EXPLANTATION OF SILICONE BREAST IMPLANTS

Silicone gel-filled breast implants have been employed clinically for decades for aesthetic augmentation or postmastectomy reconstruction. M ost patients and surgeons attest to the efficacy and safety of these d evices. However, more recently in the medical literature and popular m edia, silicone gel-filled breast implants have been claimed to incite an array of clinical sequelae such as capsular formation, granulomatou s disease, arthritis, arthralgia, fibromyalgia, autoimmune collagen va scular disease, human adjuvant disease, siliconosis, silicone-related disease, and silicone implant-associated syndrome. During a recent 24- month period, 25 referred patients underwent explantation of bilateral silicone gel-filled prostheses at the University of South Alabama. Pa tient-reported symptoms and signs included mastodynia, arthralgia, fib romyalgia, xerophthalmia, xerostomia, hypesthesia, and amblyopia. Clin ical examination and mammography were reliable in diagnosing implant r upture, but only re-exploration reliably detected implant leakage. Mos t patients underwent concurrent replacement with saline-filled devices . Histopathologic analyses of all tissue samples revealed chronic infl ammation. Subjective improvement of patient-reported symptoms and sign s occurred over the course of months postoperatively. There was no mor tality associated with explantation, with or without replacement, but an overall morbidity incidence of 20 per cent (5 of 25) was observed. Predicated upon review of the available scientific literature and anal ysis of this modest number of patients, the following perspectives are germane. 1) A small cohort of patients of status postimplantation of silicone gel-filled devices will manifest chronic morbidity. Identifyi ng such patients prospectively remains problematic. 2) Whether or not silicone gel incites adverse systemic phenomena is unproven, although it has been implicated. 3) Symptomatic patients with silicone gel-fill ed implants in place should be considered for removal, with full knowl edge of the morbidity associated with revisional procedures. 4) Patien ts currently undergoing breast augmentation or reconstruction employin g prosthetics are perhaps best served by insertion of saline-filled de vices. 5) Patient-physician dialogue regarding the risk-benefit analys is of prosthetic implantation is imperative. Patients consenting to su ch procedures must be willing to assume risks.