Explantation of silicone breast implants

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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.

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