Abstract
Introduction
Silicone breast implants (SBI) may induce systemic autoimmune disease as part of autoimmune syndrome induced by adjuvants (ASIA). This syndrome bears similarities to fibromyalgia and chronic fatigue syndrome (CFS). We sought to determine whether there are any associations between SBI and depression, fibromyalgia and CFS in a rheumatology clinic population.
Methods
The electronic files of rheumatology clinic patients at the Royal Adelaide Hospital between 2000 and 2017 were searched for patients who had received SBI prior to rheumatological diagnosis. Demographics, diagnosis, implant history and whether the patient had depression, fibromyalgia or CFS were recorded. Controls were rheumatology clinic patients, half of whom had systemic sclerosis (SSc) and the other half had systemic lupus erythematosus (SLE). They were matched to cases 3:1 for age (within 2 years) and gender.
Results
Thirty patients had received SBI (mean age 47.9, 100% female). Twelve had a diagnosis of depression, 6 of fibromyalgia and 3 of CFS. Implant rupture was not associated with any of these (p = 1). There was no difference in the incidence of depression (p = 1), fibromyalgia (p = 0.76) or CFS (p = 0.3) between cases and SLE controls. When compared with SSc controls, there were significantly more patients with fibromyalgia and/or CFS in the case group (20.0% of cases vs 2.2% of SSc controls, p = 0.01) but no difference in depression (p = 0.12).
Conclusion
Fibromyalgia and CFS are more common in patients with silicone implants than SSc controls but not SLE controls. Prospective study of development of depression, fibromyalgia and CFS in recipients of SBI is required.
Similar content being viewed by others
References
Brown JB, Fryer MP, Randall P, Lu M (1953) Silicones in plastic surgery; laboratory and clinical investigations, a preliminary report. Plast Reconstr Surg 12(5):374–376
Brown JB, Fryer MP, Ohlwiler DA (1960) Study and use of synthetic materials, such as silicones and teflon, as subcutaneous prostheses. Plast Reconstr Surg 26(3):264–279
Winer LH, Sternberg TH, Lehman R, Ashley FL (1964) Tissue reactions to injected silicone liquids. A report of three cases. Arch Dermatol 90:588–593
Bridges AJ, Vasey FB (1993) Silicone breast implants. History, safety, and potential complications. Arch Intern Med 153(23):2638–2644
van Diest PJ, Beekman WH, Hage JJ (1998) Pathology of silicone leakage from breast implants. J Clin Pathol 51(7):493–497
van Nunen SA, Gatenby PA, Basten A (1982) Post-mammoplasty connective tissue disease. Arthritis Rheum 25(6):694–697
Watad A, Quaresma M, Brown S, Cohen Tervaert JW, Rodriguez-Pint I, Cervera R, Perricone C, Shoenfeld Y (2017) Autoimmune/inflammatory syndrome induced by adjuvants (Shoenfeld's syndrome) - an update. Lupus 26(7):675–681. https://doi.org/10.1177/0961203316686406
Janowsky EC, Kupper LL, Hulka BS (2000) Meta-analyses of the relation between silicone breast implants and the risk of connective-tissue diseases. N Engl J Med 342(11):781–790. https://doi.org/10.1056/NEJM200003163421105
Alijotas-Reig J, Esteve-Valverde E, Gil-Aliberas N, Garcia-Gimenez V (2018) Autoimmune/inflammatory syndrome induced by adjuvants-ASIA-related to biomaterials: analysis of 45 cases and comprehensive review of the literature. Immunol Res 66(1):120–140. https://doi.org/10.1007/s12026-017-8980-5
Cohen Tervaert JW, Colaris MJ, van der Hulst RR (2017) Silicone breast implants and autoimmune rheumatic diseases: myth or reality. Curr Opin Rheumatol 29(4):348–354. https://doi.org/10.1097/BOR.0000000000000391
Colaris MJL, de Boer M, van der Hulst RR, Cohen Tervaert JW (2017) Two hundreds cases of ASIA syndrome following silicone implants: a comparative study of 30 years and a review of current literature. Immunol Res 65(1):120–128. https://doi.org/10.1007/s12026-016-8821-y
