EDITORIAL ESPANOL:

====================

Hola amigos del DERMA CYBER, DERMAGIC con ustedes de nuevo. El tema bastante interesante, IMPLANTES MAMARIOS, LA PIEL Y LA SALUD. Los senos, grandes o pequeños siempre generan una opinión. La mujer de hoy dia por cuestiones de estética, recurre a los implantes para mejorar su figura, están muy de moda hoy dia les senos exuberantes. En otros casos se recurre al implante luego de extirpación de lesiones en ellos. Lo cierto del caso es que todavía se discute su efecto nocivo para el cuerpo. Estas 38 referencias nos hablan de los pro y contra de estos implantes, espero que las disfruten.. los senos seguirán dando que hablar por mucho tiempo...!!! 

Nos veremos en la red en una nueva oportunidad !!!

Saludos,,,

Dr. José Lapenta R.,,,

 EDITORIAL ENGLISH:

===================

Hello friends of the DERMA CYBER, DERMAGIC with you again. The quite interesting topic, BREAST IMPLANTS, THE SKIN AND HEALTH. The breasts, big or small they always generate an opinion. The woman of nowadays for aesthetics questions, decides to implant them to improve their figure, they are very in fashion nowadays the exuberant breasts. In other cases it is used the implants after extirpation of lesions in them. The certain of the case is that today many people still discusses their noxious effect for the body. These 38 references speak us the pro and cons of these implant, I hope you enjoy them.. The breasts will continue giving to speak for a lot of time...!!!

We will see in the net in a new opportunity !!!

Greetings,,,

Dr. José Lapenta R. 

======================================================================

DERMAGIC/EXPRESS(47)

======================================================================

IMPLANTES MAMARIOS, LA PIEL Y LA SALUD 

BREAST IMPLANTS, THE SKIN AND HEALTH 

======================================================================

0.) Sézary syndrome following rupture of silicone gel breast prosthesis

1.) Carcinogenic potential of silicone breast implants: a Connecticut

statewide study.

2.) Cutaneous T-cell lymphoma in association with silicone breast implants. 

3.) Atypical chest pain syndrome in patients with breast implants. 

4.) Serum antinuclear antibodies in women with silicone breast implants

[see comments] 

5.) Silicone gel filled breast implants and connective tissue disease: an

overview [see comments] 

6.) Silicone breast implant-associated scarring dystrophy of the arm. 

7.) Sclerodermalike esophageal disease in children breast-fed by mothers

with silicone breast implants [see comments] 

8.) Breast augmentation: a risk factor for breast cancer? [see comments] 

9.) Clinical and laboratory features of patients with scleroderma and

silicone implants.

10.) A clinical and immunologic evaluation of women with silicone breast

implants and symptoms of rheumatic disease [see comments].

11.) Systemic sclerosis after augmentation mammoplasty with silicone

implants. [Review]

12.) Antinuclear autoantibodies in women with silicone breast implants.

13.) Antibodies to silicone elastomers and reactions to

ventriculoperitoneal shunts. 

14.) Outcome study of the psychological changes after silicone breast

implant removal.

15.) [Hashimoto's thyroiditis and silicone breast implants: 2 cases]

16.) Cellular immune reactivities in women with silicone breast implants: a

preliminary 

investigation [see comments]

17.) Unusual masses found within ruptured silicone gel breast prostheses.

18.) Silicone breast implants: pathology.

19.) Capsular contracture with textured versus smooth saline-filled

implants for breast 

augmentation: a prospective clinical study.

20.) Lymphocyte response to silica among offspring of silicone breast implant 

recipients.

21.) Ruptured or intact: what can linear echoes within silicone breast

implants tell us?

22.) Inflammatory reaction and capsular contracture around smooth silicone

implants.

23.) Breast implantation and the incidence of upper extremity somatic

complaints.

24.) A review of the possible health implications of silicone breast implants.

25.) [The value of sonography for the discovery of complications after the

implantation of silicone gel prostheses for breast augmentation or

reconstruction]

26.) Explantation of silicone breast implants.

27.) Neurosarcoidosis following augmentation mammoplasty with silicone.

28.) Are breast implants anticarcinogenic? A 14-year follow-up of the Los

Angeles Study.

29.) [Silicone breast implants and breast cancer]

30.) Lack of evidence of systemic inflammatory rheumatic disorders in

symptomatic women 

with breast implants.

31.) Breast implants in patients with differentiated and undifferentiated

connective 

tissue disease.

32.) Epidemiology of systemic sclerosis.

33.) Use of antipolymer antibody assay in recipients of silicone breast

implants.

34.) Complications leading to surgery after breast implantation [see comments]

35.) Silicone gel and octamethylcyclotetrasiloxane (D4) enhances antibody

production to 

bovine serum albumin in mice.

36.) Visualization of silicone gel in human breast tissue using new

infrared imaging 

spectroscopy.

37.) The epidemiology of scleroderma among women: assessment of risk from

exposure to 

silicone and silica.

========================================================================

========================================================================

0.) Sézary syndrome following rupture of silicone gel breast pro sthesis

========================================================================

Author: A. ledo, E. Sendagorta

Department of Dermatology Hospital »Ramón y Cajal«, Madrid, Spain

Case report.

A 48-year-old women underwent augmentation mammoplasty with silicone gel

prosthesis in February 1980. Three months later she developed scaling of

the palms and soles. This per-sisted until she progressively developed a

generalized pruritic, erythematous, scaly eruption in March 1983, when we

first studied this patient (Fig. 1). Physical ex-amination also showed

onychodystrophy and left axillary and bilateral inguinal nodes. There was

no evidence of hepato-splenomegaly. Breast implants were re-moved 3 months

later because of a sus-pected inflammatory reaction to the

silicone. The left implant was found to be ruptured; poorly encapsulated

gel was re-moved by sacrificing surrounding breast tissue. It was

impossible to determine if ah extravasated gel had been removed. A complete

work-up for erythroderma was done. The peripheral blood smear showed Sézary

celís from 1 to 4%; the total leuko-cyte count varying from 12,500 to

17,000/ mm3. Several skin biopsies showed only non-specific dermal

inflammation (Fig. 2). Bone marrow smear was normal. A biopsy

Fig. 1. Generalized erythroderma with edema and scaling of the skin.

Fig. 2. 5km biopsy showing nonspecific dermal inflammation. H & E x5()

(See the attach)

from a right inguinal node was diagnostic of dermatopathic lymphadenopathy.

De-layed hypersensitivity skin test were alí negative

Pre-Sézary erythroderma was diag-nosed, and treatment was started with

topical steroids with modest improvement. In September 1985 the

erythroderma be-come more severe but with no change in general status. The

absolute Sézary celí count was 3,552/mm3 at that time. A skin biopsy had

some features suggestive but not diagnostic of cutaneous T-cell lympho-ma.

A diagnosis of Sézary syndrome was made and therapy was started with 4 mg/

day chlorambucil and 20 mg/day of oral prednisone. Within the last 6 months

the Sézary celí counts have been substantially reduced with this combined

therapy.

Comment. Early forms of cosmetic breast augmentation surgery involved the

direct injection of liquid silicone into the breasts, often causing an

intense local inflammatory reaction (1). Although the advent of elastomeric

silicone envelope prosthesis reduced this severe reaction, it is well known

that silicone particles can still get from such implants into the

surrounding tissues and to regional lymph nodes (2) with resultant

inflammatory reactions. Silicone is a potentially antigenic material, and 2

cases of contact dermatitis to silicone have been described in the

literature (3, 4). Silicone may also provoke an autoimmune response by

conversion to silica, a substance known to exert pro-found effects on the

imifiune system. A variety of autoimmune diseases has been described in

association with cosmetic surgery, including progressive systemic

sclerosis, systemic lupus erythematosus, rheumatoid arthritis, thyroiditis,

Sjógren's syndrome and morphea (5). Digby and Wells (6) reported a case of

malignant lymphoma developing in a regional lymph node 9 years after

insertion of silicone finger prosthesis. They also cited a similar case

that had been brought to their notice but not reported. Benjamin et al. (7)

have

also described one patient with silicone lymphadenopathy with concomitant

malig-nant lymphoma following rupture of silas-tic joint implants.

That chronic stimulation of the immune system may lead to tumour formation

has been known for years. Tan et al. (8) suggested that mycosis fungoides

repre-sents a chronic granulomatous response to persistent unidentified

antigen. Epidemiologic observations have found that the incidence of prior

allergic condi-tions such as contact allergy, urticaria and drug allergy,

is notably increased in pa-tients with mycosis fungoides. Buechner and

Winkelmann (9) have recently de-scribed 7 patients with pre-Sézary

ery-throderma evolving to Sézary syndrome; interestingly, these patients

had a history of multiple allergic reactions.

We believe that the present case repre-sents a model of chronic lymphoid

stimula-tion that progressed from an inflammatory (pre-Sézary erythroderma)

to a prolifera-tive (Sézary syndrome) stage. Although an association

between the development of Sézary syndrome and the inflammatory reaction to

the silicone is not positively established, we would like to draw

atten-tion to the need for awareness of possible complications whenever

foreign materials are implanted into the body.

========================================================================

1.) Carcinogenic potential of silicone breast implants: a Connecticut

statewide study.

========================================================================

Kern KA; Flannery JT; Kuehn PG

Department of Surgery, Hartford Hospital, Connecticut, USA.

