Acta Dermatovenerol Croat. 2007;15(1):45.
What should be used as tools in women at risk of autimmune disease?
Lipozencic J, Marinovic B.
Brest implants made of materials such as ivory, rubber, or ox cartilage have been used since the 19th century. After the 1940s, direct subcutaneous silicone injections were introduced, which caused serious complications (infections and migration to distant tissues). In the 1960s, a solid silicone envelope filled with silicone gel or saline was used. Escape of silicone from the envelope of these implants could be either intracapsular or extracapsular, penetrating though the fibrous capsule formed around the implant. In 1992, the US Food and Drug Administration decided that silicone gel-filled implants could only be used in women in clinical studies, for revision after unsatisfactory saline implantation, or after mastectomy for breast cancer. In contrast, these implants have been regularly used for cosmetic purpose in Europe. Autoimmune disorders in women with silicone implants were reported in the 1970s and 1980s, including systemic lupus erythematosus, scleroderma, rheumatoid arthritis and some rheumatologic conditions (1). Several studies examined the association between implants and the development of connective tissue disease (CTD), with a relative risk of 1.24 for CTD in women silicone breast implants (1-5). In Tel Aviv, five women with CTD who had silicone implants were treated for 18 months (1). These five cases covered a wide spectrum of CTDs in women who had silicone implants for periods of up to 25 years. Two of these five cases had other possible causes of their CTD, i.e. metastatic breast cancer in patients with dermatomyositis, or drug induction (high doses of paracetamol, metamizole, ibuprofen). The diagnoses were: morphea, dermatomyositis, systemic sclerosis, chilblain lupus/vasculitis, and eosinophilic fasciitis. In patients with fibromyalgia it has been suggested to be related to silicone implants (1). None of the patients wanted explanation. Because of the multifactorial nature of most autoimmune disorders, women seeking breast implants should be screened for the known triggers for developing CTD. Until we have better diagnostic tools, the women at risk of autoimmune diseases should not be considered for implantation of silicone devices for cosmetic purpose.
PMID: 17433180 [PubMed - in process]