Pavlov-Dolijanovic S, Vujasinovic Stupar N (2017) Women with silicone breast implants and autoimmune inflammatory syndrome induced by adjuvants: description of three patients and a critical review of the literature. Rheumatol Int 37(8):1405–1411. https://doi.org/10.1007/s00296-017-3731-4
Balk EM, Earley A, Avendano EA, Raman G (2016) Long-term health outcomes in women with silicone gel breast implants: a systematic review. Ann Intern Med 164(3):164–175. https://doi.org/10.7326/M15-1169
Coroneos CJ, Selber JC, Offodile AC 2nd, Butler CE, Clemens MW (2018) US FDA breast implant postapproval studies: long-term outcomes in 99,993 patients. Ann Surg 269:30–36. https://doi.org/10.1097/SLA.0000000000002990
Watad A, Rosenberg V, Tiosano S, Cohen Tervaert JW, Yavne Y, Shoenfeld Y, Shalev V, Chodick G, Amital H (2018) Silicone breast implants and the risk of autoimmune/rheumatic disorders: a real-world analysis. Int J Epidemiol 47(6):1846–1854. https://doi.org/10.1093/ije/dyy217
Goren I, Segal G, Shoenfeld Y (2015) Autoimmune/inflammatory syndrome induced by adjuvant (ASIA) evolution after silicone implants. Who is at risk? Clin Rheumatol 34(10):1661–1666. https://doi.org/10.1007/s10067-015-2931-0
Maijers MC, de Blok CJ, Niessen FB, van der Veldt AA, Ritt MJ, Winters HA, Kramer MH, Nanayakkara PW (2013) Women with silicone breast implants and unexplained systemic symptoms: a descriptive cohort study. Neth J Med 71(10):534–540
Sharif K, Watad A, Bragazzi NL, Lichtbroun M, Martini M, Perricone C, Amital H, Shoenfeld Y (2018) On chronic fatigue syndrome and nosological categories. Clin Rheumatol 37(5):1161–1170. https://doi.org/10.1007/s10067-018-4009-2
Michielsen HJ, Van Houdenhove B, Leirs I, Vandenbroeck A, Onghena P (2006) Depression, attribution style and self-esteem in chronic fatigue syndrome and fibromyalgia patients: is there a link? Clin Rheumatol 25(2):183–188. https://doi.org/10.1007/s10067-005-1154-1
Morrisroe K, Stevens W, Proudman S, Nikpour M (2017) A systematic review of the epidemiology, disease characteristics and management of systemic sclerosis in Australian adults. Int J Rheum Dis 20(11):1728–1750. https://doi.org/10.1111/1756-185X.13203
Charles J, Britt H, Pan Y (2013) Rheumatoid arthritis. Aust Fam Physician 42(11):765
Wolfram D, Rabensteiner E, Grundtman C, Bock G, Mayerl C, Parson W, Almanzar G, Hasenohrl C, Piza-Katzer H, Wick G (2012) T regulatory cells and TH17 cells in peri-silicone implant capsular fibrosis. Plast Reconstr Surg 129(2):327e–337e. https://doi.org/10.1097/PRS.0b013e31823aeacf
Teuber SS, Rowley MJ, Yoshida SH, Ansari AA, Gershwin ME (1993) Anti-collagen autoantibodies are found in women with silicone breast implants. J Autoimmun 6(3):367–377. https://doi.org/10.1006/jaut.1993.1031
Vojdani A, Campbell A, Brautbar N (1992) Immune functional impairment in patients with clinical abnormalities and silicone breast implants. Toxicol Ind Health 8(6):415–429
Cohen Tervaert JW, Kappel RM (2013) Silicone implant incompatibility syndrome (SIIS): a frequent cause of ASIA (Shoenfeld's syndrome). Immunol Res 56(2–3):293–298. https://doi.org/10.1007/s12026-013-8401-3
Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB (2010) The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res 62(5):600–610. https://doi.org/10.1002/acr.20140
Rodriguez-Pinto I, Agmon-Levin N, Howard A, Shoenfeld Y (2014) Fibromyalgia and cytokines. Immunol Lett 161(2):200–203. https://doi.org/10.1016/j.imlet.2014.01.009
Uceyler N, Hauser W, Sommer C (2011) Systematic review with meta-analysis: cytokines in fibromyalgia syndrome. BMC Musculoskelet Disord 12:245. https://doi.org/10.1186/1471-2474-12-245
Lipworth L, Tarone RE, McLaughlin JK (2004) Breast implants and fibromyalgia: a review of the epidemiologic evidence. Ann Plast Surg 52(3):284–287
