Microscopic Techniques and Histologic Findings in Silicone Mammary Implant Capsules and Regional Paranodal Tissues

  • D. R. Shanklin
  • D. L Smalley
Part of the Current Topics in Microbiology and Immunology book series (CT MICROBIOLOGY, volume 210)

Abstract

The best known silicone medical devices are mammary implant prostheses. Capsular fibrosis is a common result after use of these devices. An acute inflammatory reaction occurs adjacent to silicone mammary implants shortly after insertion in experimental animals [1-3]. This is expected on the basis of surgical creation of an artificial tissue plane for the prosthesis independent of reaction to silicone by adjacent connective tissues. Vistnes et al. did not quantify the acute reaction after ten days, noting rather that it became minimal by 42 days [3]. The singular difference from a simple surgical plane without foreign material lies in the early formation of a planar capsule, which thickened only slightly with time in the absence of silicone spillage [3]. Vistnes et al. reported thicker capsules both early and late following prosthetic rupture [3]. We have seen few comparable early human tissues but clinical assessments [4-6] have been reported since 1965 [5], shortly after the introduction of silicone devices for human use. Moreover, cAMP as a chemical marker for acute inflammatory reaction has been found in both human and animal material [7]; experimental work has shown comparable cellular responses to intraperitoneal injection of silicones [8].

