Review Question - QID 103035

Capsular contraction occurs when the immune system of the host responds to the foreign material in the breast implant. As part of the immune response collagen fiber formation occurs which can squeeze and distort the implant.

Silicone implants are generally safe; however, patients considering such a procedure should be advised of the potential negative outcomes. Most commonly, implants may result in a negative aesthetic outcome (deflation) or pain as result of capsular contracture. Occasionally, implants can rupture, as seen most frequently with trauma to the breast. To date, autoimmune diseases (RA, SLE, scleroderma, ect.) have been suggested to be possibly linked to silicone in small studies but no epidemiological studies or meta-analyses have shown any relationship with breast implantation.

Field et al. describe complications associated with breast mammoplasty with silicone implants, including unequal diffusion of silicone through the implant and capsular contracture. These may be prevented with regular implant exercises. Breast shape changes may be a result of malignant processes and thus implants must be followed with serial mammograms to differentiate surgical from malignant changes.

Lidar et al. examine the controversy of silicone and suggests that it may play a role in a newly defined syndrome that encompasses many immune-related symptoms. This disorder has been termed ASIA ('Autoimmune Syndrome Induced by Adjuvant'). Scleroderma has also been implicated in association with silicone implantation.

Illustration A shows a classic example of severe capsular contracture of the right breast. Note the asymmetry.

Incorrect Answers:
Answer 2: Graft versus host disease requires that the transplanted tissue be immunocompetent; a silicone breast implant is not immunocompetent.
Answer 3: Migraine headaches have not been associated with silicone breast implants.
Answer 4: T-cell lymphoma has recently been shown to occur in some women with silicone implants, albeit with low incidence - this is not a common complication.
Answer 5: There is some suggestion within the literature but no strong evidence linking silicone breast implants to autoimmune disorders.