Plast Reconstr Surg (UNITED STATES) Sep 1997 100 (3) p737-47;

discussion 748-9

ISSN: 0032-1052

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9711

Subfile: AIM; INDEX MEDICUS

To clarify the carcinogenic potential of silicone breast implants, 680

implant 

procedures performed on women in Connecticut with no prior history of

cancer were 

correlated with the subsequent development of primary breast and nonbreast

cancers. 

Neoplastic events after the placement of silicone breast implants during

the 13-year 

interval from October 1, 1980, through September 30, 1993, were quantified

using a 

retrospective, linked-registry method. ICD-9-CM discharge codes contained

in the Uni 

formed Hospital Discharge Data Sets (UHDDS) from 34 hospitals across

Connecticut were 

linked to procedure codes for unilateral and bilateral implants, and to

medical 

histories for new malignancies after the implant procedures. Data were

cross-linked 

to the Connecticut Tumor Registry to confirm the clinical history of each

cancer. 

The rates of breast and nonbreast cancers in patients with silicone breast

implants 

were compared with those of a control population drawn from the UHDDS of

1022 women 

undergoing sterilization by tubal ligation between 1981 to 1985. Ages

(mean +/- SD) 

were similar in the implant group (34 +/- 10 years) and in the

sterilization group 

(32 +/- 6 years). The mean follow-up in the implant group (4.6 years) was

also 

similar to that of the control group (5.4 years). Compared with the

control group, 

the implant group demonstrated lower rates of breast cancer (0.59 versus 0.88 

percent, p = 0.35) and nonbreast cancer (0.59 versus 2.7 percent, p =

0.001). 

Correspondingly, the implant group had a lower relative risk of breast cancer 

(relative risk = 0.67, 95 percent, confidence interval = 0.20 to 2.17) and

nonbreast 

cancer (relative risk = 0.21, 95 percent, confidence interval = 0.07 to

0.60). Based 

on these data, it was concluded that silicone breast implants are not

carcinogenic, 

because they are not associated with increased rates of either breast or

nonbreast 

cancers. The validity and threats to the conclusions are discussed, and

the results 

are placed into context with similar findings from other studies.

========================================================================

2.) Cutaneous T-cell lymphoma in association with silicone breast implants. 

========================================================================

ARTICLE SOURCE: J Am Acad Dermatol (United States), Jun 1995, 32(6) p939-42 

AUTHOR(S): Duvic M; Moore D; Menter A; Vonderheid EC 

PUBLICATION TYPE: JOURNAL ARTICLE 

ABSTRACT: BACKGROUND: Cutaneous T-cell lymphoma (CTCL) is a chronic

malignancy of helper T cells with the CD4 phenotype. It occurs less

frequently in young women but is increasing in incidence for unknown

reasons. Silicone breast implants have been associated with T-cell-mediated

autoimmune reactions. OBJECTIVE: Our purpose was to suggest the hypothesis

that CTCL may arise after breast implants and that different patients with

CTCL may be stimulated by different antigens. METHODS: Investigators with

many patients with CTCL were queried regarding the occurrence of CTCL in

women after breast implants. RESULTS: Three cases of confirmed CTCL after

breast implants were identified and are reported. In one patient with

Sezary syndrome and CTCL, the disease went into remission after removal of

implants, resolution of chronic staphylococcal infection, and initiation of

photopheresis and interferon alfa therapy. Another patient had progressive

disease. CONCLUSION: CTCL may occur in association with breast implants in

young female patients, but causality is unknown. If CTCL is antigen driven,

then it is likely to result from several different antigens in different

groups of patients. 

========================================================================

3.) Atypical chest pain syndrome in patients with breast implants. 

========================================================================

ARTICLE SOURCE: South Med J (United States), Oct 1994, 87(10) p978-84 

AUTHOR(S): Lu LB; Shoaib BO; Patten BM 

PUBLICATION TYPE: JOURNAL ARTICLE 

ABSTRACT: Eleven patients, aged 36 to 55 years, with silicone breast

implants had episodes of severe chest pain similar to heart attacks 6 weeks

to 7 years after breast implantation; one patient had a severe attack 1

month after explantation. The chest pain, which was not related to physical

exertion, lasted from 15 minutes to 4 days, and descriptions of it varied

from a "pressing" type of pain to "stabbing" pain with radiation to the

shoulders, left arm, and jaw. The associated symptoms were diaphoresis,

nausea, vomiting, dyspnea, and palpitations. All of the patients had a

normal electrocardiogram (ECG) with the exception of one, whose ECG showed

nonspecific ST changes. Ten had cardiac evaluations, all of which yielded

normal results. All had implant removal, and five were found to have at

least one ruptured implant. Nine had an implant capsule biopsy; all had

chronic inflammatory rinds, and five had free silicone in tissue whether or

not the implants were ruptured. All eight who had a pectoralis major muscle

biopsy had abnormal results: (neurogenic atrophy [six], fasciitis [three],

myositis [one], chronic inflammation [one], free silicone [one], and

neuroma [one]). We concluded that silicone breast implants may cause an

atypical chest pain syndrome, probably due to local inflammatory reactions

and neuroma formation. 

========================================================================

4.) Serum antinuclear antibodies in women with silicone breast implants

[see comments] 

========================================================================

COMMENTS: Comment in: J Rheumatol 1995 Feb; 22(2):198-200 

ARTICLE SOURCE: J Rheumatol (Canada), Feb 1995, 22(2) p236-40 

AUTHOR(S): Cuellar ML; Scopelitis E; Tenenbaum SA; Garry RF; Silveira LH;

Cabrera G; Espinoza LR 

PUBLICATION TYPE: JOURNAL ARTICLE 

ABSTRACT: OBJECTIVE. Recent evidence suggests that immunologic

abnormalities are not uncommon in individuals with silicone breast

implants. The purpose of our study was to evaluate in a consecutive manner,

the prevalence of autoimmunity as assessed by the presence of antinuclear

antibodies in a larger number of patients with silicone breast implants.

METHODS. Antinuclear antibody (ANA) testing using an indirect

immunofluorescence technique was performed on 813 individuals with silicone

breast implants. All subjects except for 3 transsexual males, were female.

The overwhelming majority, over 99%, were white. The average age of the

subjects was 46.2, with a range of 17 to 72 years. RESULTS. ANA positivity

was found in 244 of 813 individuals (30%) using a mouse kidney substrate;

and in 470 of 813 (57.8%) using a HEp-2 cell line. The most common

immunofluorescent pattern found using HEp-2 was speckled, present in 341

(72.5%) individuals, followed by homogeneous pattern in 113 (24%),

nucleolar in 63 (13.4%), and 5 (1.06%) were anticentromere. Anti-dsDNA

antibodies measured by an ELISA assay were found in 6 of 71 patients (8%).

Rheumatoid factor and C-reactive protein were found above healthy controls

in less than 10% of cases studied. The high prevalence of ANA found in

patients with silicone breast implants agrees with similar observations by

others. The finding of anticentromere and nucleolar patterns has great

interest and relevance. These fairly distinct ANA patterns are most

commonly seen in the idiopathic form of scleroderma and related conditions.

CONCLUSION. These findings suggest that ANA positivity is relatively common

in individuals with silicone breast implants, and may support the existence

of autoimmune mechanisms in the pathogenesis of the clinical manifestations

seen in this population. 

========================================================================

5.) Silicone gel filled breast implants and connective tissue disease: an

overview [see comments] 

========================================================================

COMMENTS: Comment in: J Rheumatol 1994 Oct; 21(10):1979-80 

ARTICLE SOURCE: J Rheumatol (Canada), Feb 1994, 21(2) p239-45 

AUTHOR(S): Spiera RF; Gibofsky A; Spiera H 

PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (79 references); REVIEW, TUTORIAL 

ABSTRACT: OBJECTIVE. To review the literature examining the association of

silicone gel filled implants and connective tissue disease. METHODS.

Computerized literature searches and manual review of bibliographies.

RESULTS. Numerous concerns have arisen regarding the safety of silicone gel

filled breast implants. The structure of these prostheses is reviewed.

Silicones are not biologically inert. Injectable as well as implantable

silicones have proven capable of eliciting inflammatory and

fibroproliferative responses. Silicone leakage from silicone gel filled

implants is well documented as is distant migration of silicone in the

host. In the past decade, over 60 cases of connective tissue disease

following mammoplasty with silicone gel filled implants have been reported.

About half of these patients developed scleroderma or scleroderma-like

illnesses. This reported overrepresentation of scleroderma compared to

other rheumatic diseases mimics the Japanese experience with injectable

silicones. Possible biological rationale for the association is presented.

CONCLUSION. The physical and biological properties of silicone gel filled

implants and their behavior in vivo is compatible with the hypothesis that

they may contribute to the development of connective tissue disease. The

association seems most likely with scleroderma; however, there is as yet

inadequate epidemiological data to definitively establish causality. 

========================================================================

6.) Silicone breast implant-associated scarring dystrophy of the arm. 

