ANNALS OF INTERNAL MEDICINE

LETTER

Silicone Breast Implants and Atypical Autoimmune Disease

15 November 1993 | Volume 119 Issue 10 | Pages 1053-1054

Bridges and associates [1] have provided timely documentation of clinical and immunologic features in women with rheumatologic complaints after silicone augmentation mammoplasty. Human adjuvant disease is a connective tissue disorder that sometimes meets American College of Rheumatology criteria for the diagnosis of systemic lupus erythematosus, rheumatoid arthritis, progressive systemic sclerosis, mixed connective tissue disease, or unclassified rheumatic syndromes [1-5] and occurs 6 to 15 years after implantation mammoplasty [1-5]. We describe a 39-year-old white woman who had augmentation mammoplasty in 1982 and revision of a ruptured left implant in 1989 and who developed a skin rash and eye inflammation in the fall of 1990. Her skin lesions fit the description of those reported by Bridges and colleagues as an intermediate cutaneous scleroderma. Laboratory testing was noteworthy for a positive antinuclear antibody test result (titer, 1:320) using HEp-2 cells as the tissue substrate and a negative result for dsDNA by indirect immunofluorescence using Crithidia luciliae as substrate. Skin and eye inflammation persisted for months, despite therapy with topical skin and eye steroid preparations but resolved within 10 days of removal of the intact breast implants.

The rapid improvement after intact implant removal strongly suggests an association between her scleroderma-like reaction and the silicone breast implants. The episcleritis and conjunctivitis have not been described as a manifestation of this syndrome but clearly are seen in several rheumatic diseases. We agree that atypical autoimmune illness may occur in some women after placement of silicone breast implants [1].

References

1. Bridges AJ, Conley C, Wang G, Burns PE, Vasey FB. A clinical and immunological evaluation of women with silicone breast implants and symptoms of rheumatic disease. Ann Intern Med. 1993; 118:929-36.

2. Spiera H. Scleroderma after silicone augmentation mammoplasty. JAMA. 1988; 260:236-8.

3. Brozena SJ, Fenske NA, Cruse CW, Espinoza CG, Vasey FB, Germain BF, et al. Human adjuvant disease following augmentation mammoplasty. Arch Dermatol. 1988; 124:1383-6.

4. Weisman MH, Vecchione TR, Albert D, Moor LT, Mueller MR. Connective tissue disease following breast augmentation: a preliminary test of the human adjuvant disease hypothesis. Plast Reconstr Surg. 1988; 82:626-30.

5. Varga J, Jimenez S. Augmentation mammoplasty and scleroderma. Arch Dermatol. 1990; 126:1220-2.

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