Ramos-Gallardo G, Cuenca-Pardo J, Vélez-Benítez E, Vega-Sánchez MA, Joya-Virgen K

Language: Spanish
References: 29
Page: 50-55
PDF size: 914.54 Kb.

ABSTRACT

Breast implants are widely used devices in aesthetic and reconstructive surgery; however, concern has increased regarding nonspecific systemic manifestations attributed to implants, referred to as breast implant illness or ASIA syndrome. The available evidence remains controversial, and standardized diagnostic criteria to guide clinical management are lacking. A narrative review was carried out in PubMed, Embase, Cochrane, Medline, Fisterra, Medigraphic, and Google Scholar in both English and Spanish. Search terms included breast implant explantation, ASIA syndrome, breast implant illness, autoimmune inflammatory response and systemic symptoms associated with implants. Reported symptoms, diagnostic criteria, improvement after explantation, and surgical aspects of implant removal were analyzed. Clinical manifestations are broad and overlap with autoimmune disorders. Diagnosis is based on Shoenfeld criteria, which include exposure to adjuvants and two major or minor clinical manifestations. Improvement after explantation is variable and may be attributed to psychological factors. Capsulectomy should be reserved for suspected malignant pathology, such as breast implant–associated anaplastic large cell lymphoma, owing to its additional risks. Although a definitive causal relationship between implants and systemic disease has not been demonstrated, plausible immunological mechanisms support the existence of a vulnerable patient subgroup. Progress toward standardized terminology and multidisciplinary management is necessary to support individualized, evidence-based clinical decisions.

REFERENCES

1. Ramos-Gallardo G, Vélez-Benítez E, Cuenca-Pardo J, Cárdenas-Camarena L, Ramírez-Montañana A, Carballo-Zarate A. What is the process for breast implant manufacturing? Inside eight breast implant factories. Aesthetic Plast Surg 2020; 44 (6): 2063-2074.

2. ISO 14607 (2018). Non-active surgical implants—mammary implants—particular requirement. Edition 3, 2018.

3. Singh N, Picha GJ, Hardas B, Schumacher A, Murphy DK. Five-year safety data for more than 55,000 subjects following breast implantation: comparison of rare adverse event rates with silicone implants versus national norms and saline implants. Plast Reconstr Surg 2017; 140 (4): 666-679.

4. Desouches C, Aharoni C, Magalon G. Descriptive analysis of the various mammary implants available on European market in 2005. Ann Chir Plast Esthet 2005; 50 (5): 694-701.

5. Suh LJ, Khan I, Kelley-Patteson C, Mohan G, Hassanein AH, Sinha M. Breast implant-associated immunological disorders. J Immunol Res 2022; 2022: 8536149.

6. Hoa S, Milord K, Hudson M, Nicolaidis SC, Bourré-Tessier J. Risk of rheumatic disease in breast implant users: a qualitative systematic review. Gland Surg 2021; 10 (8): 2557-2576. doi: 10.21037/gs-21-266

7. Kabir R, Stanton E, Sorenson TJ, Hemal K, Boyd CJ, Karp NS et al. Breast implant illness as a clinical entity: a systematic review of the literature. Aesthet Surg J 2024; 44 (9): NP629-NP636. doi: 10.1093/asj/sjae095.

8. Tervaert JWC, Shoenfeld Y, Cruciani C, Scarpa C, Bassetto F. Breast implant illness: is it causally related to breast implants? Autoimmun Rev 2024; 23 (1): 103448. doi: 10.1016/j.autrev.2023.103448.

9. Tamayo CAM, Estévez del Toro MH, Alvarado SR, Chong LA. Autoimmune inflammatory syndrome, with symptoms of fibromyalgia, induced by adjuvants after administration of a modeling agent. Rev Colomb Reumatol 2019; 26 (2) 145-147. Available in: https://doi.org/10.1016/j.rcreue.2018.02.002.

10. Bresnick SD. Self-reported breast implant illness: the contribution of systemic illnesses and other factors to patient symptoms. Aesthet Surg J Open Forum 2023; 5: ojad030. doi: 10.1093/asjof/ojad030.

11. Suri K, Billick S. Breast implant illness through a psychiatric lens. Aesthetic Plast Surg 2024; 48 (4): 559-567. doi: 10.1007/s00266-023-03692-6.

12. Bresnick SD. Understanding breast implant illness: the important role of nocebo and placebo-like effects. Aesthet Surg J 2023; 43 (5): NP399-NP400. doi: 10.1093/asj/sjad015.

13. Lee MA. Reply: breast implant illness, biofilm, and the role of capsulectomy. Plast Reconstr Surg Glob Open 2020; 8 (8): e2994. doi: 10.1097/GOX.0000000000002994.