========================================================================

ARTICLE SOURCE: Arch Dermatol (United States), Jan 1995, 131(1) p54-6 

AUTHOR(S): Teuber SS; Ito LK; Anderson M; Gershwin ME 

PUBLICATION TYPE: JOURNAL ARTICLE 

ABSTRACT: BACKGROUND: Breast implants have been known to rupture after

trauma or closed capsulotomy with spread of the gel down the arm or

abdominal wall. Nodular foreign-body granulomatous reactions have been

reported in these cases. We report the unique occurrence of significant

overlying scarring and ulceration following silicone gel migration down the

affected arm. OBSERVATIONS: A 47-year-old woman experienced rupture of her

right silicone gel implant with migration of the silicone down her arm 10

years before our examination. Skin changes with atrophic hidebound scarring

and ulceration slowly progressed over the last 7 years. Radiographs and

magnetic resonance imaging scans demonstrated material consistent with

silicone in the soft tissues. CONCLUSIONS: Silicone is not an inert

substance and can rarely result in devastating local tissue destruction

where migration has occurred. The possibility of significant silicone gel

migration should be considered during evaluation of patients with ruptured

implants. 

========================================================================

7.) Sclerodermalike esophageal disease in children breast-fed by mothers

with silicone breast implants [see comments] [published erratum appears 

in JAMA 1994 Sep 14; 272(10):770] 

========================================================================

ARTICLE SOURCE: JAMA (United States), Jan 19 1994, 271(3) p213-6 

AUTHOR(S): Levine JJ; Ilowite NT 

PUBLICATION TYPE: JOURNAL ARTICLE 

ABSTRACT: OBJECTIVE--To determine whether breast-fed children of mothers

with silicone implants are at increased risk for the development of

sclerodermalike esophageal involvement compared with children not exposed

to silicone implants. DESIGN--Case-series [corrected].

SETTING--Referral-based pediatric gastroenterology clinic. PATIENTS--Eleven

children (mean age, 6.0 years; range, 1.5 to 13 years; six boys and five

girls) referred for abdominal pain who were born to mothers who had

silicone breast implants (eight breast-fed children and three bottle-fed)

were compared with 17 patients (mean age, 10.7 years; range, 2 to 18 years;

11 boys and six girls) with abdominal pain who were not exposed to silicone

implants. METHODS--All children underwent esophageal manometry and upper

intestinal endoscopy with esophageal biopsy and were tested for antinuclear

antibody and autoantibodies to Scl-70, centromere, ribonucleoprotein, Sm,

Ro, La, and phospholipid. RESULTS--Six of the eight breast-fed children

from mothers with silicone implants had significantly abnormal esophageal

motility with nearly absent peristalsis in the distal two thirds of the

esophagus and decreased lower sphincter pressure. Upper esophageal

pressures and motility were normal. Compared with controls, the breast-fed

children had significantly decreased lower sphincter pressure and abnormal

esophageal wave propagation. These manometric abnormalities were not seen

in the three bottle-fed children. There was no difference in the expression

of autoantibodies in the breast-fed children compared with the bottle-fed

children or controls. CONCLUSIONS--A relationship appears to exist between

breast-feeding by mothers with silicone implants and abnormal esophageal

motility. Studies evaluating larger numbers of children are needed to

determine the extent of the risk. 

========================================================================

8.) Breast augmentation: a risk factor for breast cancer? [see comments] 

========================================================================

ARTICLE SOURCE: N Engl J Med (United States), Jun 18 1992, 326(25) p1649-53 

AUTHOR(S): Berkel H; Birdsell DC; Jenkins H 

PUBLICATION TYPE: JOURNAL ARTICLE 

ABSTRACT: BACKGROUND. A relation between breast augmentation and the

subsequent risk of breast cancer has been postulated. Since an estimated 2

million women in the United States alone have received breast implants,

even a small increase in the risk of breast cancer could have considerable

public health consequences. METHODS. We performed a population-based

nonconcurrent cohort-linkage study. All women in Alberta, Canada, who

underwent cosmetic breast augmentation from 1973 through 1986 were included

in the implant cohort (n = 11,676). This cohort was compared with the

cohort of all women in Alberta in whom a first primary breast cancer was

diagnosed (n = 13,557). The expected number of breast-cancer cases in the

implant cohort was estimated by applying age-specific and calendar

year--specific incidence rates of breast cancer (obtained from the Alberta

Cancer Registry) to the implant cohort. Standardized incidence ratios were

calculated by dividing the observed by the expected number of breast-cancer

cases in the implant cohort. RESULTS. Forty-one patients with implants were

subsequently found to have breast cancer. The expected number was 86.2. The

standardized incidence ratio was thus 47.6 percent, significantly lower

than expected (P less than 0.01). The average length of follow-up in the

implant cohort was 10.2 years, and the average length of time from breast

augmentation to the diagnosis of breast cancer was 7.5 years. CONCLUSIONS.

Women who undergo breast augmentation with silicone implants have a lower

risk of breast cancer than the general population. This finding suggests

that these women are drawn from a population already at low risk and that

the implants do not substantially increase the risk. 

========================================================================

9.) Clinical and laboratory features of patients with scleroderma and

silicone implants.

========================================================================

AU: Field-T; Bridges-AJ

AD: Department of Medicine, University of Wisconsin Hospital, Madison

53792, USA.

SO: Curr-Top-Microbiol-Immunol. 1996; 210: 283-90

AB: We reviewed the available clinical and laboratory data from 56 patients

with scleroderma and silicone implants from the English medical literature

and 19 cases which have not been previously reported. The average age of

onset of scleroderma was 43.6 +/- 10 years (range 20-73). Patients had

silicone implants for an average of 9 +/- 4 years prior to the development

of scleroderma (range 1-32). Most patients had limited scleroderma (41%).

Twenty three percent had intermediate scleroderma and 36% had diffuse

scleroderma. Clinical findings included: Raynaud's phenomenon in 77%,

esophageal dysfunction in 53%, and pulmonary involvement in 47%. Cardiac

and renal involvement were uncommon. Antinuclear antibodies by

immunofluorescence were found in 83 percent of patients. The

immunofluorescence pattern was speckled in 53%, centromere in 31% and

nucleolar in 9%. Other antibodies (Scl-70, RNP, SSA/Ro, PM-Scl) were found

in only a small proportion of patients. A clinical, serologic and

immunogenetic comparison of patients with silicone implants and scleroderma

and patients with idiopathic scleroderma is needed to better understand the

pathogenesis of this disorder.

========================================================================

10.) A clinical and immunologic evaluation of women with silicone breast

implants and symptoms of rheumatic disease [see comments].

========================================================================

AUTHOR(S): Bridges AJ; Conley C; Wang G; Burns DE; Vasey FB.

SOURCE: Annals of Internal Medicine 1993 Jun 15;118(12):929-36

OBJECTIVE: To describe the clinical and serologic features of women with

silicone breast implants who were referred for symptoms of rheumatic

disease. DESIGN: A case series. SETTING: University and private

rheumatology practices. PATIENTS: A total of 156 women with silicone breast

implants and rheumatic disease complaints. Controls for the serologic

studies included women with silicone implants and no rheumatic symptoms (n

= 12) and women with fibromyalgia without silicone implants (n = 174).

MEASUREMENTS: Complete physical examination and testing for

immunoglobulins; complement; C-reactive protein; rheumatoid factor; and

autoantibodies by indirect immunofluorescence, immunodiffusion, and Western

blot. RESULTS: Three subgroups of patients were defined based on clinical

and laboratory findings: joint and muscle pain (n = 95), joint swelling (n

= 32), and connective tissue disease (n = 29). Most women had normal

immunologic studies. The patients with joint swelling had mild, asymmetric,

rheumatoid-factor-negative synovitis that did not meet American College of

Rheumatology criteria for rheumatoid arthritis. Fourteen patients had a

scleroderma-like illness and anti-centromere or anti-PM-Sci antibodies by

Western blot. Ten patients had a positive Western blot for BB' polypeptide,

a small nuclear ribonucleoprotein (snRNP), but did not meet criteria for

systemic lupus erythematosus. No autoantibodies to known disease-related

polypeptides were detected on Western blot in the control groups.

CONCLUSION: Most women with silicone implants and rheumatic complaints had

normal results of serologic tests and nonspecific symptoms, suggesting no

serious connective tissue disease. However, a subset of women had clinical

signs and serologic tests that were unusual even for referred patients.

These observations suggest, but cannot establish, that some women with

silicone breast implants may develop atypical immunologic reactions.40

========================================================================

11.) Systemic sclerosis after augmentation mammoplasty with silicone

implants. [Review]

========================================================================

AUTHOR(S): Varga J; Schumacher HR; Jimenez SA.

SOURCE: Annals of Internal Medicine 1989 Sep 1;111(5):377-83

We describe four women who presented with systemic sclerosis several years

after cosmetic augmentation mammoplasty with silicone-gel implants. The

interval between implantation mammoplasty and the onset of systemic

sclerosis ranged from 6 to 15 years. All patients fulfilled the criteria

established by the American Rheumatism Association for systemic sclerosis

and had Raynaud phenomenon, arthralgia, and evidence of pulmonary or

gastrointestinal involvement. Enlargement of lymph nodes draining the

prostheses was noted in two patients. Antinuclear antibodies were detected

in three patients and showed speckled or nucleolar patterns. Removal of the

prostheses in two cases did not result in improvement of systemic

sclerosis. Evidence of silicone leakage from the implants included the

following. The observation by light microscopy of refractile particles in

tissues distant from the prostheses, the observation by electron microscopy

of electron-dense structures consistent with silica, and the definitive

identification of the element silicon by energy-dispersive analysis in

these electron-dense structures. A marked, chronic inflammatory infiltrate

containing lymphocytes, "foamy" histiocytes, and larger numbers of

multi-nucleated giant cells with vacuoles and asteroid bodies was found at

the same sites. Our demonstration that silicone escapes from

elastomer-silicone-gel breast implants and appears to be closely associated

with a chronic inflammatory reaction suggests that silicone plays a role in

the development of certain cases of systemic sclerosis. [References: 32]130

========================================================================

12.) Antinuclear autoantibodies in women with silicone breast implants.

