Silicone gel filled breast implants and connective tissue disease: an overview.
OBJECTIVE
To review the literature examining the association of silicone gel filled implants and connective tissue disease.


METHODS
Computerized literature searches and manual review of bibliographies.


RESULTS
Numerous concerns have arisen regarding the safety of silicone gel filled breast implants. The structure of these prostheses is reviewed. Silicones are not biologically inert. Injectable as well as implantable silicones have proven capable of eliciting inflammatory and fibroproliferative responses. Silicone leakage from silicone gel filled implants is well documented as is distant migration of silicone in the host. In the past decade, over 60 cases of connective tissue disease following mammoplasty with silicone gel filled implants have been reported. About half of these patients developed scleroderma or scleroderma-like illnesses. This reported overrepresentation of scleroderma compared to other rheumatic diseases mimics the Japanese experience with injectable silicones. Possible biological rationale for the association is presented.


CONCLUSIONS
The physical and biological properties of silicone gel filled implants and their behavior in vivo is compatible with the hypothesis that they may contribute to the development of connective tissue disease. The association seems most likely with scleroderma; however, there is as yet inadequate epidemiological data to definitively establish causality.
Spiera
R F
RF
Hospital for Special Surgery, Cornell University Medical College, New York, NY 10021.
Gibofsky
A
A
Spiera
H
H
D000818:Animals; D001327:Autoimmune Diseases / Q000209:etiology; D001940:Breast / Q000601:surgery*; D003240:Connective Tissue Diseases / Q000209:etiology* / Q000276:immunology; D005260:Female; D005782:Gels; D006680:HLA Antigens; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects; D019736:Prostheses and Implants / Q000009:adverse effects*; D012595:Scleroderma, Systemic / Q000209:etiology; D012828:Silicones / Q000009:adverse effects*
D005782:Gels; D006680:HLA Antigens; D012828:Silicones