Silicone Breast Implants and Neurologic Disorders

Close to 700 articles can be found in the medical literature relating illness to silicone gel implant mammoplasty. Most of these articles are case series or single case reports describing autoimmune disorders (e.g., rheumatoid arthritis, scleroderma, or lupus erythematosus) in women with silicone gel implants. An estimated one to two million women have these devices implanted. Several recent articles and abstracts have linked neurologic disorders to silicone breast implants, engendering inquiries to the American Academy of Neurology (AAN). AAN's Practice Committee was thus asked to search for and summarize relevant scientific evidence and to draw conclusions regarding the nature of the associations, if any, between breast implants and neurologic disorders. A review of some recently published epidemiologic studies concerning breast implants and autoimmune disorders, the most frequently alleged association, is included in this paper for comparison. A Medlars search was performed, including Medline and Backfiles through 1975. Several search strategies were tried, but the search described here generated the greatest number of relevant articles. Both foreign language articles and case reports were included. The search terms all breast: was linked by and to all silicon: which was then linked by and to all adverse affects pre-exploded (AE&[px]), which resulted in 671 citations, the majority concerned with connective tissue disorders. This output was linked by and to nervous system diseases (px) (pre-exploded) or neurologic manifestations (px) (pre-exploded). This search led to 14 articles. Most of these 14 reports do not outline neurologic disorders per se but often describe case reports of painful syndromes of one kind or another as in the examples that follow. Vasey l indicated that some women who had silicone breast implants complain of chronic fatigue, muscle pain, peripheral neuritis, and bladder dysfunction. Collins et al. 2 presented an MRI study of the brachial plexus suggesting that the brachial plexus can be compromised by ruptured silicone breast implants. Another report of 11 patients published by Lu et al. 3 suggested that an atypical chest pain syndrome develops in some women with breast implants. All 11 women had their implants removed and eight had abnormal findings on pectoralis major muscle biopsy (neurogenic atrophy in six patients, myositis in one, and a neuroma in one). The authors concluded that the pain was secondary to local inflammatory reactions. Frey et al. 4 described tarsal tunnel syndrome secondary to silicone injections, and Sanger et al. 5 described silicone gel infiltration of the …