========================================================================

AUTHOR(S): Press RI; Peebles CL; Kumagai Y; Ochs RL; Tan EM.

SOURCE: Lancet 1992 Nov 28;340(8831):1304-7

Clinical syndromes resembling autoimmune diseases have been reported in

women who have had breast augmentation procedures. To see whether there is

a humoral immune response in these diseases that is similar to the immune

response in their idiopathic counterparts, we assessed the immunological

specificity of antinuclear antibodies (ANAs) and certain epidemiological

features in 24 patients, all of whom (with 1 exception) had received

silicone gel breast implants. ANA specificities were identified by indirect

immunofluorescence, immunodiffusion, western blot analysis, and

immunoprecipitation of radiolabelled intracellular proteins. Of 11 patients

who had symptoms and signs that met criteria for defined autoimmune

diseases, 7 had scleroderma or subsets of this disorder and the others had

systemic lupus erythematosus, rheumatoid arthritis, or overlapping

autoimmune diseases. High ANA titres were present in 10 of these 11

patients and the ANA specificities were similar to those found in the

idiopathic forms of the corresponding autoimmune diseases. Trauma, with

resultant rupture of implants, accelerated onset of symptoms. 13 other

patients had autoimmune disorders of a less clearly defined nature and low

titres of ANAs whose specificities could not be identified. ANAs are

associated with the development of autoimmune complications in women with

silicone breast implants. Further studies are needed to see whether this

relation is one of cause and effect and whether ANAs might be early

serological markers preceding development of autoimmune symptoms.

========================================================================

13.) Antibodies to silicone elastomers and reactions to

ventriculoperitoneal shunts [published erratum appears in Lancet 1992 Sep

26;340(8822):800].

========================================================================

AUTHOR(S): Goldblum RM; Pelley RP; O'Donell AA; Pyron D; Heggers JP.

SOURCE: Lancet 1992 Aug 29;340(8818):510-3

Silicone elastomers used to make medical implants and prostheses are

generally believed to be biologically inert. However, we have seen two

patients who showed severe, apparently immunemediated, reactions to

ventriculoperitoneal (VP) shunts. We used an enzyme-linked immunosorbent

assay in which Silastic tubing served as the solid-phase antigen to test

serum from the two patients, five other VP shunt patients without

inflammatory reactions, and nine healthy adults. IgG binding to Silastic

tubing was consistently higher in the two patients than in the healthy or

patient controls. The IgG seemed to be binding specifically, since IgG Fab

fragments also bound to the tubing, and preincubation of serum with

Silastic or silylated proteins removed most of the activity. These findings

show that specific immune reactivity to elastomers of polydimethylsiloxane

can develop in human beings.

========================================================================

14.) Outcome study of the psychological changes after silicone breast

implant removal.

========================================================================

Roberts C; Wells KE; Daniels S

Department of Psychosocial Oncology, H.Lee Moffitt Cancer Center and

Research 

Institute, Tampa, Fla, USA.

Plast Reconstr Surg (UNITED STATES) Sep 1997 100 (3) p595-9 ISSN:

0032-1052

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9711

Subfile: AIM; INDEX MEDICUS

INTRODUCTION: The purpose of this longitudinal study is to determine if

there are 

changes in psychological well-being after breast implant removal. METHODS:

Thirty-

seven women underwent breast implant removal and completed a preoperative

baseline, 

early postoperative (4 to 9 months), and late postoperative (> 10 months)

Brief 

Symptom Inventory, a measure of psychological distress. RESULTS: After

breast 

implant removal the mean Global Severity Scores on the Brief Symptom

Inventory of 

women undergoing implant removal increased over the three time periods,

indicating 

increasing psychological distress. When the group was divided into those

who had 

breast reconstruction after implant removal (implant replacement with

saline-filled 

implants or TRAM flaps) and those who did not have reconstruction, both

groups had 

increasing psychological distress, but the women who had reconstruction had

slightly 

higher scores. Women with a history of psychiatric treatment showed the

greatest 

increase in psychological symptoms. CONCLUSION: Breast implant removal did

not have 

psychological benefits in this group of women. Breast reconstruction after

removal 

did not appear to be psychologically beneficial to this cohort.

========================================================================

15.) [Hashimoto's thyroiditis and silicone breast implants: 2 cases]

Thyroidite de hashimoto et protheses mammaires en silicone: 2 observations.

========================================================================

Vayssairat M; Mimoun M; Houot B; Abuaf N; Rouquette AM; Chaouat M

Hopital Tenon, Paris.

J Mal Vasc (FRANCE) Jul 1997 22 (3) p198-9 ISSN: 0398-0499

Language: FRENCH Summary Language: ENGLISH

Document Type: 

JOURNAL ARTICLE English Abstract

Journal Announcement: 9711

Subfile: INDEX MEDICUS

The silicone implant controversy wavers between reassuring

epidemiological studies 

and about 300 case reports of patients developing a definite or

incomplete/atypical 

connective tissue disease (CTD) after receiving a silicone gel-filled

breast implant 

(SBI). Since Hashimoto's thyroiditis (HT) is rarely reported in this

context, we 

report here two new cases of HT associated with a history of bilateral

cosmetic SBIs. 

The first patient was a 45-year-old white woman who had SBIs in 1976. In

1991 she 

developed HT, evolving to thyroid deficiency which was compensated with

levothyroxine 

treatment. In addition, the patient complained of fatigue, arthralgia,

morning 

stiffness and developed a sicca syndrome necessitating artificial tears.

The 1995 

evaluation disclosed the presence of antinuclear antibodies at a titre of

1/640, and 

high level anti-thyroid microsomal antibodies (1/256,000). Gamma globulins

rose to 

22.6%. Thyroid ultrasonography showed an enlarged thyroid gland with a

diffusely 

hypoechogenic pattern. The implants were painful, and in 1996 they were

removed. 

Microscope examination of the fibrous capsule surrounding the prostheses

showed 

extremely dense connective tissue with fibrosis. The second patient was a

55-year-

old white woman who had SBIs in 1984. In 1995, she developed HT with

clinical pain 

and tenderness of the thyroid gland, with mild hyperthyroidism and positive 

antithyroglobulin antibodies, and was given corticosteroid treatment for 5

months. 

In 1996, the implants were again painful and the patient developed positive 

antinuclear antibodies with a titre of 1/200. Ultrasonography showed a

heterogeneous 

thyroid gland, and implant removal was advised. Hashimoto's thyroiditis is 

recognized as a subset of chronic auto-immune thyroiditis, and its

association with 

SBI is rare. In these 2 observations, an association without relation is

possible, 

but a future survey of similar cases seems warranted.

========================================================================

16.) Cellular immune reactivities in women with silicone breast implants: a

preliminary 

investigation [see comments]

========================================================================

Ellis TM; Hardt NS; Campbell L; Piacentini DA; Atkinson MA

Department of Pathology, University of Florida, Gainesville 32610-0275, USA.

Ann Allergy Asthma Immunol (UNITED STATES) Aug 1997 79 (2) p151-4

ISSN: 1081-

1206 Contract/Grant No.: R01AI/DK39250--AI--NIAID; R29DK45342--DK--NIDDK

Note: Comment in: Ann Allergy Asthma Immunol 1997 Aug;79(2):89-90

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9711

Subfile: INDEX MEDICUS

BACKGROUND: Surgical implantation of silicone breast prostheses has been

conducted 

and considered safe for over 30 years. Some implant recipients, however,

complain of 

a group of symptoms similar to those observed in connective tissue disorders, 

rheumatoid arthritis, systemic lupus erythematosus, or polymyositis. To

date, 

immunologic sequelae have not been confirmed and remain controversial.

OBJECTIVE: To 

examine an autoimmune-like basis for the "silicone associated disease"

reported by 

some women with silicone breast prostheses. METHODS: Proliferative

responses of 

peripheral blood mononuclear cells against a panel of control and

connective tissue 

proteins and to compounds common to silicone prostheses were measured in 26

women who 

received silicone breast implants (with implants in place an average of 166.4 

[standard deviation (SD) 58.3] months), and 23 age-matched and sex-matched

healthy 

controls. RESULTS: The frequency and intensity of cellular immune

responses against 

collagen I, collagen III, fibrinogen, and fibronectin were significantly

increased in 

silicone breast implant recipients versus controls. In implant subjects,

the highest 

frequency of immune reactivity was directed against collagen I (11/26, 42%)

with 

collagen III being the most immunostimulatory self-antigen with a mean

stimulation 

index (SI) of 8.2 [95% confidence interval (95% CI) 3.2]. In addition,

10/26 (39%) 

of the implant recipients responded to more than one of the connective tissue 

antigens versus 0/23 (0%, P = .0007) healthy controls. Immunologic

reactivities to 

other antigens, including silicone-based compounds, were remarkably similar. 

