Expert: Glen Aukerman, M.D. - 2/7/2008

Question
Hello.  I am a person who prefers natural treatments over medications.  I realize I am contradicting my beliefs when I say that at 38 years old, I want to get breast implants.  However, I was wondering what you might know about the possibility of silicone poisoning.  I want saline implants but the shell of those implants are made of silicone.  I can ask plastic surgeons this question all day but they "blow it off" as nothing.  That's why I am turning to you.  Do you have any knowledge of what, if any, problems these silicone shells could cause?  Thanks so much for your help.

Answer
Yes, there is a chance of reactions with lung tissue, lymph nodes etc

1 - 6 of 6One page.
1: J Immunol Methods. 2007 Dec 1;328(1-2):118-27. Epub 2007 Sep 19.Related Articles, Links   
Simultaneous analysis of multiple serum proteins adhering to the surface of medical grade polydimethylsiloxane elastomers.

Backovic A, Wolfram D, Del-Frari B, Piza H, Huber LA, Wick G.

Division for Experimental Pathophysiology and Immunology, Biocenter, Innsbruck Medical University, Fritz-Pregl Str 3/4, A-6020, Innsbruck, Austria. Aleksandar.Backovic@i-med.ac.at

Although polydimethylsiloxane (PDMS, silicone) elastomers are presumed to be chemically inert and of negligible toxicity, they induce a prompt acute inflammatory response with subsequent fibrotic reactions. Since local inflammatory and fibrotic side effects are associated with the proteinaceous film on the surface of silicone implants, the process of protein adherence to silicone is of practical medical relevance, and interesting from theoretical, clinical and biotechnological perspectives. It is hypothesized that the systemic side effects resembling rheumatoid and other connective tissue diseases may be triggered by local immunological changes, but this functional relationship has yet to be defined. Because the proteinaceous film on the surface of silicone has been identified as a key player in the activation of host defense mechanisms, we propose a test system based on a proteomics screen to simultaneously identify proteins adsorbed from serum to the surface of silicone. Herein, we describe protein adsorption kinetics on the surface of silicone implants, correlate the adhesion properties of serum proteins with the occurrence of adverse reactions to silicone, and successfully discriminate their signature on the silicone surface in a blinded study of patients suffering from fibrotic reactions (as determined by Baker scale) to silicone implants.

Publication Types:
Research Support, Non-U.S. Gov't

PMID: 17920619 [PubMed - indexed for MEDLINE]

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2: Isr Med Assoc J. 2007 Feb;9(2):121-2.Related Articles, Links
Prolonged fever due to silicone granulomatosis.

Blum A, Abboud W, Shajrawi I, Tatour I.

Department of Internal Medicine A, Padeh Poriya Medical Center, Tiberias, Lower Galilee, Israel. , navablum@hotmail.com

Publication Types:
Case Reports

PMID: 17348488 [PubMed - indexed for MEDLINE]

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3: Invest Ophthalmol Vis Sci. 2006 Oct;47(10):4532-9.Related Articles, Links  
Delivery from episcleral exoplants.

Pontes de Carvalho RA, Krausse ML, Murphree AL, Schmitt EE, Campochiaro PA, Maumenee IH.

Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287-9277, USA.

PURPOSE: To assess the impact of an episcleral exoplant on transscleral delivery. METHODS: New Zealand White rabbits were given a periocular injection of sodium fluorescein (fluorescein, 376 Da) or an episcleral exoplant loaded with fluorescein. Two types of exoplants were tested: (1) a rigid polyethylene device, impermeable on one side and open to the sclera on the other, that contained compressed pellets of fluorescein and was sutured loosely (apposition group) or tightly to indent the sclera (indentation group) and (2) flexible refillable silicone exoplants also open to the sclera that were secured by suturing, to form a sealed episcleral chamber that was filled with a fluorescein solution. Ocular and plasma fluorophotometry were performed at several time points, and histology was performed to evaluate the effect of exoplants on the periocular tissue. RESULTS: Within 20 minutes of a periocular injection of fluorescein, peak fluorescence was visible in the anterior chamber (AC) and at later time points was displaced toward the retina; at all time points, the highest fluorescence was in the AC. For the polyethylene device indentation group, peak fluorescence was in the retina and posterior vitreous and spread to the AC over time. For the apposition exoplant group, two peaks of fluorescence were seen initially, one in the retina and posterior vitreous and one in the AC. The area under the concentration time curve (AUC +/- SE) for fluorescein concentration was 144.4 +/- 15.1 mug . h/mL for the retinal peak and 43.6 +/- 7.1 mug . h/mL for the posterior vitreous peak after injection of 5 mg of fluorescein into a silicone exoplant, compared with a retinal peak of 3.9 +/- 0.3 and a posterior vitreous peak of 0.99 +/- 0.26 mug . h/mL after periocular injection of 5 mg of fluorescein (P < 0.01 for each). Peak plasma fluorescein levels were significantly reduced in the exoplant group compared with periocular injection. CONCLUSIONS: An episcleral exoplant facilitates diffusion of fluorescein through the sclera resulting in high levels in the retina and posterior vitreous; levels are markedly increased compared with periocular injection of the same amount of fluorescein. It also reduces peak plasma levels indicating reduction of systemic absorption. This procedure provides a new approach that can be combined with sustained-release preparations to optimize delivery of agents to the retina and choroid while minimizing the potential for systemic toxicity.

