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Hoteit B, Pinsolle V, Delgove A, Dannepond A, Michot A. [Siliconosis with rheumatoid polyarthritis following a breast implant rupture: Case report and literature review]. ANN CHIR PLAST ESTH 2023; 68:368-372. [PMID: 36966097 DOI: 10.1016/j.anplas.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/26/2023] [Accepted: 03/05/2023] [Indexed: 03/27/2023]
Abstract
Breast implant rupture is a common complication in plastic surgery, with various clinical presentations, due to silicone migration. In this article, we present the case of a patient with ruptured silicone implants, who developed siliconosis with rheumatoid polyarthritis, and evolved favourably after explantation surgery. The physiopathology of this disease, and the implication of silicone migration are still controversial, and yet to be confirmed.
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Affiliation(s)
- B Hoteit
- Service de chirurgie plastique, reconstructrice et esthétique, chirurgie de la main, centre Francois-Xavier-Michelet, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - V Pinsolle
- Service de chirurgie plastique, reconstructrice et esthétique, chirurgie de la main, centre Francois-Xavier-Michelet, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - A Delgove
- Service de chirurgie plastique, reconstructrice et esthétique, chirurgie de la main, centre Francois-Xavier-Michelet, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - A Dannepond
- Service de chirurgie oncologique, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux, France
| | - A Michot
- Service de chirurgie oncologique, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux, France
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Lamm SH. Silicone Breast Implants, Breast Cancer and Specific Connective Tissue Diseases: A Systematic Review of the Data in the Epidemiological Literature. Int J Toxicol 2016. [DOI: 10.1080/109158198226297] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Unanswered concerns about the systemic safety of silicone breast implants (BI) underlay the Food and Drug Administration's moratorium pronouncement in 1992. Since then, many epidemiological studies have been reported that examined either the association between BI and cancer, particularly breast cancer, or the association between BI and connective tissue diseases (CTD), particularly scleroderma. These studies are reviewed, and their data are synthesized. Three breast cancer easel control studies that examine BI as a risk factor show no association between BI and breast cancer. Nor do four BI cohort studies. The data appear to show a reduced risk. No association has been seen between Bl and either breast sarcomas or total cancers. Case-control studies do not show an association between BI and scleroderma (four studies), rheumatoid arthritis (three studies), systemic lupus erythematosus (two studies), or other connective tissue diseases. Eight cohort studies of women with breast implants sought an association between BI and CTD. Seven had negative results. One found a statistically significant risk of self-reported CTD of 1.24 (upper confidence limit = 1.41), but medical record review for diagnostic confirmation has not yet been performed. In toto, the epidemiological studies do not indicate an association between breast implants and breast cancer, though they suggest possibly a negative association. In toto, the epidemiological studies do not indicate an association between breast implants and specific connective tissue diseases, though one study's current results present a small statistically significant association with self-reported CTD.
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Affiliation(s)
- Steven H. Lamm
- Consultants in Epidemiology and Occupational Health, Inc., Washington, DC., USA
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Rohrich RJ, Adams WP, Potter JK. A Review of Psychological Outcomes and Suicide in Aesthetic Breast Augmentation. Plast Reconstr Surg 2007; 119:401-408. [PMID: 17255699 DOI: 10.1097/01.prs.0000245342.06662.00] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Aesthetic surgery is an essential component of plastic surgery and has become increasingly popular in American society. In 2002, 1.8 million surgical cosmetic procedures were performed in the United States, representing a 294 percent increase from 1992. The 1992 U.S. Food and Drug Administration moratorium on silicone breast implants arose in response to numerous reports of connective tissue disease associated with silicone gel breast augmentation and has led to a decade-long battle over the safety of silicone breast implants that continues today. Numerous scientific and epidemiologic studies of the past decade have established that there is no association between silicone breast prostheses and systemic disease. Recently, a new front has opened in the conflict regarding the safety of breast augmentation: the psychological impact of breast augmentation. Quality studies assessing the psychological characteristics of breast augmentation patients and the psychological impact of breast augmentation surgery are few and most studies are flawed in their methods. Recent reports have provided corroborating evidence to support the psychological benefits of cosmetic surgery and breast augmentation. New reports citing an increased risk for suicide among women with breast implants have brought renewed concerns but are unable to demonstrate a cause-and-effect relationship between breast implants and suicide. The present challenge is to determine whether the increased risk reported in epidemiologic studies is falsely associated with breast implants or whether it represents underlying risk factors or psychopathology in women undergoing breast augmentation that puts them at increased risk for suicide. The purpose of this article is to review the literature regarding the psychological impact of breast augmentation and assesses current scientific findings, with emphasis on the validity of suicide risk in breast augmentation patients.