CONCLUSIONS: The identification of self-reactivity towards these connective

tissue 

antigens may provide important information for attempts at associating

silicone 

breast implants with disease.

========================================================================

17.) Unusual masses found within ruptured silicone gel breast prostheses.

========================================================================

Hughes KC; Calabretta AM; Hirai T; Manders EK

Division of Plastic and Reconstructive Surgery, Milton S. Hershey Medical

Center, 

Hershey, Pa., USA.

Plast Reconstr Surg (UNITED STATES) Aug 1997 100 (2) p525-8 ISSN:

0032-1052

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9711

Subfile: AIM; INDEX MEDICUS

Imaging of breast implants has assumed more importance in medicine than

ever before. 

Radiologists and surgeons alike have struggled to accurately identify folds

in 

prostheses, rupture of prostheses, and migration of gel. Here we present two 

patients with an unusual presentation of masses within the gel of ruptured

silicone 

gel-containing prostheses. In one instance, the mass was an organized

hematoma. In 

the other, two round, calcified masses were found that we presume are

hematomas that 

have become calcified over time. Radiologists and surgeons identifying

spherical or 

ovoid masses seemingly within gel breast prostheses should entertain the

possibility 

that the mass represents an organized hematoma and that the implant is

ruptured.

========================================================================

18.) Silicone breast implants: pathology.

========================================================================

Raso DS; Greene WB

Department of Pathology, Medical University of South Carolina,

Charleston, USA.

Ultrastruct Pathol (UNITED STATES) May-Jun 1997 21 (3) p263-71 ISSN:

0191-3123

Language: ENGLISH

Document Type: JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL 

Journal Announcement: 9709

Subfile: INDEX MEDICUS

Questions as to the bioreactivity of silicone breast implants (SBIs) have

recently 

been intensely scrutinized, most notably by the media and legal system.

Pathologists 

must be aware of the controversy and treat each SBI and associated tissue

as a 

potential lawsuit. Grossly, silicone is a clear, viscous substance that

may be 

observed either within or extruding from a silastic bag. By light

microscopy, 

silicone is a nonstainable, nonpolarizable, refractile substance. Thicker

sections, 

especially when viewed by non-Kohler illumination, phase-contrast, and

darkfield 

microscopy will enhance visualization. Ultrastructurally, silicone is an

electron-

dense, amorphous substance often located within phagocytic vacuoles or 

extracellularly within the stroma. Correlating electron probe

microanalysis allows 

for reliable identification. In most cases, a fibrous capsule surrounds

the SBI, 

with the interface lining varying from a virtually acellular to a

synovial-like 

lining composed of phagocytic and secretory cells. Silicone can often be

identified 

within the fibrous capsule and also in distant tissues biopsied for suspected 

autoimmune disorders, such as synovium, skin, and lymph nodes, often without 

ultrastructural evidence of cytologic effects. This study has demonstrated

that 

silicone accumulates at distant tissue sites due to preexisting

inflammation acting 

as a stimulus. Thus, silicone is not a primary inducer of inflammatory

disease 

processes. These findings are supported by various large epidemiologic

studies. (46 

References)

========================================================================

19.) Capsular contracture with textured versus smooth saline-filled

implants for breast 

augmentation: a prospective clinical study.

========================================================================

Tarpila E; Ghassemifar R; Fagrell D; Berggren A

Department of Plastic Surgery, University Hospital, Linkoping, Sweden.

Plast Reconstr Surg (UNITED STATES) Jun 1997 99 (7) p1934-9 ISSN:

0032-1052

Language: ENGLISH

Document Type: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED

TRIAL 

Journal Announcement: 9709

Subfile: AIM; INDEX MEDICUS

Texturization of silicone-filled breast implants has been shown to reduce

the 

incidence of capsular contracture. A double-blind clinical study was

undertaken to 

compare this incidence in saline-filled implants with textured or with smooth 

surfaces. Twenty-one women underwent mammary augmentation with a textured

implant in 

one breast and a smooth implant in the other. The implants were placed 

subglandularly. All operations were performed by the same surgeon and all

follow-up 

examinations by another. Breast hardness was evaluated 6 months

postoperatively with 

applanation tonometry, using Baker's grading, and after 12 months, now also

with a 

questionnaire concerning the patient's evaluation. Capsular contracture

(Baker 3) 

had occurred in 33 percent of the breasts at the end of the study, and was

bilateral 

in five cases. The incidence of contracture and the patients' views on the

results 

did not differ between textured and smooth prostheses or between right and

left 

breasts. Five patients requested reoperation, two of them because of

breast hardness. 

Texturization of saline-filled implants thus did not reduce the incidence

of capsular 

contracture.

========================================================================

20.) Lymphocyte response to silica among offspring of silicone breast implant 

recipients.

========================================================================

Smalley DL; Levine JJ; Shanklin DR; Hall MF; Stevens MV

Baptist Memorial Health Care System, University of Tenessee, Memphis, USA.

Immunobiology (GERMANY) 97 1996 196 (5) p567-74 ISSN: 0171-2985

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9709

Subfile: INDEX MEDICUS

The current study evaluated immune response to silicon dioxide in

children born to 

women with silicone breast implants. In part one of the study, the T

lymphocytes of 

21 of 24 such children were significantly stimulated by silicon dioxide

(silica). 

Part two consisted of eleven children, four born preimplantation and seven

born 

postimplantation. None of the preimplant offspring showed T cell responses

to 

silica; five of the seven postimplant children were positive for T cell

memory for 

silica. Part three was a blinded study based on statistically significant 

differences in T cell stimulation with silicon dioxide between postimplant

children 

and controls. These findings indicate a common immune reaction, that of T

cell 

memory, occurs in mothers and their children born after exposure to

silicone mammary 

implants placed prior to pregnancy. Since not all such children were

breast fed the 

result favors transplacental passage of immunogens such as silicone

oligomers or 

through maternofetal cellular traffic.

========================================================================

21.) Ruptured or intact: what can linear echoes within silicone breast

implants tell us?

========================================================================

Palmon LU; Foshager MC; Parantainen H; Everson LI; Cunningham B

Department of Radiology, University of Minnesota Hospital and Clinic,

Minneapolis, 

MN 55455, USA.

AJR Am J Roentgenol (UNITED STATES) Jun 1997 168 (6) p1595-8 ISSN:

0361-803X

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9708

Subfile: AIM; INDEX MEDICUS

OBJECTIVE: During sonographic evaluation of silicone breast implants for

possible 

rupture, we have frequently encountered several patterns of linear echoes

within the 

implants. To our knowledge, the significance of this finding has not been 

established in the literature. The purpose of this study was to determine

whether 

internal echoes are significant in predicting implant rupture. SUBJECTS

AND METHODS: 

Thirty-three patients with 64 silicone implants were prospectively entered

into a 

study that included gray-scale sonography of the implants and subsequent

surgical 

removal. Echo patterns within the implants were retrospectively evaluated

on hard-

copy films and compared with the integrity of the implant at surgery.

RESULTS: Three 

categories of internal echo patterns were identified: "thick linear

echoes." "thin 

linear echoes," and "commas." One or more of these echo patterns were seen

in 57 

(89%) of the 64 implants. Thick linear echoes were seen in 23 (36%) of the

64 

implants, thin linear echoes were seen in 33 (52%) of the 64 implants, and

commas 

were seen in 47 (73%) of the 64 implants. All echo patterns were seen in

intact and 

ruptured implants with nearly equal frequency. We found no statistical

significance 

for any echo pattern in predicting whether an implant was ruptured or

intact. Of the 

64 implants, four were entirely free of internal echoes. All four implants

were 

intact. CONCLUSION: A variety of linear echoes can be seen in most

silicone breast 

implants on gray-scale sonography. The presence or absence of linear

echoes is not 

useful in predicting implant rupture. Complete absence of internal echoes,

while 

highly predictive of an intact implant, is infrequently seen.

========================================================================

22.) Inflammatory reaction and capsular contracture around smooth silicone

implants.

========================================================================

Carpaneda CA

Aesthetic Plast Surg (UNITED STATES) Mar-Apr 1997 21 (2) p110-4 ISSN:

0364-216X

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9708

Subfile: INDEX MEDICUS

Histologic studies were performed on capsular tissue resected from 21

patients who 

were implanted with smooth silicone prostheses filled with gel. The results 

disclosed a nonuniform response to the implants. The granulomatous

reaction to the 

silicone showed important variations along the same surface of the

implants, between 

the plane and the concave surfaces, between equivalent points at the right

and left 

sides, and among the patients. Also, a significant difference was observed

between 

reactions and capsules in early and late stages. The author believes these 

variations of the capsular inflammatory reaction promote different sites of 

contraction between cell-to-cell, or cell-to-collagen-to-cell. These

adding forces 

result in vectors of different intensities and directions around the

implants which 

explains the various clinical grades of capsular contracture.

========================================================================

23.) Breast implantation and the incidence of upper extremity somatic

complaints.

========================================================================

Kulick M; Daneshmand H

Department of Plastic and Reconstructive Surgery, Saint Francis Memorial

Hospital, 

San Francisco, California 94108, USA.

Aesthetic Plast Surg (UNITED STATES) Mar-Apr 1997 21 (2) p105-9 ISSN:

0364-216X

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9708

Subfile: INDEX MEDICUS

Attention has been drawn to elevated laboratory tests of inflammation as

indicators 

of a possible reaction to silicone breast implants. These patients have

complaints 

of joint pain, pain, and myalgia that were possibly caused by a reaction to

silicone. 

