Is explantation of silicone breast implants useful in patients with complaints?

Abstract

In this review, we present a critical review of the existing literature reflecting the results of explantation of silicone breast implants in patients with silicone-related complaints and/or autoimmune diseases. A literature search was performed to discuss the following issues: which clinical manifestations and autoimmune diseases improve after explantation, and what is the course of these complaints after explantation. Next, we reviewed studies in which the effect of explantation on laboratory findings observed in patients with silicone breast implants was studied, and lastly, we reviewed studies that described the effect of reconstruction of the breast with a new implant or autologous tissue after explantation. We calculated from the literature that explantation of the silicone breast improved silicone-related complaints in 75 % of the patients (469 of 622). In patients with autoimmune diseases, however, improvement was only infrequently observed without additional therapy with immunosuppressive therapy, i.e., in 16 % of the patients (3 of 18). The effect of explantation did not influence autoantibody testing such as ANA. We discuss several possibilities which could clarify why patients improve after explantation. Firstly, the inflammatory response could be reduced after explantation. Secondly, explantation of the implants may remove a nociceptive stimulus, which may be the causative factor for many complaints. Options for reconstruction of the explanted breast are autologous tissue and/or water-/hydrocellulose-filled breast implant. Unfortunately, in very few studies attention was paid to reconstructive possibilities. Therefore, no adequate conclusion regarding this issue could be drawn. In conclusion, explantation is useful for improvement of silicone-related complaints in 75 % of the patients, whereas in patients who developed autoimmune diseases improvement is only observed when explantation is combined with immunosuppressive therapy. In a patient with silicone-related complaints in which explantation is considered, the patient should be counseled for the different options of reconstruction after explantation.

Mechanisms of Breast Implant Toxicity: Will the Real Ringmaster Please Stand Up

“…Heavy metals adversely affect enzymes, DNA, and leukocyte respiration; can be toxic to muscle, brain, lungs, kidneys, liver, blood, and nerves; and when present in excess amounts can mimic multiple sclerosis, Parkinson's, Alzheimer's, and muscular dystrophy (21) . Clinical correlates reported in implant recipients include (but are not limited to) hair loss, recurrent infections in a variety of sites, weakness, fatigue, muscle twitching, nail cracking and splitting, cognitive dysfunction, a multitude of other nervous system disorders (e.g., paresthesias; dysesthesias; dizziness; gait imbalance); and abdominal pain, nausea, constipation, and loose stools from dysfunction of the myenteric plexus) (1,2,3,4,5,6,7,12,16,20,22) . i.…”

“…In actuality, the presence or absence of autoantibodies in patients with these devices has no relevance for diagnosing siliconeinduced disease (4,16,20,22) . In yet another publication Tervaert and colleagues try to prop up their mistakes by publishing a review of commingled conditions (both explicit and/or loosely defined), all of which lack any unifying clinical features but are all supposed to represent silicone-induced toxicity based on a haphazard response to explanation (7) . Their "kitchen sink" approach is devoid of even the most basic elements of proper investigative methodology including, but not limited to: chronological disease development over time (which has been documented to be a dose-response curve); rupture versus non- rupture analysis; duration of implantation analysis; a more comprehensive, reproducible and consistent data base for recording the ailments of their patients; prior exchange surgeries; intrinsic validity analysis; explanation results that take into account the duration of prior implantation; and the well-known fact that a patient fulfilling criteria for a classical connective tissue disease doesn't necessarily imply that one has arrived at the correct diagnosis (16.20) .…”

“…Numerous publications in the past five years have supported the assertion that silicone gel-filled breast implants are genuinely capable of causing a novel systemic illness (1,2,3,4,5,6,7) . Prior claims of a similar nature existed in the 1990's when the controversy first swirled around this issue, but legitimacy at that time was elusive due to faulty methodologies utilized by many investigators (1,4) .…”

“…Silicone-induced autoimmune theories have recently been resurrected in the form of ASIA (autoinflammatory syndrome induced by adjuvants, or Shoenfeld's syndrome), which promotes the concept of multi-organ inflammatory responses to silicone gel (3,5,6,7,9) . The deficiencies of ASIA and the failure of its proponents to consider multiple other mechanisms of disease causation have been outlined in a recent letter to the editor (10) .…”

Role of environmental factors in autoimmunity: pearls from the 10th international Congress on autoimmunity, Leipzig, Germany 2016

“…De Boer and colleagues [31] suggested that at least in those with breast implants, explantation of the silicone prosthesis improved the complaints in 75 % of the patients. Such improvement was only infrequently observed without additional therapy with immunosuppressive therapy in those developing a full-blown autoimmune disease [32].…”