There is still no clear evidence that they do
- Cyrus Coope, Professor of rheumatologya,
- Elaine Dennison, Wellcome training research fellowa
- a MRC Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD
Few more controversial issues exist in modern rheumatology than the putative association between silicone breast implants and systemic connective tissue disease. The term silicone refers to a family of chemically related organic silicon compounds derived from silica (SiO2). Small quantities of silicone are found in joint prostheses, artificial heart valves, and baby bottle nipples, but the major medical use of the fluid compound, polydimethyl siloxane, is in implants. Silicone breast implants were developed in 1962 and are used mainly for cosmetic augmentation (80%) and reconstruction after surgery for breast cancer.1 By 1992, 1-2.5 million women had received such implants in north America,2 and 100 000–150 000 British women are currently estimated to have them. Silicone implants have been associated with hardening (thought to be due in part to leakage), occasional rupture, and enlargement of lymph nodes draining the implant site.3 It is the possible link with systemic connective tissue diseases, however, that has fuelled an acrimonious medical, regulatory, and legal debate.
Although the first report of a connective tissue disease after direct injection of silicone into the breast dates from 1964,4 the first three patients with silicone implants who developed these disorders were documented in 1982.2 …