Summary
Three hundred consecutive women with silicone breast implants (SBI), referred to the arthritis clinic with a variety of musculoskeletal complaints, were evaluated for the presence of underlying connective tissue disease. A complete history and physical examination were performed, as well as laboratory testing for C-reactive protein, rheumatoid factor, and autoantibody determination by indirect immunofluorescence and immunodiffusion. The group mean age was 44.4 years (range 25–69), the mean time from initial implant surgery to appearance of symptoms was 6.8 years (range: 6m−19y) and 83.3% of women studied had clinical manifestations highly suggestive of an underlying connective tissue disorder. Fifty-four percent met criteria for fibromyalgia and/or chronic fatigue syndrome, distinct connective tissue diseases was detected in 11%, undifferentiated connective tissue disease or human adjuvant disease was found in 10.6%, and a variety of disorders such as angioneurotic oedema, frozen shoulder, multiple sclerosis-like syndorome were present. Several other miscellaneous conditions including recurrent and unexplained low grade fever, hair loss, skin rash, sicca symptoms, Raynaud's phenomenon, carpal tunnel syndrome, memory loss, headaches, chest pain, and shortness of breathe were also seen accompanying specific and non-specific lconditions. Seventy percent of patients who underwent explantation of the implants reported improvement of their systemic symptomatology. A significant proportion of SBI patients referred for rheumatic evaluation have clinical manifestations highly suggestive of an underlying connective tissue disease. Furthermore, improvement of their symptomatology follows explantation of the implants in over half of the patients.
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Miyoshi, K., Miyamura, T., Kobayashi, T., et al. Hypergammaglobulinemia by prolonged adjuvaticity in men: Disorders developed after augmentation mammaplasty. J Keio Soc 1964, 2122, 9–14.
Miyoshi, K., Shiragami, H., Yoshida, K. Adjuvant disease of man. Clin Immunol 1973, 5, 785–794.
Kumagai, Y., Shiokawa, Y., Medsger, T.A., Rodnan, G.P. Clinical spectrum of connective tissue disease after cosmetic surgery. Arthritis Rheum 1979, 27, 1–12.
Brozena, S.J., Fenske, N.A., Cruse, W., Espinoza, C.G., Vasey, F.B., Germain, B.F., Espinoza, L.R. Human adjuvant disease following augmentation mammaplasty. Arch Dermatol 1988, 124, 1383–1386.
Spiera, H., Kerr, L.D. Scleroderma following silicone implantation: Accumulative experience of 11 cases. J Rheum 1993, 20, 958–961.
Gutierrez, F.J., Espinoza, L.R. Progressive systemic sclerosis complicated by severe hypertension: Reversal after silicone implant removal. Am J Med 1990, 89, 390–392.
Endo, L.P., Lawrence, E.N., Longley, S., Corman, L.C., Panush, R.S. Silicone and rheumatic diseases. Semin Arthritis Rheum 1987, 17, 112–118.
Walsh, F., Solomon, D., Espinoza, L., Glenn, A., Whitelocke, H. Human adjuvant disease. A new cause of chylous effusions. Arch Intern Med 1989, 149, 1194–1196.
Byron, M.A., Venning, A., Mowat, A.G. Post-mammaplasty human adjuvant disease. Br J Rheum 1984, 23, 227–229.
Varga, J., Schumacher, H.R., Jimènez, S.A. Systemic sclerosis after augmentation mammaplasty with silicone implants. Ann Intern Med 1989, 111, 377–383.
Press, R.I., Peebles, C.L., Kumagai, Y., Ochs, R.L., Tan, E.M. Antinuclear autoantibodies in women with silicone breast implants. 1992, 340, 1304–1307.
Bridges, A.J., Conley, C., Wang, G., Burnes, D.E., Vasey, F.B. A clinical and immunologic evaluation of women with slicone breast implants and symptoms of rheumatic disease. 1993, 118, 929–936
Van Nunen, S., Gatemby, P., Basten, A. Post-mammaplasty connective tissue disease. Arthritis Rheum 1982, 25, 694–697.