This study is a retrospective review of 100 consecutive patients (79

female, 21 male) 

who were evaluated because of a purported industrial injury to the upper

extremity. 

Patients were examined by a single examiner and all had laboratory

screening for 

indicators of inflammation (sedimentation rate, anti-nuclear antibody

levels, C-

reactive protein, anti-streptolysin, rheumatic factor), endocrine

abnormalities 

(thyroid panel), and serum glucose. None of the patients had any history

of breast 

augmentation with any implant. Of the 79 female patients, 50 had an

identifiable 

clinical diagnosis and 18 of them had elevation of at least one of the

indicators of 

inflammation. The remaining 29 did not have an identifiable diagnosis and

21 of them 

had elevation of at least one indicator of inflammation (P < 0.01). There

were 74 

out of 79 females with subjective complaints of upper extremity pain, joint

pain, and 

aching. Forty-five of these patients had an identifiable diagnosis and 17

of them 

had elevation of at least one inflammatory indicator. Of the 74 female

patients, 29 

had no identifiable diagnosis and 21 of them had elevation of at least one 

inflammatory indicator (P < 0.01). In summary, there were a high number of

female 

patients with complaints of upper extremity symptoms with no prior exposure

to 

silicone from breast implantation. There was a statistically significant

correlation 

in these patients who had no identifiable diagnosis and elevated indicators

in 

inflammation. This study suggests these markers of inflammation should not

be used 

as indicators of a reaction to silicone from breast implantation in

patients with 

upper extremity subjective complaints.

========================================================================

24.) A review of the possible health implications of silicone breast implants.

========================================================================

Noone RB

Department of Surgery, University of Pennsylvania School of Medicine,

Philadelphia, 

USA.

Cancer (UNITED STATES) May 1 1997 79 (9) p1747-56 ISSN: 0008-543X

Language: ENGLISH

Document Type: JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL 

Journal Announcement: 9707

Subfile: AIM; INDEX MEDICUS

BACKGROUND: The silicone gel breast implant has long been an important

method of 

reconstruction for the mastectomy patient. Because of concerns about

possible health 

implications of the implant, the Food and Drug Administration banned its

use for 

augmentation mammaplasty and limited its use in the mastectomy patient to a

research 

protocol study. This article reviews the recent literature about the

possible health 

hazards of the silicone implant. METHODS: In this review of the

literature, specific 

attention was directed toward structural failure of the device as well as the 

diagnosis of rupture, tissue response to silicone, systemic immunologic

response to 

silicone, the relationship of silicone to connective tissue diseases, and the 

association of the silicone implant with breast carcinoma in both the

augmentation 

mammaplasty patient and the patient undergoing postmastectomy

reconstruction. A 

total of 88 works were reviewed. RESULTS: The literature fails to support an 

association between silicone gel breast implants and systemic diseases.

Although 

implants may cause local symptoms, rupture over time, or be associated with

an 

immunologic reaction, comprehensive epidemiologic studies have concluded

that there 

is no connection between breast implants and the known connective tissue

diseases or 

between the implants and breast carcinoma. There is no increase in the

risk of 

recurrence in mastectomy patients reconstructed with implants and no delay

in the 

detection of recurrences. Recent laboratory studies in animals suggest

that silicone 

may have anticarcinogenic effects. CONCLUSIONS: Silicone gel breast

implants may 

rupture and cause local symptoms, but they have not been demonstrated to be a 

systemic health hazard for patients who have undergone augmentation

mammaplasty or 

postmastectomy reconstruction. (88 References)

========================================================================

25.) [The value of sonography for the discovery of complications after the

implantation of silicone gel prostheses for breast augmentation or

reconstruction]

Stellenwert der Sonographie fur die Aufdeckung von Komplikationen nach

Implantation 

von Silikongelkissen zur Mammaaugmentation bzw. -rekonstruktion.

========================================================================

Lorenz R; Stark GB; Hedde JP

Abteilung fur Diagnostische Radiologie, Stadt. Krankenhaus Solingen.

Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr (GERMANY) Mar 1997

166 (3) 

p233-7 ISSN: 0936-6652

Language: GERMAN Summary Language: ENGLISH

Document Type: 

JOURNAL ARTICLE English Abstract

Journal Announcement: 9707

Subfile: INDEX MEDICUS

PURPOSE: To determine sensitivity and specificity of real-time

ultrasonography in 

detecting breast implant complications. MATERIAL AND METHODS: The results of 

preoperative ultrasonography of 121 silicone implants in 65 patients were

compared 

with the results after operative implant removal. RESULTS: With a

sensitivity of 

89.25% and a specificity of 92.1%, complications such as gel bleeding (n =

43), 

rupture with leakage (n = 63), and implant dissolution (n = 4) become

manifest. 

Capsule formation, fibrosis, siliconoma and calcifications were often

underestimated 

in their extent. Negative ultrasonography findings were found in 10.7% (n

= 13) with 

positive clinical findings. CONCLUSIONS: The combination of clinical and 

ultrasonography findings leads to the detection of implant complications.

========================================================================

26.) Explantation of silicone breast implants.

========================================================================

Thomas WO 3rd; Harper LL; Wong SW; Michalski JP; Harris CN; Moore JT;

Rodning CB

Department of Surgery, College of Medicine/Medical Center, University of

South 

Alabama, Mobile, USA.

Am Surg (UNITED STATES) May 1997 63 (5) p421-9 ISSN: 0003-1348

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9707

Subfile: INDEX MEDICUS

Silicone gel-filled breast implants have been employed clinically for

decades for 

aesthetic augmentation or postmastectomy reconstruction. Most patients and

surgeons 

attest to the efficacy and safety of these devices. However, more recently

in the 

medical literature and popular media, silicone gel-filled breast implants

have been 

claimed to incite an array of clinical sequelae such as capsular formation, 

granulomatous disease, arthritis, arthralgia, fibromyalgia, autoimmune

collagen 

vascular disease, human adjuvant disease, siliconosis, silicone-related

disease, and 

silicone implant-associated syndrome. During a recent 24-month period, 25

referred 

patients underwent explantation of bilateral silicone gel-filled prostheses

at the 

University of South Alabama. Patient-reported symptoms and signs included 

mastodynia, arthralgia, fibromyalgia, xerophthalmia, xerostomia,

hypesthesia, and 

amblyopia. Clinical examination and mammography were reliable in

diagnosing implant 

rupture, but only re-exploration reliably detected implant leakage. Most

patients 

underwent concurrent replacement with saline-filled devices. Histopathologic 

analyses of all tissue samples revealed chronic inflammation. Subjective

improvement 

of patient-reported symptoms and signs occurred over the course of months 

postoperatively. There was no mortality associated with explantation, with

or 

without replacement, but an overall morbidity incidence of 20 per cent (5

of 25) was 

observed. Predicated upon review of the available scientific literature

and analysis 

of this modest number of patients, the following perspectives are germane.

1) A 

small cohort of patients of status postimplantation of silicone gel-filled

devices 

will manifest chronic morbidity. Identifying such patients prospectively

remains 

problematic. 2) Whether or not silicone gel incites adverse systemic

phenomena is 

unproven, although it has been implicated. 3) Symptomatic patients with

silicone gel-

filled implants in place should be considered for removal, with full

knowledge of the 

morbidity associated with revisional procedures. 4) Patients currently

undergoing 

breast augmentation or reconstruction employing prosthetics are perhaps

best served 

by insertion of saline-filled devices. 5) Patient-physician dialogue

regarding the 

risk-benefit analysis of prosthetic implantation is imperative. Patients

consenting 

to such procedures must be willing to assume risks.

========================================================================

27.) Neurosarcoidosis following augmentation mammoplasty with silicone.

========================================================================

Yoshida T; Tanaka M; Okamoto K; Hirai S

Department of Neurology, Gunma University School of Medicine, Japan.

Neurol Res (ENGLAND) Aug 1996 18 (4) p319-20 ISSN: 0161-6412

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9707

Subfile: INDEX MEDICUS

We report a patient with neurosarcoidosis, which developed 22 years after 

augmentation mammoplasty by the injection of silicone gel. She presented

with 

bilateral hilar lymphadenopathy, left-sided lower cranial nerve palsies

(8th, 9th, 

and 10th), and vestibular ataxia, which improved following the

administration of 

prednisolone. Biopsy of the breast nodules showed granulomatous changes

identical 

with those of sarcoidosis, while infrared spectrophotometry disclosed that

the 

nodules contained polydimethylsiloxane, a major component of the silicone gel 

injection. This is the first report of neurosarcoidosis following silicone 

mammoplasty.

========================================================================

28.) Are breast implants anticarcinogenic? A 14-year follow-up of the Los

Angeles Study.

========================================================================

Deapen DM; Bernstein L; Brody GS

Department of Preventive Medicine, School of Medicine, University of

Southern 

California, Los Angeles, USA.

