision graft material is typically FDA-cleared acellular dermal matrix from established product lines like SureDerm, MegaDerm, or LargeDerm.

For Jake’s case — silicone explant plus dermal graft revision — the Korean estimate came in under $10,000 all in. Procedure-specific quotes vary by clinic, material, and patient condition, and prices change over time, so anyone considering this should get a current quote directly from the clinics.

The biggest difference, Jake said later, wasn’t even the price. It was the process. In Korea, a phone call inquiry was sufficient. Walking in to schedule an appointment on arrival was normal. A pre-booked appointment was preferred but not required.

Jake bought a plane ticket.

A Gangnam clinic, the day after arrival

What Jake did was simple. He called the clinic before leaving the US to describe his situation in two sentences. He landed, slept, walked in the next day. The first consultation covered everything: the physical exam revealed thirty-year-old silicone, early erosion, some fibrosis. The surgeon asked the direct question — did he want a removal only, or removal plus a new revision.

What was different from his American experience was that all of the information arrived at once. Cost, options, recovery timeline, technique, surgeon’s case experience. Consent paperwork was processed the same day.

The friend had given Jake three clinic names — Clinic A in Gangnam, Clinic B in Apgujeong, Clinic C in Samseong-dong. All three were urology clinics specializing in penile prosthetic surgery, with case volumes that exceeded any American specialist Jake could have found. He picked one.

Jake’s original plan had been a simple removal. Take the thirty-year-old thing out and live with whatever was left. But one of the options the surgeon walked him through was an explant performed simultaneously with a dermal graft revision — using either an acellular dermal matrix product or autologous tissue.

What an American specialist had done 50 to 100 times in fifteen years, this clinic did every day.

Jake decided on the spot. As long as the same anesthesia and the same incision were already involved, do it once.

U.S. vs. South Korea: Urology Specialization and Cost Architecture

A structural breakdown of provider density, surgical volume metrics, and cash-pay clinical rates between both healthcare systems.

What he said when he came back

During the recovery period in a Seoul hotel, Jake worked. Late-night Korean time, US client calls, a laptop on the desk. The amount of physical absence from his business was the same it would have been in the US — what changed was whether that time was waiting or being treated.

What he said, more or less, was that money was never the issue. Finding a doctor with real experience was the issue.

He slept on the flight home. Thirty years’ worth.

For American men who had this done in the 1990s

This article isn’t really about Jake. It’s about the cohort. The cohort of American men who underwent cosmetic penile enhancement during the 1990s — many of whom are now in their late fifties and early sixties — was estimated at more than ten thousand at the time the market collapsed. Modern penile implant market data shows that the 60–69 age cohort accounts for 43.75% of revenue, which is to say: this generation has just arrived at the age where the bills come due.

If you’re in that cohort and something has started to feel different — redness, intermittent bleeding, pain, change in appearance — ignoring it isn’t a strategy that ages well. Silicone granulomas can present 20 to 30 years after the original procedure. Erosion is progressive.

Finding a US specialist for penile implant removal is hard but not impossible. Known names work in Pennsylvania, Toronto, and Anaheim. The Korean option begins with the kinds of clinics described above.

This isn’t a recommendation. It’s information.

Related reading

· Case Files #2 — Cataract Surgery Cost: Linda’s Korea Case
· Case Files #3 — Knee Replacement Cost: Tom’s $96,000 Decision
· Testosterone & Erectile Dysfunction in Men After 50

Medical disclaimer

The content of this article is not medical advice and is not a substitute for diagnosis or treatment. Individual situations require direct evaluation by a qualified medical professional. Cited cost data reflects sources at the time of writing and varies by clinic, procedure, and patient condition; current pricing should be confirmed directly with the relevant clinics. This case represents one man’s experience, and outcomes vary by individual.

Thanks for reading. Take care of yourself — nobody else will do it for you.