Keywords

Arthritis Dioxide Dust Rubber Dimethyl 

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References

  1. 1.
    Rees TD, Ballantyne DL, Seidman L, Hawthorne GA (1967) Visceral response to subcutaneous and intraperitoneal injections of silicone in mice. Plast Reconstr Surg 39:402–410PubMedCrossRefGoogle Scholar
  2. 2.
    Rigdon RH, Dricks A (1975) Reaction associated with a silicone rubber gel: an experimental study. J Biomed Mater Res 9:645–659PubMedCrossRefGoogle Scholar
  3. 3.
    Vistnes L, Bentley JW, Fogarty DC (1977) Experimental study of tissue response to ruptured gel-filled mammary prostheses. Plast Reconstr Surg 59:31–34PubMedCrossRefGoogle Scholar
  4. 4.
    Burkhardt BR, Dempsey PD, Schnur PL, Tofield JJ (1986) Capsular contracture, a prospective study of the effects of local antibacterial agents. Plast Reconstr Surg 77:919–930PubMedCrossRefGoogle Scholar
  5. 5.
    Rees TD, Platt JM, Ballantyne DL (1965) An investigation of cutaneous response to dimethyl-poly siloxane (silicone liquid) in animals and human—a preliminary report. Plast Reconstr Surg 35:131–139PubMedCrossRefGoogle Scholar
  6. 6.
    Rushton DN, Brindley GS, Polkey CE, Browning GV (1989) Implant infections and antibiotic-impregnated silicone rubber coating. J Neurol Neurosurg Psychiat 52:223–229PubMedCrossRefGoogle Scholar
  7. 7.
    Faga A, Merlino M (1985) cAMP levels in reactive tissues around dimethylpolysiloxane solid implants. Plast Reconstr Surg 76:570–573PubMedCrossRefGoogle Scholar
  8. 8.
    Champion R, Faulborn J, Bowald S, Erb P (1987) Peritoneal reaction to liquid silicone: an experimental study Graefes Arch Clin Exp Ophthalmol 225:141–145PubMedCrossRefGoogle Scholar
  9. 9.
    Stratmeyer ME (1991) ed., Silicone in medical devices, HHS Publication FDA 92-4249, Rockville, Maryland, 330 p.Google Scholar
  10. 10.
    de Camara DL, Sheridan JM, Kammer BA (1993) Rupture and aging of silicone gel breast implants. Plast Reconstr Surg 91:828–836PubMedCrossRefGoogle Scholar
  11. 11.
    Dowden RV (1993) Detection of gel implant rupture: a clinical test. Plast Reconstr Surg 91:548–550PubMedCrossRefGoogle Scholar
  12. 12.
    Levine RA, Collins TL (1991) Definitive diagnosis of breast implant rupture by ultrasonography. Plast Reconstr Surg 87:1126–1128PubMedCrossRefGoogle Scholar
  13. 13.
    Rosculet KA, Ikeda DM, Forrest ME, Oneal RM, Rubin JM, Jeffries DO, Helvie MA (1992) Ruptured gel-filled silicone breast implants: sonographic findings in 19 cases. Amer J Roentgenol 159:711–716Google Scholar
  14. 14.
    Brem RF, Tempany CM, Zerhouni EA (1992) MR detection of breast implant rupture. J Comput Assist Tmogr 16:157–159Google Scholar
  15. 15.
    Harris KM, Ganott MA, Shestak KC, Losken HW, Tobon H (1993) Silicone implant rupture: detection with US. Radiology 187:761–768PubMedGoogle Scholar
  16. 16.
    Barker DE, Retsky M, Schulz SL (1981) The new low bleed mammary prosthesis: an experimental study in mice. Aesth Plast Surg 5:85–91CrossRefGoogle Scholar
  17. 17.
    Barker DE, Retsky M, Searles SL (1985) New low-bleed implant-silastic II. Aesth Plast Surg 9:39–41CrossRefGoogle Scholar
  18. 18.
    Caffee HH (1986) The influence of silicone bleed on capsule contracture. Ann Plast Surg 17:284–287PubMedCrossRefGoogle Scholar
  19. 19.
    Cohen IK (1984) Leakage of breast prostheses. Arch Surg 119:615 (letter)PubMedGoogle Scholar
  20. 20.
    Bilbey JH, Connell DG (1993) MRI diagnosis of a ruptured breast implant presenting as an infra-clavicular mass. Can Ass Radiol J 44:224–226Google Scholar
  21. 21.
    Leibman AJ, Kossoff MB, Kruse BD (1992) Intraductal extension of silicone from a ruptured breast implant. Plast Reconstr Surg 89:546–547PubMedCrossRefGoogle Scholar
  22. 22.
    Sanger JR, Kolachalam R, Komorowski RA, Yousif NJ, Maltoub HS (1991) Silicone gel extravasation into the arm: a clinical and experimental correlation of the effect on peripheral nerve, in: Stratmeyer ME, ed. Silicone in medical devices, HHS Publication FDA 92-4249, Rockville, Maryland, pp. 69–76Google Scholar
  23. 23.
    Taupmann RE, Adler S (1993) Silicone pleural effusion due to iatrogenic breast implant rupture. South medJ 86:570–571CrossRefGoogle Scholar
  24. 24.
