Migration and accumulation of silicone in the liver of women with silicone gel-filled breast implants.
1H NMR localized spectroscopy (STEAM), combined with echocardiography (ECG), respiratory gating, and water and fat suppression, was used to quantify silicone concentrations in the liver of women with silicone gel-filled breast implants. Localized spectroscopy was performed on 15 patients with silicone gel-filled breast prostheses and on eight volunteers with no implants. The 1H spectra in the liver of patients showed silicone resonances from 0.3 to -0.8 ppm, attributable to protons in the methyl groups of silicone. The presence of silicone in the liver could first be detected 3-4 years after breast prostheses implantation. No correlation between silicone concentrations and implantation times was observed. However, our results indicated that silicone concentrations may reflect implant integrity: detectable silicone concentrations in the liver appeared to be higher when the implants were ruptured than when the implants appeared intact. Moreover, new resonances in the range of -2.6 to -4 ppm were observed in most patients after long-term implantation. As these species increase with implantation time, the new resonances may reflect chemically changed silicone (paramagnetically shifted silicon complexes bound to iron) accumulated over time. The sensitivity of 1H NMR localized spectroscopy is sufficient to detect silicon concentrations as low as 0.20 mM. Results from one patient whose implants had been removed 14 months prior to the NMR examination showed no detectable silicone in the liver, indicating that it may have been excreted via bile or degraded to silica and high coordinated silicon complexes. Quantitative 1H localized spectroscopy of the liver in women with silicone gel-filled breast implants may provide valuable information concerning silicone accumulation and degradation in vivo, as well as about the kinetics of its elimination from the body after implant removal.
Pfleiderer
B
B
NMR Center, Department of Radiology, Massachusetts General Hospital, Charlestown 02129.
Garrido
L
L
D018427:Breast Implants / Q000009:adverse effects*; D004452:Echocardiography; D004868:Equipment Failure; D005260:Female; D005548:Foreign-Body Migration / Q000175:diagnosis* / Q000378:metabolism; D005782:Gels; D006801:Humans; D008099:Liver / Q000378:metabolism*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008961:Models, Structural; D012828:Silicones / Q000009:adverse effects / Q000493:pharmacokinetics; D013997:Time Factors
D005782:Gels; D012828:Silicones