Appenzeller, Simone

Carvalho, Jozelio Freire de

Hortolam, Juliane G

Clinics

English

PubMed

Cadernos Espinosanos (E-Journal)

Connective tissue diseases following silicone breastimplantation: where do we stand?Juliane G Hortolam, Joze´lio Freire de Carvalho, Simone AppenzellerState University of Campinas, Faculty of Medical Science, Department of Medicine, Rheumatology Unit, Campinas/SP, Brazil.Silicone, which is considered biologically inert, has beenused in many different types of medical devices, includingtubing; breast, joint and penile implants; artificial heartvalves; and intraocular lenses, among others. After asilicone implant is placed, a mild reaction to the foreignbody is generally observed, followed by encapsulation (1).Case reports of women with silicone breast implants andconnective tissue disease (CTD), especially scleroderma,began to appear in English-language medical literature inthe 1980s. Currently, it is widely believed that there is noassociation between silicone breast implants and autoim-mune disease (1). However, when a patient presents withautoimmune symptoms after silicone breast implantation,the question often arises again.Although several authors have reported the appearanceof CTDs (e.g., scleroderma, Still’s disease, systemic lupuserythematosus (SLE), Sjogren’s Syndrome and dermato-myositis) after silicone breast implantation, several case-control studies do not show such an association. However,there are a few points that deserve attention. Silicone breastimplants act as a foreign body, and inflammatory responsesto silicone, such as granulomatous skin reactions to injectedsilicone, synovitis around silicone prosthetic joints andlymphadenopathy proximal to silicone prostheses, havebeen observed (2,3). Microscopic evidence of silicone hasbeen observed far from the original site (e.g., in the liver),suggesting that a small quantity of silicone particlesdetaches and migrates through the lymphatic or circulatorysystem to other organs (1,4–6). They may act as adjuvantsand start an inflammatory process in joints or activate theimmune system and stimulate the production of autoanti-bodies (1,2).The activation of the immune system has been demon-strated by the presence of antibodies to silicone and thepresence of autoantibodies in the sera of patients withsilicone breast implants. Although several studies havedetected increased titers of anti-silicone antibodies, noassociation with clinical findings has been observed (6-10).Significantly more patients with silicone breast implantspresent with positive anti-DNA, Sjogren syndrome antigen B(anti-SSB/La) and anticollagen II (6-10). Antibodies andsymptoms were more evident in patients who had possessedimplants for a longer time period (10).In conclusion, silicone breast implants may act as aforeign body and elicit autoantibody production. However,thus far, no clear link between the presence of autoanti-bodies and symptoms has been observed.& AUTHOR CONTRIBUTIONSAll authors participated in the preparation and correction of the text.& REFERENCES1. Levy Y, Rotman-Pikielny P, Ehrenfeld M, Shoenfeld Y. Silicone breastimplantation-induced scleroderma: description of four patients and acritical review of the literature. Lupus. 2009;18(13):1226-32, http://dx.doi.org/10.1177/0961203309347795.2. Groff CD, Schned AR, Taylor TH. Silicone-induced adenopathy eightyears after metacarpophalangeal arthroplasty. Arthritis Rheum.1981;24(12):1578-81, http://dx.doi.org/10.1002/art.1780241220.3. Cristie AJ, Weinherger KA, Dietrich M. Silicone lymphadenopathy andsynovitis. Complications of silicone elastomer finger joint prostheses,JAMA 1977;237(14):1463-4.4. Anderson DR, Schwartz J, Cottrill CM, McClain SA, Ross JS, MagidsonJG, Klainer A, Bisaccia E. Silicone granuloma in acral skin in a patientwith silicone-gel breast implants and systemic sclerosis. Int J Dermatol.1996;35(1):36-8.5. Sergott TJ, Limoli JP, Baldwin CM Jr, Laub DR. Human adjuvant disease,possible autoimmune disease after silicone implantation: a review of theliterature, case studies. Plast Reconstr Surg. 1986;78(1):104-14.6. Iannello S, Belfiore F. Silicone breast prosthesis and rheumatoid arthritis:a new systemic disease: siliconosis. A case report and a critical review ofthe literature. Minerva Med. 1998;89(4):117-9.7. Goldblum RM, Pelley RP, O’Donell AA, Pyron D, Heggers JP.Antibodies to silicone elastomers and reactions to ventriculoperitonealshunts. Lancet 1992;340(8818):510-3, http://dx.doi.org/10.1016/0140-6736(92)91710-P.8. Teuber SS, Rowley MJ, Yoshida SH, Ansari AA, Gershwin ME. Anti-collagen autoantibodies are found in women with silicone breastimplants. J Autoimmun. 1993;6(3):367-77, http://dx.doi.org/10.1006/jaut.1993.1031.9. Karlson EW, Hankinson SE, Liang MH, Sanchez-Guerrero J, Colditz GA,Rosenau BJ, et al. Association of silicone breast implants withimmunologic abnormalities: a prospective study. Am J Med.1999;106(1):11-19.10. Zandman-Goddard G, Blank M, Ehrenfeld M, Gilburd B, Peter J,Shoenfeld Y. A comparison of autoantibody production in asymptomaticand symptomatic women with silicone breast implants. J Rheumatol1999;26(1):73-7.Email: appenzellersimone@yahoo.comTel.: 55 19 3289-1818Copyright  2013 CLINICS – This is an Open Access article distributed underthe terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided theoriginal work is properly cited.No potential conflict of interest was reported.DOI: 10.6061/clinics/2013(03)E01EDITORIAL281

Connective tissue diseases following silicone breast implantation: where do we stand?

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