silicone and saline- aspergillus and then some

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The semi-permeability of silicone: a saline-filled breast implant with intraluminal and pericapsular Aspergillus flavus

P.K. a, , , C. Raineb, M. Ragbirb, S. MacFarlaneb and J. O'Donoghueb

aDepartment of General Surgery, Royal Infirmary, Newcastle upon Tyne NE1 4LP, UK bDepartment of Plastic Surgery, Royal Infirmary, Newcastle upon Tyne, UK

Summary

Fungal infection of breast implants is a rare complication. Growth of fungi within the lumen of saline-filled implants has previously been demonstrated in laboratory studies, however, clinical infections are rare. We report a case of Aspergillus flavus growth within and around a saline-filled breast implant that was inserted 18 months previously. This was successfully treated with implant removal and wound irrigation. Possible routes of microbial contamination as well as survival mechanisms of organisms within saline-filled implants are discussed. This case reiterates that the silicone envelope of a saline-filled implant is selectively permeable and we believe this is instrumental in facilitating intraluminal microbial growth. This also emphasises the importance of stringent asepsis when dealing with saline-filled breast implants including avoiding contamination of the saline filling fluid.

ScienceDirect - Revue de Médecine Interne, La : Reported complications of breast implants

Reported complications of breast implants

MJ Wattiauxa, *

a Service de médecine interne, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine 75012 Paris France

Reçu le: 1 Septembre 1997;

accepté le: 15 Septembre 1997.

Available online 6 October 1999.

Abstract

In the past few years silicone breast implants have been a highly charged and controversial topic for psychologic, health and politico-legal reasons for patients and for surgical, medical and research concern for professionals. Both sides are interested in knowing about the complications encountered with these implants on one hand and to find the ideal device needed for mammary reconstruction on the other. Indeed silicone does not fulfill the characteristics initially expected for a synthetic soft-tissue substitute. The local cellular response leads to the formation of a capsule around the implant with frequently unsatisfying cosmetic results. The well described leakage occurring through the silicone envelope allows the silicone gel to diffuse to multiple anatomic areas in the body. Scientific works demonstrated that silicone gel acts as a potent immunologic adjuvant and can induce antibodies to silicone surface-associated antigens. Breast implanted women who present with systemic clinical symptoms can be included either in the group of well defined connective tissue diseases or in the atypical connective tissue disease-like syndrome. The largest epidemiologic studies have shown reassuring evidence against large hazards but have documented a low but statistically significant risk of connective-tissue diseases in women with silicone gel filled implants. Practicioners must manage these patients with the awareness that reliable objective tests to identify the useful problem are not yet available.

ScienceDirect - Life Sciences : Silicone breast implants: Immunotoxic and epidemiologic issues

Silicone breast implants: Immunotoxic and epidemiologic issues

H. Yoshida2, 1, Shanna Swan3, Suzanne S. Teuber4, 1 and M. Gershwin1, *

1 Division of Rheumatology, Allergy and Clinical Immunology School of Medicine, University of California, , CA 95616, U.S.A. 2 Department of Food Science and Technology University of California, , CA 95616, U.S.A. 3 Department of Epidemiology, School of Public Health University of California, Berkeley, CA 94704, U.S.A. 4 Veterans Administration, Northern California System of Clinics Pleasant Hill, CA 94523, U.S.A.

Revised 15 December 1994.

Available online 20 October 1999

Abstract

Silicone gel implants for breast augmentation and reconstruction have been in use since 1962. Significant local complications include capsular contracture, rupture, gel “bleedâ€, and spread of the implant material to regional lymph nodes (1–7) as well as histologie findings of foreign body granulomas in the capsular tissue and in lymph nodes (7–9). Through magnetic resonance spectroscopy and atomic emission spectroscopy, silicon compounds were found in the blood of some women with silicone breast implants; silicone and silica have also been found in liver (10). Well publicized case reports have raised significant concerns regarding an association between implants and systemic disease. However, despite the availability of silicone implants for over 30 years, controlled epidemiological studies were not carried out until 1992. Currently available epidemiologic data are extremely limited. In part, because the majority of implants were used after 1981, the incidence of long-term problems is not yet known. In 1992, due to the unavailability of studies demonstrating the safety of implants, the U.S. Food and Drug Administration advised that silicone breast implants should be used only in reconstructive surgery and as part of clinical trials (11). This decision spurred a wave of research on the bioreactivity of silicone and clinical observations of patients with implants. Herein, we review the adverse immune effects following contact with silicone as well as the epidemiologic data available.

A pathophysiological examination of the biophysics and bioreactivity of silicone breast implants,

Seminars in Arthritis and Rheumatism, Volume 24, Issue 1, Supplement 1, August 1994, Pages 18-21

Nir Kossovsky, Stassi

Abstract

Historically, silicones have been considered biologically inert materials, and have therefore been used widely in a variety of medical applications. Recently, controversy has arisen concerning the bioreactivity of silicone; reports of adverse inflammatory and immunological complications that may be evoked by silicone breast implants have appeared in the medical literature and have received great attention from the lay press. The phenomena said to be associated with silicones may be attributed pathophysiotogically to the inherent surface activity of silicone. The human body's initial response to the silicone of breast implants is the adsorption of various plasma proteins, including clotting and complement proteins, to the implant surface. Other macromolecules in the biological milieu may follow. The conformational integrity of this adsorbed macromolecular layer affects much of the subsequent biological reaction. Clinically silent inflammation, locally significant inflammation, inflammation with constitutional symptoms, and inflammation with immunological activation are possible consequences.

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