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EDITORIAL
Connective tissue diseases following silicone breast implantation: where do we stand?
Juliane G. Hortolam, Jozélio Freire de Carvalho, Simone Appenzeller
Corresponding author
appenzellersimone@yahoo.com

Tel.: 55 19 3289-1818
State University of Campinas, Faculty of Medical Science, Department of Medicine, Rheumatology Unit, Campinas/SP, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="para10" class="elsevierStylePara elsevierViewall">Silicone&#44; which is considered biologically inert&#44; has been used in many different types of medical devices&#44; including tubing&#59; breast&#44; joint and penile implants&#59; artificial heart valves&#59; and intraocular lenses&#44; among others&#46; After a silicone implant is placed&#44; a mild reaction to the foreign body is generally observed&#44; followed by encapsulation &#40;<a class="elsevierStyleCrossRef" href="#bib1">1</a>&#41;&#46;</p><p id="para20" class="elsevierStylePara elsevierViewall">Case reports of women with silicone breast implants and connective tissue disease &#40;CTD&#41;&#44; especially scleroderma&#44; began to appear in English-language medical literature in the 1980s&#46; Currently&#44; it is widely believed that there is no association between silicone breast implants and autoimmune disease &#40;<a class="elsevierStyleCrossRef" href="#bib1">1</a>&#41;&#46; However&#44; when a patient presents with autoimmune symptoms after silicone breast implantation&#44; the question often arises again&#46;</p><p id="para30" class="elsevierStylePara elsevierViewall">Although several authors have reported the appearance of CTDs &#40;e&#46;g&#46;&#44; scleroderma&#44; Still&#39;s disease&#44; systemic lupus erythematosus &#40;SLE&#41;&#44; Sjogren&#39;s Syndrome and dermatomyositis&#41; after silicone breast implantation&#44; several case-control studies do not show such an association&#46; However&#44; there are a few points that deserve attention&#46; Silicone breast implants act as a foreign body&#44; and inflammatory responses to silicone&#44; such as granulomatous skin reactions to injected silicone&#44; synovitis around silicone prosthetic joints and lymphadenopathy proximal to silicone prostheses&#44; have been observed &#40;<a class="elsevierStyleCrossRef" href="#bib2">2</a>&#44;<a class="elsevierStyleCrossRef" href="#bib3">3</a>&#41;&#46; Microscopic evidence of silicone has been observed far from the original site &#40;e&#46;g&#46;&#44; in the liver&#41;&#44; suggesting that a small quantity of silicone particles detaches and migrates through the lymphatic or circulatory system to other organs &#40;<a class="elsevierStyleCrossRef" href="#bib1">1</a>&#44;<a class="elsevierStyleCrossRef" href="#bib4">4</a>&#41;&#8211;&#40;<a class="elsevierStyleCrossRef" href="#bib6">6</a>&#41;&#46; They may act as adjuvants and start an inflammatory process in joints or activate the immune system and stimulate the production of autoantibodies &#40;<a class="elsevierStyleCrossRef" href="#bib1">1</a>&#44;<a class="elsevierStyleCrossRef" href="#bib2">2</a>&#41;&#46;</p><p id="para40" class="elsevierStylePara elsevierViewall">The activation of the immune system has been demonstrated by the presence of antibodies to silicone and the presence of autoantibodies in the sera of patients with silicone breast implants&#46; Although several studies have detected increased titers of anti-silicone antibodies&#44; no association with clinical findings has been observed &#40;<a class="elsevierStyleCrossRef" href="#bib6">6</a>&#41;-&#40;<a class="elsevierStyleCrossRef" href="#bib10">10</a>&#41;&#46; Significantly more patients with silicone breast implants present with positive anti-DNA&#44; Sjogren syndrome antigen B &#40;anti-SSB&#47;La&#41; and anticollagen II &#40;<a class="elsevierStyleCrossRef" href="#bib6">6</a>&#41;-&#40;<a class="elsevierStyleCrossRef" href="#bib10">10</a>&#41;&#46; Antibodies and symptoms were more evident in patients who had possessed implants for a longer time period &#40;<a class="elsevierStyleCrossRef" href="#bib10">10</a>&#41;&#46;</p><p id="para50" class="elsevierStylePara elsevierViewall">In conclusion&#44; silicone breast implants may act as a foreign body and elicit autoantibody production&#46; However&#44; thus far&#44; no clear link between the presence of autoantibodies and symptoms has been observed&#46;</p><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">AUTHOR CONTRIBUTIONS</span><p id="para60" class="elsevierStylePara elsevierViewall">All authors participated in the preparation and correction of the text&#46;</p></span></span>"
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Article information
ISSN: 18075932
Original language: English
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es en pt

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