Connective tissue disease, and breast implants

There have been case-reports of a confirmed diagnosis of systemic sclerosis, rheumatoid arthritis, or systemic lupus erythematosus in patients with silicone breast implants (Silverstein et al., 1992 Sanchez-Guerrero et al., 1994 Cuellar et al., 1995 Field Bridges, 1996). However, no association between silicone breast implants and connective tissue disease has been seen in more than... 

Edworthy SM, Martin L, Barr SG, Birdsell DC, Brant RF, Fritzler MJ (1998) A clinical study of the relationship between silicone breast implants and connective tissue disease. J Rheumatol, 25 254-260. 

Hennekens CH, Lee IM, Cook NR, Hebert PR, Karlson EW, LaMotte F, Manson JE, Buring JE (1996) Self-reported breast implants and connective-tissue diseases in female health professionals. A retrospective cohort study. J Am Med Assoc, 275 616-621. 

Perkins LL, Clark BD, Klein PJ, Cook RR (1995) A meta-analysis of breast implants and connective tissue disease. Ann Plast Surg, 35 561-570. 

CONTROLLED STUDIES EXAMINING THE RELATIONSHIP BETWEEN BREAST IMPLANTS AND CONNECTIVE TISSUE DISEASE. 

In summary, although numerous anecdotal case reports have suggested an association between silicone breast implants and connective tissue diseases, all seven controlled epidemiologic studies conducted to date have failed to confirm such an association. Whether silicone breast implants cause a new and previously undescribed condition is yet to be determined. 

Summary of controlled studies examining the relationship between breast implants (BI) and connective tissue diseases... 

Sanchez-Guerrero, J., Karlson, E.W., Colditz, G.A. et al (1994) Silicone breast implants (SBI) and connective tissue disease (CTD). Arthritis Rheum, 37 (Supplement) S282 (Abstract). 

There is a possible association between silicone breast implants and underlying connective tissue diseases (9,28-30). 

In an evaluation of the frequency and clinical characteristics of the underlying connective tissue disorders associated with silicone breast implants, 300 women with silicone breast implants were studied (45). In addition to a history and physical examination, C reactive protein, rheumatoid factor, and autoantibodies were determined. Criteria for fibromyalgia and/or chronic fatigue syndrome were met by 54% connective tissue diseases were detected in 11% and undifferentiated connective tissue disease or human adjuvant disease in 10.6%. A variety of disorders, such as angioedema, frozen shoulder, and a multiple sclerosis-like syndrome, were also found. Several other miscellaneous conditions, including recurrent and unexplained low grade fever, hair loss, skin rash, symptoms of the sicca sjmdrome, Rajmaud s phenomenon, carpal tunnel syndrome, memory loss, headaches, chest pain, and shortness of breath were also seen. Of 93 patients who underwent explantation, 70% reported improvement in their systemic symptoms. 

Concern about the use of silicone in implants and about its possible toxicity have come to public attention based on reports of a high prevalence of connective tissue disease associated with breast augmentation.Silicone appears to induce a response from polymorphonuclear cells and macrophages that bind small particles of silicone and transport them to lymph nodes, where they can accumulate. Other studies do not support a rheumatological role for sil-icone. Quantification of blood or tissue concentrations " correlates with the presence of implants but not with symptoms of joint disease. 

Gabriel SE, O Fallon WM, Kurland LT, Beard CM, Woods JE, Melton LJ 3rd. Risk of connective-tissue diseases and other disorders after breast implantation. N Engl J Med 1994 330 1697-702. 

Sanchez-Guerrero J, Colditz GA, Karlson EW, Hunter DJ, Speizer FE, Liang MH. Sihcone breast implants and the risk of connective-tissue diseases and symptoms. N Engl J Med 1995 332 1666-70. 

Friis S, Mellemkjaer L, McLaughlin JK, Breiting V, Kjaer SK, Blot W, Olson JH (1997) Connective tissue disease and other rheumatic conditions following breast implants in Denmark. Ann Plast Surg, 39 1-8. 

Nyren O, Yin L, Josefsson S, McLaughlin JK, Blot WJ, Engqvist M, Hakelius L, Boice JD, Adami HO (1998) Risk of connective tissue disease and related disorders among women with breast implants a nation-wide retrospective cohort study in Sweden. Br Med J, 316 417-422. 

Gabriel, S.E., et al. Risk of connective-tissue disease and other disorders after breast implantation. New England Journal of Medicine, 1994, 330, 1697-1702. 

In June of 1994, a population-based retrospective cohort study was published which examined the risk of a variety of connective tissue diseases and other disorders after breast implantation [65]. In this study, all women in Olmsted County, Minnesota who received a breast implant between 1 January 1964 and 31 December 1991 (the case subjects) were studied. For each case subject, two women of the same age (within three years) from the same population who had not received a breast implant and who underwent a medical evaluation within two years of the date of the implantation in the case subject were selected as control subjects. Each woman s complete inpatient and outpatient medical records were interviewed for the occurrence of various connective tissue diseases (i.e., rheumatoid arthritis, systemic lupus erythematosus, Sjogren s syndrome, dermatomyositis, polymyositis, systemic sclerosis, ankylosing spondylitis. 

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