title: Scleroderma and augmentation mammoplasty--a causal relationship?
abstract: BACKGROUND
  The studies implicating a causal relationship between silicone and scleroderma, other autoimmune disease, and fibromyalgia-like symptoms have been largely descriptive with absence of appropriate controls and no consideration of potential confounders. This case control study of augmentation mammoplasty and scleroderma represents an attempt to answer these deficiencies.
  
  
  OBJECTIVE
  To compare the frequency and temporal relationship of augmentation mammoplasty in interviewed and deceased cases and interviewed controls. To determine the frequencies of exposure to non-augmentation mammoplasty silicone, and to determine the frequencies of mastectomy and breast lumpectomy in interviewed cases and controls.
  
  
  METHODS
  Scleroderma cases and age-stratified general practice controls were interviewed using a prepilotted telephone questionnaire. Self-reported date/s of augmentation mammoplasty were ascertained, as were dates of onset of first and second scleroderma symptom/s and scleroderma diagnosis, where relevant. Comparison of socioeconomically adjusted rates was expressed in terms of rate ratios.
  
  
  RESULTS
  Augmentation mammoplasty rates were comparable between interviewed cases and controls. No augmentation mammoplasty procedures were documented in deceased scleroderma patients' medical records. Rates of exposure to non-mammoplasty silicone, mastectomy and breast lumpectomy were comparable in interviewed cases and controls.
  
  
  CONCLUSIONS
  This study failed to demonstrate an association between silicone breast implantation and the subsequent development of scleroderma, to a relative risk level as low as 4.5 with 90% power.
authors.affiliation: Rheumatology Unit, Royal North Shore Hospital, Sydney, NSW.
authors.forename: H J
authors.initials: HJ
authors.lastname: Englert
authors.forename: P
authors.initials: P
authors.lastname: Brooks
mesh_terms: D000328:Adult; D017675:CREST Syndrome / Q000453:epidemiology / Q000209:etiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D019736:Prostheses and Implants / Q000009:adverse effects*; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000453:epidemiology* / Q000209:etiology; D012828:Silicones / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D012828:Silicones