Plast Reconstr Surg (UNITED STATES) Apr 1997 99 (5) p1346-53 ISSN:

0032-1052

Contract/Grant No.: CA-14089--CA--NCI; CA-17054--CA--NCI

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9707

Subfile: AIM; INDEX MEDICUS

Despite decades of use, the long-term safety of breast implants in women

remains a 

concern. While the incidence of breast cancer among women has increased

dramatically 

in the past decade, the implant-related risk of carcinoma of the breast

only recently 

has received widespread attention. An additional concern is that the

presence of the 

implant may delay tumor detection. This study allows examination of breast

cancer 

risk and detection issues among patients with long-term exposure. We

conducted a 

record linkage cohort study of cosmetic breast implant patients. We

abstracted the 

records of the private practices of 35 broad-certified plastic surgeons in

Los 

Angeles County, California. We included 3182 white women who received

cosmetic 

breast implants between 1953 and 1980. Spanish-surnamed women,

nonresidents of Los 

Angeles County, and patients with prior subcutaneous mastectomy or breast

cancer were 

excluded. Cancer outcomes through 1991 have been ascertained through

record linkage 

with the Los Angeles County Cancer Surveillance Program. With a median

follow-up of 

14.4 years, 31 breast cancer cases were observed, compared with 49.2

expected, based 

on Los Angeles County population-based incidence rates (standardized

incidence ratio 

= 63.0 percent; 95 percent confidence limits: 42.8 and 89.5 percent). The 

distribution of stage of disease at diagnosis among women with implants did

not 

differ from that of all similar breast cancer patients in Los Angeles

County. In Los 

Angeles County, augmentation mammaplasty patients experience a

significantly lower 

than expected risk of breast cancer and no delay in breast cancer detection

after an 

average of 14.4 years of exposure. While the linkage methodology allows the 

possibility of failing to detect diagnosed cancer cases and does not permit 

collection of some pertinent risk factors, the six other published

epidemiologic 

studies on the topic also report breast cancer risk to be at or below the

expected 

rate.

========================================================================

29.) [Silicone breast implants and breast cancer]

Silikonebrystproteser og brystkraeft.

========================================================================

Kjoller KH; Krag C; Friis S

Plastikkirurgisk afdeling V, Amtssygehuset i Herlev.

Ugeskr Laeger (DENMARK) Mar 17 1997 159 (12) p1744-8 ISSN: 0041-5782

Language: DANISH Summary Language: ENGLISH

Document Type: 

JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL English Abstract

Journal Announcement: 9706

Subfile: INDEX MEDICUS

Sarcomas have been shown to develop next to foreign body implants, silicone 

included, in animal experiments. However, this carcinogenesis is not

believed to 

have any human relevance. A review of the existing epidemiological studies

suggests 

that women with silicone breast implants have a reduced risk for developing

breast 

cancer. However, the presence of breast implants does obscure mammographic 

visualization as well as palpation of mammary tissue. This has led to the

assumption 

that breast cancer detection could be compromised in women with breast

implants. In 

the few studies that have dealt with this issue, women with breast implants

were 

diagnosed with the same stage of disease as women without implants.

However, the 

percentage of false negative mammographies was increased in one study. In 

conclusion, there is currently no evidence of an association between breast

implants 

and cancer or postponed breast cancer detection. (37 References)

========================================================================

30.) Lack of evidence of systemic inflammatory rheumatic disorders in

symptomatic women 

with breast implants.

========================================================================

Blackburn WD Jr; Grotting JC; Everson MP

Research Service, Birmingham VA Medical Center, Ala, USA.

Plast Reconstr Surg (UNITED STATES) Apr 1997 99 (4) p1054-60 ISSN:

0032-1052

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9706

Subfile: AIM; INDEX MEDICUS

Breast implants containing silicone have been used for approximately 30

years for 

breast augmentation or reconstruction. In general, the implants have been

well 

tolerated and reports have indicated a high degree of patient satisfaction. 

Nonetheless, there have been anecdotal reports of patients with

musculoskeletal 

complaints that have been attributed to silicone breast implants. To

investigate 

this further, we prospectively examined 70 women with silicone breast

implants who 

had complaints that they or their referring physicians thought were related

to their 

implants. On clinical examination, the majority of the patients had

fibromyalgia, 

osteoarthritis, or soft-tissue rheumatism. One patient had rheumatoid

arthritis, 

which predated her implants, and one had Sjogren's syndrome. Because many

of our 

patients had myalgic symptoms, we further evaluated these patients by

measuring 

circulating levels of soluble factors including interleukin-6,

interleukin-8, tumor 

necrosis factor-alpha, soluble intercellular adhesion molecule-1, and soluble 

interleukin-2 receptor, which have been previously found to be elevated in

patients 

with inflammatory diseases. We found that the levels of these molecules in

women 

with silicone breast implants were not different from those seen in normal

subjects 

and were significantly less than those seen when examining chronic

inflammatory 

disorders such as rheumatoid arthritis or systemic lupus erythematosus. In

summary, 

our clinical and laboratory evaluation of symptomatic breast implant

patients argues 

against an association of silicone breast implants with a distinctive

rheumatic 

disease or a systemic inflammatory disorder. Given these findings and the

clinical 

picture, it is our impression that most symptomatic women with silicone

breast 

implants have well-delineated noninflammatory musculoskeletal syndromes.

Moreover, 

these data fail to support the concept that their symptoms are due to a

systemic 

inflammatory response related to their implants.

========================================================================

31.) Breast implants in patients with differentiated and undifferentiated

connective 

tissue disease.

========================================================================

Williams HJ; Weisman MH; Berry CC

University of Utah School of Medicine, Salt Lake City 84132, USA.

Arthritis Rheum (UNITED STATES) Mar 1997 40 (3) p437-40 ISSN: 0004-3591

Contract/Grant No.: 1-AM-6-2228--AM--NIADDK

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9706

Subfile: AIM; INDEX MEDICUS

OBJECTIVE: To assess the frequency of breast implantation and the

relationship of 

the implants to the onset of symptoms in patients with differentiated and 

undifferentiated connective tissue disease (CTD). METHODS: We evaluated an

inception 

cohort of patients with differentiated and undifferentiated CTD and

symptoms of < 12 

months duration when enrolled in 1983-1987. The risk of having breast

implants in 

those patients with early symptoms of CTD was determined in comparison with

that in a 

non-concurrent control group. RESULTS: Only 3 of 323 women in the cohort had 

historical, physical, or chest radiographic evidence of breast

implantation. In 1 of 

the 3 patients, the symptoms of CTD began before the breast implantation.

The odds 

ratio was calculated at 1.15, with a 95% confidence interval ranging from

0.23 to 

3.41. CONCLUSION: This study showed an absence of significant risk for

prior breast 

implantation surgery in patients with well-defined or undifferentiated CTD.

========================================================================

32.) Epidemiology of systemic sclerosis.

========================================================================

Silman AJ; Newman J

University of Manchester, ARC Epidemiology Research Unit, School of

Epidemiology 

and Health Sciences, UK.

Curr Opin Rheumatol (UNITED STATES) Nov 1996 8 (6) p585-9 ISSN:

1040-8711

Language: ENGLISH

Document Type: JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL 

Journal Announcement: 9705

Subfile: INDEX MEDICUS

There have been few recent studies of the descriptive epidemiology of

systemic 

sclerosis, but in recent work the limited form of the disease seems more

prominent 

than reported in previous studies. Molecular genetic investigation of

systemic 

sclerosis remains disappointing in identifying susceptibility alleles.

There are 

some associations in relation to HLA class II alleles, specifically DP, DQ,

and DR. 

These associations, however, seem to be more important in predicting the

nature of 

the autoimmune response rather than describing disease susceptibility

itself. The 

study of occupational and environmental influences has been dominated by

studies on 

the role of silicone gel breast implants. These studies, driven by

medicolegal 

constraints, have overwhelmingly failed to prove any association. Other

studies 

confirm the continuing likelihood that organic solvents are implicated, at

least in a 

proportion of cases. (38 References)

========================================================================

33.) Use of antipolymer antibody assay in recipients of silicone breast

implants.

========================================================================

Tenenbaum SA; Rice JC; Espinoza LR; Cuellar ML; Plymale DR; Sander DM;

Williamson 

LL; Haislip AM; Gluck OS; Tesser JR; Nogy L; Stribrny KM; Bevan JA; Garry RF

Department of Microbiology and Immunology, Tulane University School of

Medicine, 

New Orleans, LA 70112, USA.

Lancet (ENGLAND) Feb 15 1997 349 (9050) p449-54 ISSN: 0140-6736

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9705

Subfile: AIM; INDEX MEDICUS

BACKGROUND: Local complications (encapsulation, rashes, rupture, and

leakage) can 

occur after placement of silicone gel-containing breast implants (SBI).

Whether SBI 

exposure results in systemic manifestations in some recipients is

controversial. We 

have carried out a blinded study to assess whether there is any difference

between 

SBI recipients and non-exposed controls in the proportions positive for serum 

antibodies directed against polymeric substances. METHODS: We recruited

female SBI 

recipients (including those without symptoms) who presented to a single

rheumatology 

clinic. A physician global assessment was used to classify SBI recipients

who did 

not meet criteria for specific autoimmune diseases according to the

severity of local 

and systemic signs and symptoms. Controls were recruited from among clinic

staff and 

their acquaintances. Results of the antipolymer antibody (APA) assay were

compared 

with those of an assay for antinuclear antibodies (ANA) and with the

severity of the 

signs and symptoms. FINDINGS: Positive APA results were found in one (3%)

of 34 SBI 

recipients with limited symptoms, two (8%) of 26 with mild symptoms, seven

(44%) of 

16 with moderate symptoms, and 13 (68%) of 19 with advanced symptoms. Four

(17%) of 

23 healthy non-SBI-exposed controls and two (10%) of 20 non-exposed women

with 

classic autoimmune diseases were positive for APA. Thus, women with

moderate or 

advanced symptoms were significantly more likely than those with limited or

mild 

symptoms, or non-exposed controls to have APA (p < 0.001). The proportion

with 

positive ANA results was higher for women with classic autoimmune diseases

14 (70%) 

of 20 than for any SBI-exposed subgroup (0-33%). INTERPRETATION: The APA

assay can 

objectively contribute to distinguishing between SBI recipients with

limited or mild 

signs and symptoms. SBI recipients with more severe manifestations, and

patients 

with specific autoimmune diseases. Further studies will be needed to

define the 

signs and symptoms associated with exposure to SBI.