PMID: 17003449 [PubMed - indexed for MEDLINE]

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4: Anal Chem. 2006 Aug 1;78(15):5609-11.Related Articles, Links   
Comment on:
Anal Chem. 2006 May 1;78(9):2925-33.

Comments on total platinum concentration and platinum oxidation states in body fluids, tissue, and explants from women exposed to silicone and saline breast implants by IC-ICPMS.

Brook MA.

Department of Chemistry, McMaster University, 1280 Main Street W., Hamilton, ON, Canada. mabrook@mcmaster.ca

The paper by Lykissa and Maharaj (Lykissa, E. D.; Maharaj, S. V. M. Anal. Chem. 2006, 78, 2925-2933) comes to two main conclusions: platinum is found at elevated levels in women who have received breast implants, and the platinum is present in unusual oxidation states. The authors make clear their view that these are very surprising and disturbing results, both because of the quantity of platinum found and the association between higher oxidation states of platinum and toxicity of various types (sensitization-contact dermatitis, carcinogencity, among others). However, the conclusions arrived at by the authors are unsupported by the Experimental Section of the paper and the data that are reported there, and contravene the well-established chemistry of platinum.

Publication Types:
Comment

PMID: 16878904 [PubMed - indexed for MEDLINE]

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5: J Mater Sci Mater Med. 2006 Mar;17(3):259-66.Related Articles, Links   
Silicone based polyurethane materials: a promising biocompatible elastomeric formulation for cardiovascular applications.

Briganti E, Losi P, Raffi A, Scoccianti M, Munaò A, Soldani G.

Laboratory for Biomaterials & Graft Technology, G. Pasquinucci Hospital, Institute of Clinical Physiology CNR, Massa, Italy.

The biocompatibility of a new material for cardiovascular applications constituted by a poly(ether)urethane (PEtU) and a silicone [polydimethylsiloxane (PDMS)] was evaluated. The achieved material shows properties similar to both polyurethanes and silicones. The material was transformed into porous membranes by a spray-deposition technique. Since any material preparation and manufacturing procedure may introduce some toxicity, in vitro cytotoxicity screening tests were carried out. Human umbilical vein endothelial cells (HUVECs) and a mouse fibroblasts cell line (L929) were cultivated with extracts obtained from materials containing 10, 40 and 100% (w/w) of PDMS. The commercially available Estane 5714-F1 and Cardiothane 51 were used as controls. Extracts were incubated up to 72 hours with HUVECs and L929 cells. The cytotoxic effect was evaluated by light microscopy, cell viability (MTT reduction and neutral red uptake) and proliferation (5-bromo-2'-deoxyuridine incorporation) tests. In vivo studies were carried out using materials containing the same PDMS percentages as for in vitro experiments. The same commercial controls were used. Results obtained with cell culture studies agreed with those obtained in the in vivo experiments and showed that the material preparation and manufacturing procedure do not introduce any toxicity in the products at each PDMS concentration investigated.

Publication Types:
Evaluation Studies
Research Support, Non-U.S. Gov't

PMID: 16555118 [PubMed - indexed for MEDLINE]

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6: Biomaterials. 2002 Sep;23(17):3545-53.Related Articles, Links  
Soft tissue response to microtextured silicone and poly-L-lactic acid implants: fibronectin pre-coating vs. radio-frequency glow discharge treatment.

Parker JA, Walboomers XF, Von den HJ, Maltha JC, Jansen JA.

Department of Biomaterials, College of Dental Science, University Medical Center Nijmegen, Netherlands.

From in vitro studies it is known that a plasma-treatment can enhance cell spreading. Similar effects can be observed after pretreatment of the surface with a protein coating, to mediate cell adhesion. The aim of the current study was to evaluate the in vivo effects of these surface modifications, in a three-month experiment in a goat model. We made silicone and poly-L-lactic acid implants with double-sided parallel micro-grooves (depth 1.0 microm, width 10.0 microm), a random surface roughness, or a smooth surface. Implants either received a radio-frequency glow discharge (RFGD) treatment, a fibronectin (Fn) pre-coating, or no pre-treatment. Subsequently, they were inserted into subcutaneous pockets created on the flanks of goats for 1, 3 or 12 weeks. Histological analysis showed that a fibrous tissue capsule had formed around all implants. Histomorphometrical analysis was performed on capsule thickness, capsule quality and the implant-tissue interface quality. Fn-treated surfaces showed a considerable early inflammatory reaction. Besides this, RFGD treatment or Fn pre-coating did not further influence any of the measured parameters. In conclusion, pre-treatment of polymer implant surfaces with Fn or RFGD treatment did not significantly influence tissue reaction around implants with micro-grooved, roughened or smooth surfaces.

Publication Types:
Research Support, Non-U.S. Gov't