ATYPICAL CHEST PAIN SYNDROME IN PATIENTS WITH BREAST IMPLANTS

Eleven patients, aged 36 to 55 years, with silicone breast implants ha d episodes of severe chest pain similar to heart attacks 6 weeks to 7 years after breast implantation; one patient had a severe attack 1 mon th after explantation. The chest pain, which was not related to physic al exertion, tasted from 15 minutes to 4 days, and descriptions of it varied from a ''pressing'' type of pain to ''stabbing'' pain with radi ation to the shoulders, left arm, and jaw. The associated symptoms wer e diaphoresis, nausea, vomiting, dyspnea, and palpitations. All of the patients had a normal electrocardiogram (ECG) with the exception of o ne, whose ECG showed nonspecific ST changes. Ten had cardiac evaluatio ns, all of which yielded normal results. All had implant removal, and five were found to have at least one ruptured implant. Nine had an imp lant capsule biopsy; all had chronic inflammatory rinds, and five had free silicone in tissue whether or not the implants were ruptured. All eight who had a pectoralis major muscle biopsy had abnormal results: (neurogenic atrophy [six], fasciitis [three], myositis [one], chronic inflammation [one], free silicone [one], and neuroma [one]). We conclu ded that silicone breast implants may cause an atypical chest pain syn drome, probably due to local inflammatory reactions and neuroma format ion.