14. Swanson E. Breast implant illness, biofilm, and the role of capsulectomy. Plast Reconstr Surg Glob Open 2020; 8 (7): e2999. doi: 10.1097/GOX.0000000000002999.

15. Cook J, Holmes CJ, Wixtrom R, Newman MI, Pozner JN. Characterizing the microbiome of the contracted breast capsule using next generation sequencing. Aesthet Surg J 2021; 41 (4): 440-447. doi: 10.1093/asj/sjaa097.

16. Boyd CJ, Chiodo MV, Lisiecki JL, Wagner RD, Rohrich RJ. Systematic review of capsular contracture management following breast augmentation: an update. Plast Reconstr Surg 2024; 153 (2): 303e-321e. doi: 10.1097/PRS.0000000000010358.

17. Abi-Rafeh J, Safran T, Winocour S, Dionisopoulos T, Davison P, Vorstenbosch J. Complications of capsulectomies: an analysis of the American College of Surgeons national surgical quality improvement program database. Aesthet Surg J Open Forum 2022; 4: ojac025. doi: 10.1093/asjof/ojac025.

18. Gerzenshtein J. The dishonesty of referring to total intact capsulectomy as "en bloc" resection or capsulectomy. Plast Reconstr Surg. 2020; 145 (1): 227e-228e. doi: 10.1097/PRS.0000000000006362.

19. Tevis SE, Hunt KK, Clemens MW. Stepwise en bloc resection of breast implant-associated anaplastic large cell lymphoma with oncologic considerations. Aesthet Surg J Open Forum 2019; 1 (1): ojz005. doi: 10.1093/asjof/ojz005.

20. Afshari A, Nguyen L, Glassman GE, Perdikis G, Grotting JC, Higdon KK. Incidence and preoperative risk factors for major complications after capsulectomy: analysis of 3048 patients. Aesthet Surg J 2022; 42 (6): 603-612. doi: 10.1093/asj/sjac004.

21. Gascoigne AC, Malata CM. Pleural damage during capsulectomy and exchange of long-standing breast implants in Poland syndrome: a cautionary tale. Ann Plast Surg 2012; 69 (2): 148-151. doi: 10.1097/SAP.0b013e318226b4c4.

22. Roth FS, Felder JM, Friedman JD. Breast capsulectomy specimens and their clinical implications. Plast Reconstr Surg 2010; 126 (6): 1848-1852. doi: 10.1097/PRS.0b013e3181f4463c.

23. Colaris MJL, de Boer M, van der Hulst RR, Cohen Tervaert JW. Two hundreds cases of ASIA syndrome following silicone implants: a comparative study of 30 years and a review of current literature. Immunol Res 2017; 65 (1): 120-128. doi: 10.1007/s12026-016-8821-y

24. Ospina-Gómez JE, Latorre-Arévalo MG, Ayala-Gutierrez MC, Monsalve-Suárez EF, Amaya-Muñoz MC, Caceres-Ramírez C et al. Clinical characteristics of ASIA syndrome in patients with silicone breast implants: a scoping review. World J Plast Surg 2025; 14 (2): 11-20. doi: 10.61186/wjps.14.2.11.

25. Atiyeh B, Emsieh S. Breast implant illness (BII): real syndrome or a social media phenomenon? a narrative review of the literature. Aesthetic Plast Surg 2022; 46 (1): 43-57. doi: 10.1007/s00266-021-02428-8.

26. Caravantes-Cortes MI, Roldan-Valadez E, Zwojewski-Martinez RD, Salazar-Ruiz SY, Carballo-Zarate AA. Breast prosthesis syndrome: pathophysiology and management algorithm. Aesthetic Plast Surg 2020; 44 (5): 1423-1437. Available in: http://dx.doi.org/10.1007/s00266-020-01663-9

27. Bragazzi NL, Hejly A, Watad A, Adawi M, Amital H, Shoenfeld Y. ASIA syndrome and endocrine autoimmune disorders. Best Pract Res Clin Endocrinol Metab 2020; 34 (1): 101412. doi: 10.1016/j.beem.2020.101412.

28. Ribeiro PDC, Sato EI. Autoimmune/autoinflammatory syndrome induced by adjuvants: a focus on silicone. Clin Rheumatol 2022; 41 (11): 3275-3283. doi: 10.1007/s10067-022-06274-0.

29. Colaris MJL, van der Hulst RR, Tervaert JWC. Vitamin D deficiency as a risk factor for the development of autoantibodies in patients with ASIA and silicone breast implants: a cohort study and review of the literature. Clin Rheumatol 2017; 36 (5): 981-993. doi: 10.1007/s10067-017-3589-6.