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Affiliation(s)
- Rod J Rohrich
- Dallas, Texas From the Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical School
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Abstract
Several controversial neurotoxic syndromes have received notoriety in the past several decades. For each, the controversy involves the most fundamental question about the existence of the disorder as a clinically diagnosable entity. Interestingly, the most controversial of these syndromes share several features, including argument about the existence of each syndrome in the courtroom. The authors focus their discussion on three problems (painter's encephalopathy, silicone breast implant neurotoxicity, and the Gulf War syndrome) for which no scientific consensus has been reached that would establish them as diagnosable disorders. These syndromes do not meet traditional disease criteria, and until a clear set of symptoms and objective signs can be defined, a definite course and clear cause demonstrated, and specific tests and treatments identified, these syndromes are likely to remain highly controversial.
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Affiliation(s)
- J W Albers
- Departments of Neurology, Psychiatry, and Environmental and Industrial Health, School of Public Health, University of Michigan Health System, Ann Arbor, USA
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Shanklin DR, Smalley DL. The immunopathology of siliconosis. History, clinical presentation, and relation to silicosis and the chemistry of silicon and silicone. Immunol Res 1999; 18:125-73. [PMID: 9951648 DOI: 10.1007/bf02788777] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Recent evidence confirms the fundamental involvement of the human immune system in the reaction to implantation of silicone-based medical devices. An as yet-to-be particularized epitope of many complex substances sharing siloxane structures is presented through the MHC-II apparatus with development and retention of T cell memory. This memory can be tested for in practical terms using one or more forms of silica, which links the immuno-histopathology and autoimmune attributes of "silicosis" with those of "siliconosis." The lesions of siliconosis are typical of those for persistent antigens and delayed, cell mediated hypersensitivity. The basic descriptive pathology of the reaction to silicone has been known since soon after introduction of silicones in medical procedures, with the exception of some details related to the more recent discoveries on the role of cytokines in the immunopathic process. The clinical consequences of siliconosis are common and can be severe in some individuals implanted with silicone devices.
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Affiliation(s)
- D R Shanklin
- Department of Pathology, University of Tennessee, Memphis 38163, USA
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McDonald AH, Weir K, Schneider M, Gudenkauf L, Sanger JR. Silicone gel enhances the development of autoimmune disease in New Zealand black mice but fails to induce it in BALB/cAnPt mice. CLINICAL IMMUNOLOGY AND IMMUNOPATHOLOGY 1998; 87:248-55. [PMID: 9646834 DOI: 10.1006/clin.1998.4532] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Anecdotal evidence links silicone gel breast implants with the development of autoimmune connective tissue disease in women. To investigate whether silicone gel is capable of directly inducing and/or enhancing the development of autoimmune disease, female BALB/cAnPt (BALB/c) and New Zealand Black (NZB) mice were injected subcutaneously with silicone gel, pristane, a nonmetabolizable substance that can cause plasmacytomas in BALB/c and NZB mice, or saline and monitored for the development of glomerulonephritis and autoantibody production. NZB, but not BALB/c, mice spontaneously develop autoantibodies and an autoimmune hemolytic anemia by 12 months of age. Over a period of 10 months, biweekly screening for proteinuria revealed increases in urinary protein in NZB mice that received multiple injections of either silicone gel or pristane. In contrast, urinary protein was unaffected in identically treated BALB/c mice. Although, silicone gel had no effect on serum titers of antierythrocyte antibodies in NZB mice, the hematocrits were significantly decreased. Moreover, silicone gel both increased the concentration of IgM anti-type I collagen antibodies and skewed the immunofluorescent staining pattern of serum autoantibodies on HEp-2 cells. In contrast, silicone gel failed to induce the production of anti-erythrocyte or antinuclear antibodies in BALB/c mice and induced only slight increases in IgG anti-type I collagen antibodies. These results suggest that silicone gel can exacerbate the development of autoimmune disease in autoimmune NZB mice, but fails to induce disease in normal BALB/c mice. This is consistent with several epidemiological studies failing to demonstrate an increase in the incidence of autoimmune disease in women with breast implants. However, because silicone gel was able to exacerbate autoimmune disease in NZB mice, it may play a similar role in the development of autoimmune disease in a small percentage of women who are genetically susceptible to such diseases.
