Abstract
The first case of localized scleroderma (morphea) in a 61-year-old female with unilateral rupture 3 years after bilateral saline breast implant augmentation is reported. Erythematous skin eruptions were noted on the anterior trunk and involved breast. The implant was removed and tissue biopsies were performed. On histology, the clinical lesions showed cupuliform depressed plaques with scleroatrophia of the dermis. Extensive fibrosis including caliber and disposition of collagen bundles and lymphocyte and plasma cell infiltrate were present. Intense deposits of C3d and C5b-9 were noted along the dermo-epidermal junction under direct immunoflourescence. Elevated anti-nuclear antibody and C-reactive protein levels returned to normal after implant removal. It was concluded that this localized scleroderma could be related to the silicone capsule of the ruptured saline implant. In spite of the fact that epidemiological studies have not demonstrated a relationship between silicone implants and autoimmune disease, the continual appearance of new cases such as this requires an open attitude and awareness of the possibility. Photographic and histologic case details along with a review of the literature will be presented.
References
Barnard JJ, Todd EL, Wilson WG, Mielcarek R, Rohrich RJ (1997) Distribution of organosilicon polymers in augmentation mammaplasties at autopsy. Plast Reconstr Surg 100(1):197–203, discussion 204-195
Brown SL, Parmentier CM, Woo EK, Vishnuvajjala RL, Headrick ML (1998) Silicone gel breast implant adverse event reports to the Food and Drug Administration, 1984–1995. Public Health Rep 113(6):535–543
Cohen SB, Rohrich RJ (1994) Evaluation of the patient with silicone gel breast implants and rheumatic complaints. Plast Reconstr Surg 94(1):120–125
Nyren O, Yin L, Josefsson S et al (1998) Risk of connective tissue disease and related disorders among women with breast implants: a nation-wide retrospective cohort study in Sweden. BMJ 316(7129):417–422
Rohrich RJ, Clark CP 3rd (1993) Controversy over the silicone gel breast implant: current status and clinical implications. Tex Med 89(9):52–58
Angell M (1996) Shattuck lecture—evaluating the health risks of breast implants: the interplay of medical science, the law, and public opinion. N Engl J Med 334(23):1513–1518
Bridges AJ (1995) Rheumatic disorders in patients with silicone implants: a critical review. J Biomater Sci Polym Ed 7(2):147–157
Schnur PL, Weinzweig J, Harris JB et al (1996) Silicon analysis of breast and periprosthetic capsular tissue from patients with saline or silicone gel breast implants. Plast Reconstr Surg 98(5):798–803
Mentor. Saline breast implants for breast augmentation surgery—Mentor manufacturers shaped breast implants, round breast implants, and adjustable breast implants. 2009; http://www.mentorcorp.com/breastsurgery/augmentation/augmentation_products.htm. Accessed December 28, 2009.
Weinzweig J, Schnur PL, McConnell JP et al (1998) Silicon analysis of breast and capsular tissue from patients with saline or silicone gel breast implants: II. Correlation with connective-tissue disease. Plast Reconstr Surg 101(7):1836–1841
Endo LP, Edwards NL, Longley S, Corman LC, Panush RS (1987) Silicone and rheumatic diseases. Semin Arthritis Rheum 17(2):112–118
Lazar AP, Lazar P (1991) Localized morphea after silicone gel breast implantation: more evidence for a cause-and-effect relationship. Arch Dermatol 127(2):263
Di Lorenzo G, Mansueto P, Melluso M et al (1997) Morphea after silicone gel breast implantation for cosmetic reasons in an HLA-B8, DR3-positive woman. Int Arch Allergy Immunol 112(1):93–95
Marik PE, Kark AL, Zambakides A (1990) Scleroderma after silicone augmentation mammoplasty. A report of 2 cases. S Afr Med J 77(4):212–213
Jankauskas S (1989) Scleroderma after silicone augmentation mammaplasty: is there a causative relationship? Plast Reconstr Surg 83(1):198
Montalto M, Vastola M, Santoro L et al (2004) Systemic inflammatory diseases and silicone breast prostheses: report of a case of adult still disease and review of the literature. Am J Med Sci 327(2):102–104
Sanchez-Guerrero J, Colditz GA, Karlson EW, Hunter DJ, Speizer FE, Liang MH (1995) Silicone breast implants and the risk of connective-tissue diseases and symptoms. N Engl J Med 332(25):1666–1670
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hoppe, I.C., Trovato, M.J. & Rauscher, G.E. Case report: localized scleroderma of the breast after saline implant rupture. Eur J Plast Surg 34, 127–130 (2011). https://doi.org/10.1007/s00238-010-0447-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00238-010-0447-z