Risk of Connective Tissue Disorders among Breast Implant Patients

Abstract

In a US retrospective cohort study (1960-1996), 351 (4.8%) of 7,234 patients with breast implants and 62 (2.9%) of 2,138 patients who had undergone other types of plastic surgery reported subsequent rheumatoid arthritis (RA), scleroderma, systemic lupus erythematosus, or Sjögren's syndrome (relative risk = 2.0, 95% confidence interval (CI): 1.5, 2.8). Risks of RA, scleroderma, and Sjögren's syndrome were elevated both before and after 1992, when the Food and Drug Administration changed the status of breast implants to investigational. When records for these diseases were retrieved (35-40% retrieval rate) and blindly reviewed, two expert rheumatologists assessed only a minority of the cases as being "likely" (e.g., regarding RA, 16.5% for implant patients and 23.5% for comparison patients). Recalculation of incidence rates using "likely" diagnoses found relative risks of 2.5 (95% CI: 0.8, 7.8) for RA, scleroderma, and Sjögren's syndrome combined and 1.9 (95% CI: 0.6, 6.2) for RA only. When the proportions deemed "likely" were applied to all self-reports, the estimated relative risks were 2.0 (95% CI: 0.7, 5.4) for the three disorders combined and 1.3 (95% CI: 0.5, 3.8) for RA. These results indicate that self-reports of connective tissue disorders are influenced by reporting and surveillance biases. Given the diagnostic complexities of these diseases, excess risks, if they exist, may be beyond detection even in a study of this size.

Flow Cytometric Analysis of Peripheral Blood Lymphocyte Subsets in Patients with Silicone Breast Implants

“…[2][3][4] In addition to these local phenomena, several case reports of systemic autoimmune disease (scleroderma, rheumatoid arthritis, or lupuslike symptoms) and musculoskeletal disorders have been published. [13][14][15][16][17][18][19][20][21][22][23] Despite the widespread use of silicone implants, there have been few systematic studies on the immunologic effects of silicone in humans. 6,20,24 -27 The purpose of our study was to investigate the distribution of immune cells in peripheral blood samples of patients with silicone breast implants and to understand whether silicone induces only the formation of foreign body granulomas as a local reaction or gives rise to subsequent systemic immune reactions as well.…”

Narcissism, Perfectionism, and Interest in Cosmetic Surgery

“…[1][2][3][4] Patients with a diagnosis of implant-related ALCL have had implants that were either ruptured or intact, filled either with saline or with silicone gel, and placed for either reconstructive or cosmetic purposes; these varying circumstances have not appeared to make any difference. 5,6 Although large observational epidemiological studies in North American and Scandinavian women have disproved significant associations with breast cancer or other specific cancer sites or with autoimmune disease, [11][12][13][14][15][16][17] currently, clinical and histological findings of two major reviews 5,6 speak in favor of an association between breast implants and ALK-1-negative ALCL, which presumably is an indolent form of this group of non-Hodgkin's lymphoma that is completely distinct from the systemic disease with a clinical behavior more similar to primary cutaneous ALCL than to the systemic counterpart. Thus, several authors agree that implant-related ALCL should be recognized as a separate category in the World Health Organization's classification, with its own diagnosis and treatment.…”

Apoptosis Modulation as a Promising Target for Treatment of Systemic Sclerosis

“…Genetic factors could not be excluded [5, 6], but environmental influence seems to be more important. Notably, chronic exposition to chemicals, such as organic solvents [7] and silicone [8], viral infection by cytomegalovirus (CMV), a member of herpesviruses family [9, 10], and microchimerism [11], could all play a role in the disease.…”