LAUSR

The possibility that silicone gel breast implants could play a role in causing an adverse immunologic reaction in selected patients was first postulated in the early 1990s. This led to a moratorium on the use of these devices for many years, with only selected indications being deemed acceptable by the FDA while further study of the issue was undertaken. The ultimate findings of these comprehensive studies were that there was no convincing scientific evidence that silicone gel breast implants resulted in immunologic disease in humans. This resulted in the ultimate re-introduction of these devices which now are used across the world for both aesthetic and reconstructive breast surgery. Recent findings have re-raised the issue of whether or not silicone gel implants cause immunologic disease. As a result, women are once again consulting with physicians requesting that their implants be removed in an attempt to treat a host of presenting symptoms. This paper reviews the available literature related to the results of treatment in these women, using both medical and surgical means. It is a timely review and merits further comment. As was noted during the initial experience with this issue nearly 30 years ago, the presenting symptoms for these patients remain vague and difficult to quantify. These symptoms, which are outlined in the paper, including myalgias, arthralgias, chronic fatigue, sleep disturbance and cognitive impairment, are largely subjective; therefore, accurate documentation as to severity and response to treatment becomes uncertain at best and impossible at worst. Therefore, any attempt to develop an effective treatment for these symptoms is based on such a level of uncertainty that any reporting of results has next to no scientific merit and basically becomes a reporting of subjective impressions. This environment is subject to a host of confounding variables including a vast variety of personality subtypes, the placebo effect and more social concerns including medico-legal confounding variables and interested parties that have various conflicts of interest. All of these factors make it difficult to provide accurate and effective counsel to patients who present with these symptoms and who also have silicone gel breast implants. This endeavor is only made more difficult by the rise of social media and great amount of misinformation and hearsay that is reported under the guise of sound medical advice or reporting. What can be proposed when consulting with symptomatic women who are requesting that their implants be removed is nicely outlined in the paper. First, the presenting symptoms must be taken seriously and potential alternative diagnoses investigated as much as can be done using standard medical knowledge. It is here that a qualified internist, rheumatologist, immunologist or other health care professional can be of great assistance in outlining a diagnostic plan including blood work and imaging trying to identify well more recognized disease patterns such as rheumatoid arthritis or other connective tissue diseases. Building the framework of a proper workup will allow & Dennis C. Hammond [email protected]