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Affiliation(s)
- A H McDonald
- Department of Pathology, Medical College of Wisconsin, Milwaukee, USA
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Snyder JW. Silicone breast implants. Can emerging medical, legal, and scientific concepts be reconciled? THE JOURNAL OF LEGAL MEDICINE 1997; 18:133-220. [PMID: 9230567 DOI: 10.1080/01947649709511032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- J W Snyder
- Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Frondoza C, Jones L, Rose NR, Hatakeyama A, Phelps R, Bona C. Development of scleroderma-like syndrome in Tsk/+ mice is not enhanced by silicone administration. Curr Top Microbiol Immunol 1996; 210:299-306. [PMID: 8565570 DOI: 10.1007/978-3-642-85226-8_31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The possible role of silicone in the pathogenesis of a scleroderma-like syndrome is still unresolved. It has been proposed that silicone escaping from breast implants potentiates the progression of the disease. To clarify whether silicone enhances development of fibrotic skin lesions and autoantibodies, we tested its effect on tight skin (TSK/+) mice. TSK/+ mice spontaneously develop skin fibrosis and characteristic autoantibodies which resemble human scleroderma. The results of the present study indicate that silicone administration does not enhance development of skin fibrosis nor synthesis of autoantibodies to RNA polymerase and topoisomerase in TSK/+ mice.
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Affiliation(s)
- C Frondoza
- Johns Hopkins Dept. of Orthopaedic Surgery, USA
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Field T, Bridges AJ. Clinical and laboratory features of patients with scleroderma and silicone implants. Curr Top Microbiol Immunol 1996; 210:283-90. [PMID: 8565568 DOI: 10.1007/978-3-642-85226-8_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We reviewed the available clinical and laboratory data from 56 patients with scleroderma and silicone implants from the English medical literature and 19 cases which have not been previously reported. The average age of onset of scleroderma was 43.6 +/- 10 years (range 20-73). Patients had silicone implants for an average of 9 +/- 4 years prior to the development of scleroderma (range 1-32). Most patients had limited scleroderma (41%). Twenty three percent had intermediate scleroderma and 36% had diffuse scleroderma. Clinical findings included: Raynaud's phenomenon in 77%, esophageal dysfunction in 53%, and pulmonary involvement in 47%. Cardiac and renal involvement were uncommon. Antinuclear antibodies by immunofluorescence were found in 83 percent of patients. The immunofluorescence pattern was speckled in 53%, centromere in 31% and nucleolar in 9%. Other antibodies (Scl-70, RNP, SSA/Ro, PM-Scl) were found in only a small proportion of patients. A clinical, serologic and immunogenetic comparison of patients with silicone implants and scleroderma and patients with idiopathic scleroderma is needed to better understand the pathogenesis of this disorder.
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Affiliation(s)
- T Field
- Department of Medicine, University of Wisconsin Hospital, Madison 53792, USA
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