Autoimmune Syndrome Induced by Adjuvants (ASIA) after Silicone Breast Augmentation Surgery

Abstract

Summary:Generally, the main complications of silicone implantation are local symptoms. However, some patients develop late-onset systemic symptoms often associated with a rare form of hyperactive immune response, as part of a syndrome known as autoimmune syndrome induced by adjuvants (ASIA). Reported cases of ASIA have shown resolution with explantation, but not with immunomodulatory therapy. In this report, we described a case of a previously healthy 23-year-old woman, who has undergone silicone breast implant augmentation, for aesthetic reasons, and developed localized cutaneous impairment 3 years postsurgery. She received a diagnosis of ASIA with a new presentation: Lupus-like manifestation through localized cutaneous impairment. This patient’s symptoms were managed without the need for surgical intervention, which has not been previously reported, because the patient did not want an explantation for aesthetic reasons. The patient was started on hydroxychloroquine, 400 mg per day, and remains asymptomatic after 2 years of treatment. The exact predisposition to ASIA is still unknown. Without implant explantation and with immunomodulatory treatment, this patient’s condition substantially improved. Based on our current understanding of this disease, it might not be prudent to indicate breast augmentation with silicone implants in patients with documented autoimmune reaction to an adjuvant, an established autoimmune condition, or genetic predisposition. However, if a patient does develop silicone-induced ASIA, explantation is no longer the only successfully reported option, as these symptoms can be managed with immune suppression.

Silicone Breast Implant Surface Texture Impacts Gene Expression in Periprosthetic Fibrous Capsules

“…11 Less frequent but more serious complications include autoimmune syndrome induced by adjuvants and BIA-ALCL. 12,13 Reducing complication rates of implant-based augmentation and reconstruction has the potential to result in a dramatic improvement in patient well-being and health care costs. In particular, increasing implant biocompatibility and modulating host inflammatory responses can reduce implant malfunction and postoperative complications of numerous implant-based procedures.…”

Diagnosis, investigation and management of breast implant illness

“…Nunes et al 40 Case report 1 23 Alijotas-Reig et al 4 Retrospective cohort 45 N/A available and relevant information to form a framework for discussing the evidence behind the diagnosis, investigation and management of patients who present with symptoms of BII.…”