    Shanklin DR (1991) Late tissue reactions to silicone and silica: the natural history of silicone-associated diseases with special reference to infections and immunological markers in tissue, in: Stratmeyer ME, ed., Silicone in medical devices, HHS Publication FDA 92-4249, Rockville, Maryland, pp. 103–125Google Scholar
  25. 25.
    Shanklin DR (1993) Silicone-associated diseases: tissue findings. South Med J 86:S104 (abstract)CrossRefGoogle Scholar
  26. 26.
    Shanklin DR, Smalley DL (1995) Quantitative aspects of cellular responses to silicone. Int J Occup Med Toxicol 4:99–111Google Scholar
  27. 27.
    Thomassen RW, Howbert JP, Thompson SW (1960) Transparent colorless emboli associated with dimethylsiloxane as demonstrated by phase microscopy and darkfield illumination. J Histochem Cytochem 8:2–3PubMedCrossRefGoogle Scholar
  28. 28.
    Smalley DL, Shanklin DR, Hall MF, Stevens MV, Hanissian A (1995) Immunologic stimulation of T lymphocytes by silica after use of silicone mammary implants. FASEB J 9:424–427PubMedGoogle Scholar
  29. 29.
    Goldsmith S, Kopeloff A (1961) Use of polarized-light microscopy as an aid in the diagnosis of silicosis. New Engl J Med 265:233–235PubMedCrossRefGoogle Scholar
  30. 30.
    Schepers GWH, Durkan TM, Delahant AB, Creedon FT, Redlin AJ (1957) The biological action of Degussa submicron amorphous silica dust (Dow Corning silica). AMA Arch Indus Health 16:125–146Google Scholar
  31. 31.
    Vitums VC, Edwards MJ, Niles NR, Borman JO, Lowry RD (1977) Pulmonary fibrosis from amorphous silica dust, a product of silica vapor. Arch Environ Health 32:62–68PubMedGoogle Scholar
  32. 32.
    Philippou S, Teschler H, Morgenroth K (1992) Lungenfibrose durch Inhalation von amorpher Kieselsaure [Lung fibrosis after inhalation of amorphous silica]. Zentralbl Pathol 138:41–46PubMedGoogle Scholar
  33. 33.
    Shanklin DR, Smalley DL, Hall MF, Stevens MV (1995) T cell-mediated immune response to silica in silicone breast implant patients. Curr Topic Microbiol ImmunolGoogle Scholar
  34. 34.
    Asplund O (1984) Capsular contracture in silicone gel and saline-filled breast implants after reconstruction. Plast Reconstr Surg 73:270–275PubMedCrossRefGoogle Scholar
  35. 35.
    Brantley SK, Davidson SF, Johnson MB, St. Arnold PB, Das SK (1990) The effects of prior exposure to silicone on capsule formation, histology and pressure. Ann Plast Surg 25:44–47PubMedCrossRefGoogle Scholar
  36. 36.
    Moufarrege R, Beauregard G, Bosse JP, Papillon J, Perras C (1987) Outcome of mammary capsulotomies. Ann Plast Surg 19:62–64PubMedCrossRefGoogle Scholar
  37. 37.
    Rudolph R, Abraham J, Vecchione T, Guber S, Woodward M (1978) Myofibroblasts and free silicon around breast implants. Plast Reconstr Surg 62:185–196PubMedCrossRefGoogle Scholar
  38. 38.
    Thomsen JL, Christensen L, Nielsen M, Brandt B, Breiting VB, Felby S, Nielsen E (1990) Histologic changes and silicone concentrations in human breast tissue surrounding silicone breast prostheses. Plast Reconstr Surg 85:38–41PubMedCrossRefGoogle Scholar
  39. 39.
    Ravis WD, Balogh K, Abraham JL (1985) Silicone granulomas: report of three cases and review of the literature. Human Pathol 16:19–27CrossRefGoogle Scholar
  40. 40.
    Troum OM, Mongan ES, Brody GS, Gray JD, Quismorio FP (1987) Immunological function of patients with augmentation mammoplasty (AM). Arthritis Rheum 30:S107 (abstract D96)Google Scholar
  41. 41.
    Wagner H, Belier FK, Pfautsch M ( 1977) Electron and light microscopy examination of capsules around breast implants. Plast Reconstr Surg 60:49–55PubMedCrossRefGoogle Scholar
  42. 42.
    Wickham MG, Rudolph R, Abraham J (1978) Silicon identification in prosthesis-associated fibrous capsules. Science 199:437–439PubMedCrossRefGoogle Scholar
  43. 43.
    Bergna HE (1994) Colloid chemistry of silica; an overview, in: Bergna HE ed. The colloid chemistry of silica, Amer Chem Soc, Washington DC pp 1–47, especially pp 2-6CrossRefGoogle Scholar
  44. 44.
    Ziskind M, Jones RN, Weill H(1976) Silicosis. Amer Rev Res Dis 113:643–665Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1996

Authors and Affiliations

  • D. R. Shanklin
    • 1
    • 2
  • D. L Smalley
    • 1
  1. 1.Department of PathologyUniversity of TennesseeMemphisUSA
  2. 2.Department of Obstetrics and GynecologyUniversity of TennesseeMemphisUSA

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