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Human adjuvant disease revisited: a review of eleven post-augmentation mammoplasty patients

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OBJECTIVES: We have reviewed 11 women post-augmentation mammoplasty

who were referred to our clinic with diffuse rheumatic

complaints. All patients had undergone mammoplasty with

silicone gel-filled implants prior to the onset of their

locomotor symptoms (mean latency time 7.8 years). One

physician interviewed and examined each of these patients

following a standardized format for clinical retrieval.

RESULTS: Of the patients reviewed, 6 patients had clinical

fibromyalgia based on the ACR criteria, and the remaining 5

patients had symptoms consistent with the “chronic fatigue

syndrome.” None of our patients were found to have evidence of

a defined connective tissue disease. Antinuclear antibodies

were detected in 4 (36%) patients and low level titres of

extractable nuclear antigens in only 2 (18%).

CONCLUSIONS: Previously a causal relationship between

the use of silicone gel-filled breast implants and the

subsequent development of symptoms referred to as human

adjuvant disease (HAD) has been proposed. On the basis of

currently accepted criteria we have preferred to diagnose our

post-mammoplasty patients without specific connective tissue

disease, as having chronic fatigue syndrome (CFS), or when

tender points are present, as having fibromyalgia (FMS),

rather than implying that such cases represent a separate and

unique rheumatological disease entity. In the light of our

current understanding of CFS and FMS, a relationship between

them and the previous silicone mammoplasty seems possible.

Fenske TK, Davis P, Aaron SL

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