========================================================================

34.) Complications leading to surgery after breast implantation [see comments]

========================================================================

Gabriel SE; Woods JE; O'Fallon WM; Beard CM; Kurland LT; Melton LJ 3rd

Division of Rheumatology and Internal Medicine, Mayo Clinic and Mayo

Foundation, 

Rochester, MN 55905, USA.

N Engl J Med (UNITED STATES) Mar 6 1997 336 (10) p677-82 ISSN: 0028-4793

Contract/Grant No.: AR30582--AR--NIAMS

Note: Comment in: N Engl J Med 1997 Mar 6;336(10 ):718-9

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9705

Subfile: AIM; INDEX MEDICUS

BACKGROUND: Local complications that require additional surgical

procedures are an 

important problem for women with breast implants. METHODS: We studied 749

women who 

lived in Olmsted County, Minnesota, and received a first breast implant at

the Mayo 

Clinic between 1964 and 1991. We identified complications that occurred

after the 

initial procedure and after any subsequent implantation. A complication

was defined 

as a surgical procedure performed for any of the following reasons: capsular 

contracture; rupture of the implant; hematoma or bleeding; infection or

seroma of the 

wound; chronic pain; extrusion, leakage, or sweating of the implant;

necrosis of the 

nipple, areola, or flap; malfunction of the filler port of a tissue

expander; and 

wound dehiscence. RESULTS: During follow-up (mean, 7.8 years; range, 0 to

25.8), 208 

(27.8 percent) of the women underwent 450 additional implant-related surgical 

procedures. Ninety-one (20.2 percent) were anticipated, staged procedures

or were 

done because the patient requested a size change or aesthetic improvement,

and 359 

procedures (79.8 percent) had at least one clinical indication (thus

constituting a 

complication). Complications occurred in 178 (23.8 percent) of the 749

women and 

involved 274 (18.8 percent) of the 1454 breasts with implants and 321 (18.8

percent) 

of the 1703 implants. The most frequent problem was capsular contraction

(272 

cases), followed by rupture of the implant (60), hematoma (55), and wound

infection 

(23). The rate of complications was significantly lower (P<0.001) among

women with 

cosmetic implants (6.5 percent at one year, 12 percent at five years) than

among 

women who underwent implantation after mastectomy for breast cancer (21.8

percent at 

one year, 34 percent at five years) or prophylactic mastectomy (17.3

percent at one 

year, 30.4 percent at five years). CONCLUSIONS: Women who have had breast 

implantation frequently experience local complications during the

subsequent five 

years. Complications were significantly less frequent among patients who

received 

implants for cosmetic reasons than among those who received implants after

mastectomy 

for cancer or for cancer prophylaxis.

========================================================================

35.) Silicone gel and octamethylcyclotetrasiloxane (D4) enhances antibody

production to 

bovine serum albumin in mice.

========================================================================

Nicholson JJ 3rd; Hill SL; Frondoza CG; Rose NR

Department of Molecular Microbiology and Immunology, Johns Hopkins

University, 

Baltimore, Maryland 21239, USA.

J Biomed Mater Res (UNITED STATES) Jul 1996 31 (3) p345-53 ISSN:

0021-9304

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9705

Subfile: INDEX MEDICUS

The purpose of the present study was to determine whether components of

silicone 

breast implants [silicon (polydimethylsiloxane) oil, silicone gel, and 

octamethylcyclotetrasiloxane (D4)] potentiate the antibody response to

bovine serum 

albumin (BSA) in mice. Seventy A/J mice were divided into seven groups which 

received the following: group I--phosphate buffer solution (PBS); group

II--20 

centistoke (cs) silicone oil; group III--50% silicone gel homogenized in

silicone 

oil; group IV--incomplete Freunds' adjuvant (IFA); group V--IFA mixed with

an equal 

volume of silicone oil; group VI--D4; and group VII--IFA mixed with an

equal volume 

of DA. Each 0.1 mL of treatment material(s) was mixed or emulsified with

an equal 

0.1-mL volume of 250 micrograms/mL BSA in PBS solution. Antibodies to BSA

were 

measured using an enzyme-linked immunosorbent assay. Our study

demonstrates for the 

first time that both D4 and the silicone gel potentiate antibody production

to BSA in 

mice. Histopathologic evaluation of the injection sites reveals granulomas

for mice 

injected with IFA and D4 preparations. Whether D4 or silicone gel acts as an 

adjuvant against self-antigens has yet to be determined.

========================================================================

36.) Visualization of silicone gel in human breast tissue using new

infrared imaging 

spectroscopy.

========================================================================

Kidder LH; Kalasinsky VF; Luke JL; Levin IW; Lewis EN

Laboratory of Chemical Physics, National Institute of Diabetes and

Digestive and 

Kidney Diseases, National Institutes of Health, Bethesda, Maryland

20892-0510, USA.

Nat Med (UNITED STATES) Feb 1997 3 (2) p235-7 ISSN: 1078-8956

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9705

Subfile: INDEX MEDICUS

Between 1 and 2 million women in the United States have silicone breast

implants. 

Complications include capsular contracture and calcification and possibly

connective 

tissue diseases such as scleroderma and rheumatoid arthritis, a subject of

some 

controversy. In order to accurately assess the role of silicone in any 

histopathologic change, it is necessary to confirm its presence and to

identify other 

foreign materials in the capsular tissue. Although light microscopy is

used to 

visualize regions of tissue containing foreign inclusions, their chemical

identity 

can only be determined using analytical techniques such as infrared or Raman 

microscopy. However, these conventional microprobe techniques record

spectra only at 

single points and require an a priori knowledge of the locations of the

inclusion to 

be probed. To significantly extend the capabilities of both infrared

spectroscopy 

and optical microscopy, we have developed a new infrared imaging system that 

completely integrates these two methods. In this manuscript we highlight

the ability 

of the technique to screen rapidly and to determine accurately the

presence, size and 

chemical composition of silicone gel inclusions in human breast tissue.

========================================================================

37.) The epidemiology of scleroderma among women: assessment of risk from

exposure to 

silicone and silica.

========================================================================

Burns CJ; Laing TJ; Gillespie BW; Heeringa SG; Alcser KH; Mayes MD; Wasko

MC; 

Cooper BC; Garabrant DH; Schottenfeld D

Department of Epidemiology, University of Michigan, Ann Arbor, USA.

J Rheumatol (CANADA) Nov 1996 23 (11) p1904-11 ISSN: 0315-162X

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9705

Subfile: INDEX MEDICUS

OBJECTIVE: To investigate the relationship between exposure to silicone

(including 

breast implants) and silica and the development of scleroderma (systemic

sclerosis, 

SSc) among women. METHODS: A population based case-control study was

conducted among 

women in Michigan. 274 confirmed cases of SSc diagnosed between 1985 and

1991 were 

identified by contacting rheumatologists, hospitals, and a scleroderma

support group. 

These cases and 1184 controls were interviewed by telephone to ascertain past 

exposures to silicone or silica. RESULTS: Silicone in the form of breast

implants 

was not associated with significantly increased risk of SSc (adjusted odds

ratio, 

1.30; 95% confidence interval, 0.27 to 6.23). Among 20 other potential

silicone 

exposure surveyed, self-reported exposure to silicone based glues,

sealants, and 

caulks, manufacture or repair of windows or windshields, repairing or

frequently 

using photocopy machines, consumption of simethicone-containing antacids, and 

implanted medication delivery pumps were significantly associated with SSc.

However, 

blinded assessment of all job and hobby descriptions in terms of their

potential for 

silicone exposure failed to support the first 3 associations, antacid

consumption may 

have been confounded by esophageal dysmotility before the diagnosis of SSc,

and other 

silicone containing device categories (pacemakers, central nervous system

shunts, 

other shunts and catheters) were not significantly associated with SSc.

Surgically 

implanted metallic fixation devices were associated with significantly

reduced risk 

for SSc. No association was detected between SSc and silica dust exposure. 

CONCLUSION: Consistent with other studies, we found no increased risk of

SSc among 

women with silicone breast implants, equivocal evidence of risk from other

silicone 

exposures, and no evidence of risk from silica exposure.

======================================================================

DATA-MÉDICOS/DERMAGIC-EXPRESS No (47) 31/03/99 DR. JOSE LAPENTA R. 

======================================================================

Produced by Dr. José Lapenta R. Dermatologist

Venezuela 1.998-2.024

Producido por Dr. José Lapenta R. Dermatólogo
Venezuela 1.998-2.024

Tlf: 0414-2976087 - 04127766810