Tan, E.M., Cohen, A.S., Fries, J.F. et al. The 1982 revised criteria for the classification of systemic lupus erythematous. Arthritis Rheum 1982, 25, 1271–1277.
Masi, A.T., Rodman, G.P., Medsger, T.A., Jr., et al. Preliminary criteria for the classification of systemic sceerosis (scleroderma). Arthritis Rheum 1980, 23, 581–590.
Wolfe, F., Smythe, H.A., Yunnus, M.B., et al., The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990, 33, 160–172.
Arnett, F.C., Edworthy, S.M., Bloch, D.A., et al. The American Rheumatism Association 1987 Revised Criteria for the Classification of Rheumatoid Arthritis. Arthritis Rheum 1988, 31, 315–324.
Miyoshi, K. Myaoka, T., Kobayashi, Y., Itakura, T., et al. Hypergammaglobulinelmia by prolonged adjuvanticity in man: Disorders developed after augmentation mammaplast. Igishimpo 1964, 2122, 9–14.
Borenstein, D. Siliconosis: A spectrum of illness. Sem Arthritis Rheum 1994, 24 (Suppl 1), 1–7.
Vasey, F.B., Havice, D.L., Bocanegra, T.S., et al. Clinical findings in symptomatic women with silicone breast implants. Sem Arthritis Rheum 1994, 24, (Suppl 1), 22–28.
Solomon, G. A clinical and laboratory profile of symptomatic women with silicone breast implants. Sem Arthritis Rheum 1994, 24 (Suppl 1), 29–37.
Freundlich, B., Altman, C., Sandorfi, N., et al. A profile of symptomatic patients with silicone breast implants: A Sjögren's-like syndrome. Sem Arthritis Rheum 1994, 24 (Suppl 1), 44–53.
Ostermeyer Shoaib, B., Patten, B., Calkins, D.S. Adjuvant breast disease: An evaluation of 100 symptomatic women with breast implants or silicone fluid injections. Keio J Med 1994, 43, 79–87.
Gabriel, S.E., O'Fallon, W.M., Kurland, L.T. et al. Risk of connective-tissue disease and other disorders after breast implantation. N Engl J Med 1994, 330, 1697–1702.
Solomon, G., Espinoza, L.R., Silverman, S. Breast implants and connective-tissue diseases. N Engl J Med 1994, 331, 1231.
Spiera, R.F., Gibofsky, A., Spiera, H. Breast implants and connective-tissue diseases. N Engl J Med 1994, 331, 1232.
Wallace, D., Schwartz, E. Breast implants and connective-tissue diseases. N Engl J Med 1994, 331, 1232–1233.
Lu, L.B., Ostermeyer Shoaib, B., Patten, B. Atypical chest pain syndrome in patients with breast implants. South Med J 1994,. 87, 978–984.
Cuellar, M.L., Scopelitis, E., Tenenbaum, S. et al. Serum antinuclear antibodies in women with silicopne breast implants. J Rheumatol 1995, 22, 236–240.
Fritzler, M.J., Pauls, J.D., Kinsella, T.D., Bowen, T.J. Antinuclear anticytoplasmic, and anti-Sjögren's syndrome antigen A (SS-A.Ro) antibodies in female blood donors. Clin Immunol Immunopathol 1985, 36, 120–128.
Naim, J.O., Lanzafame, R.J., Van Oss, C.J. The adjuvant effect of silicone-gel on antibody formation in rats. Immunol Invest 1993, 22, 151–161.
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Cuellar, M.L., Gluck, O., Molina, J.F. et al. Silicone breast implant — Associated musculoskeletal manifestations. Clin Rheumatol 14, 667–672 (1995). https://doi.org/10.1007/BF02207934
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DOI: https://doi.org/10.1007/BF02207934