Silicone breast prosthesis and rheumatic disease 4/5 (6)

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Silicone and rheumatic disease

MRI shows damaged silicone prosthesis to the left of the image. Baek WY, Arch Plast Surg, X. CC BY-NC 3.0

Silicone breast prosthesis and rheumatic disease

Breast prostheses with silicone have for about 30 years been suspected of causing systemic connective tissue disease or trigger the "Rheumatoid arthritis" (antibody), "Breast Implant Illness". This has not gone unnoticed. In recent years no other medical implants have been studied more thoroughly than silicone-containing breast prostheses. There are now results from major studies with more than ten years of follow-up. The results answer different questions about cosmetic breast prothesis with silicone, although there is still disagreement within the medical community (see ASIA syndromes):

Are silicone breast prostheses associated with special Systemic connective tissue diseases:?

Several methodological good studies have been made and summaries for more diagnoses. These include (dermato) myositis, Systemic sclerosis, Sjögren's syndrome og Rheumatoid arthritis (RA). Most studies suggest in the same direction: No safe relationship between the silicone prostheses and the development of these systemic connective tissue disease.

  • A large study from 2018, however, showed that women with silicone breast prostheses develop more autoimmune diseases, especially Sjøgren's syndrome, Systemic sclerosis or Sarcoidosis (reference: Watad A, 2018). Disease risk was 1,5-2 increased, but since these are rare diseases, the incidence remains low. The vast majority of silicone implants do not receive autoimmune, rheumatic disease.
  • Two other major studies do not demonstrate such a connection: Sanches-Guerrero J and employees published in 1995 in the well-known NEJM. Data from 87.501 nurses in the United States that were then healthy were followed up on average 9,9 years. Rheumatic connective tissue disease developed during this time at 516 of these. At the same time, 876 women in the study had received silicone breast prostheses. After calculating risk, the authors concluded that they did not demonstrate association between silicone breast prostheses and rheumatic connective tissue disease. Balk EM and co-workers published in 2016 in the Annals of Internal Medicine a review of 32's previously published studies on the long-term health outcomes of women with silicone breast implants. The author's conclusion, despite so many studies, was that it was not possible to conclude anything certain.

Silicone implants can increase the risk of activating pre-existing ones Autoimmune disease. Caution is advised if rheumatic disease is present or one has a known disposition for autoimmune diseases

Is there an increased risk of unspecified (undefined) systemic connective tissue disease?

  • The studies do not indicate such a connection, but autoimmune conditions may be slightly increased

Is leakage from silicone prostheses (cracked breast prostheses) associated with systemic connective tissue disease?

  • The studies show that the occurrence of connective tissue disease was not different from those who had no injured silicone breast prostheses
  • This despite the fact that the manufacturer Dow Corning had to pay huge amounts of compensation, which led to bankruptcy
  • However, traces of silicone in liver have been found, which may be a potential health problem in itself

Occurs Fibromyalgia more often after insertion of silicone prostheses?

  • Large studies show no increased occurrence of Fibromyalgia after silicone dentures

Occurs abnormal Antibodies after insertion of silicone prostheses?

  • One has tested blood for, among others, ANA, rheumatoid factors, cardiolipin antibody and silicate antibody in various studies without associations being found

Are newer breast implants safer than before?

  • Yes, prostheses are now made to hold better, and silicone leakage is less frequent (reference: Baek WY, 2014)

Can Restylane and other fillers other than silicone cause rheumatic disease?

Summary

Extensive studies do not prove that silicone prostheses cause systemic connective tissue disease, Rheumatoid arthritis (RA), Fibromyalgia or elevated Antibodies in blood tests.

  • However, a large study suggests that autoimmune is more common in women with such breast implants.
  • Caution is especially recommended in known rheumatic diseases, which also applies to Restylane and other substances injected.

Missed questions

Is having silicone-containing breast prostheses associated with an increased risk of relapse in a known rheumatic disease?

  • Until good studies are available, one should reason:
    • Women with silicone breast implants have an increased incidence (up to 1,5-2 times increased risk) of autoimmune rheumatic diseases
    • However, all physical (and mental) interventions can "trigger" the immune system. Theoretically, autoimmune systemic connective tissue disease can flare up even if silicone itself is not the cause
    • Fibromyalgia is characterized by generalized pain. Often small damage causes greater deterioration than expected. Surgical procedures of any kind can thus exacerbate the condition.
    • The conclusion may be that the indication of silicone prostheses must be weighed against the potential risk of increased complaints from the rheumatic disease. Rheumatologist and GP will be able to contribute individual advice

Can some people get sick of silicone prosthesis without being registeret in the medical studies?

  • Yes, it cannot be ruled out. Studies are based on an average of many cases. The individual with a particular genetic predisposition, pre-existing illness or hypersensitivity may react differently than the majority and average in research studies.
  • Therefore, a thorough medical examination prior to breast implant implantation is recommended.

Breast prothesis of silicone and risk of cancer

  • Recent data indicate that a rare type of cancer, anaplastic large cell lymphoma (BIA-ALCL), occurs more frequently after implanted silicone breasts. The complication nevertheless affects very few. The median time before the cancer was detected was 9 years (Reference Berlin E, 2018).

Literature


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