Yancey JR, Thomas SM (2012) Chronic fatigue syndrome: diagnosis and treatment. Am Fam Physician 86(8):741–746
Agmon-Levin N, Zafrir Y, Kivity S, Balofsky A, Amital H, Shoenfeld Y (2014) Chronic fatigue syndrome and fibromyalgia following immunization with the hepatitis B vaccine: another angle of the 'autoimmune (auto-inflammatory) syndrome induced by adjuvants' (ASIA). Immunol Res 60(2–3):376–383. https://doi.org/10.1007/s12026-014-8604-2
Jafari A, Goudarzian AH, Bagheri Nesami M (2018) Depression in women with breast cancer: a systematic review of cross-sectional studies in Iran. APJCP 19(1):1–7. https://doi.org/10.22034/apjcp.2018.19.1.1
Chen W, Lv X, Xu X, Gao X, Wang B (2018) Meta-analysis for psychological impact of breast reconstruction in patients with breast cancer. Breast cancer (Tokyo, Japan). doi:https://doi.org/10.1007/s12282-018-0846-8
Breiting VB, Holmich LR, Brandt B, Fryzek JP, Wolthers MS, Kjoller K, McLaughlin JK, Wiik A, Friis S (2004) Long-term health status of Danish women with silicone breast implants. Plast Reconstr Surg 114(1):217–226 discussion 227-218
Manoloudakis N, Labiris G, Karakitsou N, Kim JB, Sheena Y, Niakas D (2015) Characteristics of women who have had cosmetic breast implants that could be associated with increased suicide risk: a systematic review, proposing a suicide prevention model. Arch Plast Surg 42(2):131–142. https://doi.org/10.5999/aps.2015.42.2.131
Lipworth L, Kjoller K, Holmich LR, Friis S, Olsen JH, McLaughlin JK (2009) Psychological characteristics of Danish women with cosmetic breast implants. Ann Plast Surg 63(1):11–14. https://doi.org/10.1097/SAP.0b013e3181857318
Crerand CE, Infield AL, Sarwer DB (2009) Psychological considerations in cosmetic breast augmentation. Plast Surg Nurs 29(1):49–57; quiz 58-49. https://doi.org/10.1097/01.PSN.0000347725.13404.5f
Brown SL, Pennello G, Berg WA, Soo MS, Middleton MS (2001) Silicone gel breast implant rupture, extracapsular silicone, and health status in a population of women. J Rheumatol 28(5):996–1003
Hillard C, Fowler JD, Barta R, Cunningham B (2017) Silicone breast implant rupture: a review. Gland Surg 6(2):163–168. https://doi.org/10.21037/gs.2016.09.12
Baek WY, Lew DH, Lee DW (2014) A retrospective analysis of ruptured breast implants. Arch Plast Surg 41(6):734–739. https://doi.org/10.5999/aps.2014.41.6.734
Peters W, Keystone E, Smith D (1994) Factors affecting the rupture of silicone-gel breast implants. Ann Plast Surg 32(5):449–451
Seigle-Murandi F, Lefebvre F, Bruant-Rodier C, Bodin F (2017) Incidence of breast implant rupture in a 12-year retrospective cohort: evidence of quality discrepancy depending on the range. J Plast Reconstr Aesthet Surg 70(1):42–46. https://doi.org/10.1016/j.bjps.2016.11.001
Petri M, Allbritton J (1992) Antibiotic allergy in systemic lupus erythematosus: a case-control study. J Rheumatol 19(2):265–269
Aceves-Avila FJ, Benites-Godinez V (2008) Drug allergies may be more frequent in systemic lupus erythematosus than in rheumatoid arthritis. J Clin Rheumatol 14(5):261–263. https://doi.org/10.1097/RHU.0b013e31817a241a
Acknowledgments
This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. We would like to extend our gratitude to the patients who have contributed their information to the electronic database of the Royal Adelaide Hospital. All patient identifiers or details that may disclose the identity of patients have been removed.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
This was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Disclosures
None.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Khoo, T., Proudman, S. & Limaye, V. Silicone breast implants and depression, fibromyalgia and chronic fatigue syndrome in a rheumatology clinic population. Clin Rheumatol 38, 1271–1276 (2019). https://doi.org/10.1007/s10067-019-04447-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-019-04447-y