A Prospective Study on Silicone Breast Implants and the Silicone-Related Symptom Complex

Contant, Caroline M. E.; Swaak, A. J. G.; Obdeijn, A.I.M.; Wai, R. Tjong Joe; Geel, A.N. van; Eggermont, Alexander M.M.

doi:10.1007/pl00011221

Cited by 15 publications

(9 citation statements)

References 30 publications

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“…Contant et al [23] prospectively evaluated a cohort of 57 women with silicone-related symptom complex that were seen in an breast cancer centre between March 1995 and March 1997, who presented with sicca symptoms (dry eyes and dry mouth), arthralgias/arthritis, Raynaud’s phenomenon, headache, dizziness, memory difficulties, palpitations, diarrhoea and transpiration.…”

Section: Discussionmentioning

confidence: 99%

Two hundreds cases of ASIA syndrome following silicone implants: a comparative study of 30 years and a review of current literature

et al. 2016

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In this study, we compared one hundred patients with autoimmune/inflammatory syndrome induced by adjuvants (ASIA) due to silicone implant incompatibility syndrome diagnosed in 2014 in Maastricht, the Netherlands, with one hundred historical patients with adjuvant breast disease diagnosed in the Baylor College of Medicine, Houston, USA, between 1985 and 1992. Similarities and differences between these two cohorts were identified to determine whether the spectrum of silicone-related disease changed during the last 30 years. Patients with complaints possibly due to silicone-filled breast implants were prospectively examined in the Reinaert Clinic, Maastricht, the Netherlands between January 2014 and October 2014. All patients were evaluated for the fulfilment of ASIA criteria. Results were compared to results of the Baylor College cohort and 18 other reviewed historical cohorts. Clinical manifestations between the Maastricht and Baylor College cohorts were comparable. Fatigue was observed in 98 current patients and in 95 historical patients. Arthralgia was observed in 91 versus 81 historical patients. Myalgia was observed in 54 versus 91 patients. Cognitive impairment was observed in 78 versus 81 patients, pyrexia was observed in 64 versus 52 patients, sicca complaints in 73 versus 72 patients and severe neurological manifestations in 20 versus 32 patients. From the 54 patients who underwent removal of their silicone breast implant, 50 % (n = 27) of the patients experienced improvement of complaints after explantation of the implant. Also, in the 18 reviewed historical cohorts, similar clinical manifestations were described. Our findings suggest that no major changes were present in the observed clinical manifestations between the Maastricht and Baylor College cohorts. Also, despite changes in the principal constituents of the silicone implants during the past fifty years, silicone remained an adjuvant that may ‘bleed’ and subsequently may be a chronic stimulus to the immune system resulting in similar clinical manifestations as observed in the Maastricht cohort, the Baylor College cohort and 18 other large cohorts of patients. We therefore conclude that silicone-related disease has not changed during the last 30 years.

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Section: Discussionmentioning

confidence: 99%

Two hundreds cases of ASIA syndrome following silicone implants: a comparative study of 30 years and a review of current literature

et al. 2016

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“…We included studies discussing patients with breast implants (silicone- or saline-filled) who reported or presented with silicone-related complaints (Table 1) after insertion of the breast implants and who underwent explantation of the breast implant [4, 6–9]. Studies of all type were included, meaning case reports, case series, case–control studies and descriptive cohort studies.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2016

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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.

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“…Data from a cross-sectional real-world analysis matching woman who underwent silicone breast implants and autoimmune disorders, highlighted an association between this procedure and SS [ 25 ]. In another study the authors found that patients complained more SS-related symptoms at one-year follow-up after breast reconstruction even if there was no correlation with autoantibodies or imaging (magnetic resonance) changes of the implants [ 85 ]. Indeed, in an autoimmune setting, jumping into a patient who has recently undergone breast implant surgery can sporadically occur.…”

Section: Classical Examples Of the Asia Syndromementioning

confidence: 99%

Classical Examples of the Concept of the ASIA Syndrome

et al. 2020

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Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) was first introduced in 2011 by Shoenfeld et al. and encompasses a cluster of related immune mediated diseases, which develop among genetically prone individuals as a result of adjuvant agent exposure. Since the recognition of ASIA syndrome, more than 4400 documented cases have been reported so far, illustrated by heterogeneous clinical manifestations and severity. In this review, five enigmatic conditions, including sarcoidosis, Sjögren’s syndrome, undifferentiated connective tissue disease, silicone implant incompatibility syndrome (SIIS), and immune-related adverse events (irAEs), are defined as classical examples of ASIA. Certainly, these disorders have been described after an adjuvant stimulus (silicone implantation, drugs, infections, metals, vaccines, etc.) among genetically predisposed individuals (mainly the HLA-DRB1 and PTPN22 gene), which induce an hyperstimulation of the immune system resulting in the production of autoantibodies, eventually leading to the development of autoimmune diseases. Circulating autonomic autoantibodies in the sera of patients with silicone breast implants, as well as anatomopathological aspects of small fiber neuropathy in their skin biopsies have been recently described. To our knowledge, these novel insights serve as a common explanation to the non-specific clinical manifestations reported in patients with ASIA, leading to the redefinition of the ASIA syndrome diagnostic criteria.

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A Prospective Study on Silicone Breast Implants and the Silicone-Related Symptom Complex

Cited by 15 publications

References 30 publications

Two hundreds cases of ASIA syndrome following silicone implants: a comparative study of 30 years and a review of current literature

Two hundreds cases of ASIA syndrome following silicone implants: a comparative study of 30 years and a review of current literature

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

Classical Examples of the Concept of the ASIA Syndrome

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