Background: Autoimmune/inflammatory syndrome (ASIA) constitutes a set of related immune mediated diseases that share a common clinical picture and a history of a previous exposure to an adjuvant agent. From a clinical standpoint, patients present with none specific manifestations such as myalgia, arthralgia, chronic fatigue and dry mouth as well as neurological manifestations such as cognitive disturbances, memory loss and neurologic disabilities. .
Case presentation: A previously healthy 25-year-old patient who underwent breast augmentation 3 years ago, with an asymptomatic rupture of the silicone breast implant, presented with three major criteria of ASIA, and improved after bilateral implant removal. She also had pleuritis and pericarditis, rarely described in such disease. A literature review on complications related to breast implants, their questionable relationship to the onset of autoimmune pathologies, and basic aspects of the diagnosis and management of ASIA was carried out.
Conclusion: The silicone presented in breast implants should be considered as an adjuvant, with the potential to cause chronic stimulation to the immune system. This can lead to systemic manifestations that can be severe in patients genetically predisposed and potentially not reversible even after surgical removal of the implants. When facing patients with breast implants and systemic clinical symptoms, lymph node disorders, neurological manifestations, or serositis as in the case presented, without other defined etiology, the possibility of ASIA should be considered in the differential diagnosis.
Full text article
Silverman BG, Brown SL, Bright RA, Kaczmarek RG, Arrowsmith-Lowe JB, Kessler DA. Reported complications of silicone gel breast implants: an epidemiologic review. Ann Intern Med. 1996;124(8):744-56.
Surgeons. ASoP. 2015 cosmetic plastic surgery statistics 2015 [Available from: http://www. plasticsurgery.org/Documents/newsresources/statistics/2015-statistics/cosmetic-proceduretrends-2015.pdf.
Plástica SBdC. Censo bianual da Sociedade Brasileira de Cirurgia Plástica. 2018 [Available from: http://www2.cirurgiaplastica.org. br/wpcontent/uploads/2019/08/Apresentac%CC%A7a%CC%83o-Censo-2018_V3.pdf.
Brenner RJ. Evaluation of breast silicone implants. Magn Reson Imaging Clin N Am. 2013;21(3):547-60.
Shah M, Tanna N, Margolies L. Magnetic resonance imaging of breast implants. Top Magn Reson Imaging. 2014;23(6):345-53.
AL TE. Do Silicone Breast Implants Cause Rheumatologic Disorders? A Systematic Review for a Court-Appointed National Science Panel. ARTHRITIS & RHEUMATISM American College of Rheumatology. 2011;44: 2477–84.
Perricone C, Colafrancesco S, Mazor RD, Soriano A, Agmon-Levin N, Shoenfeld Y. Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) 2013: Unveiling the pathogenic, clinical and diagnostic aspects. J Autoimmun. 2013;47:1-16.
Shoenfeld Y, Agmon-Levin N. 'ASIA' - autoimmune/inflammatory syndrome induced by adjuvants. J Autoimmun. 2011;36(1):4-8.
Watad A, Sharif K, Shoenfeld Y. The ASIA syndrome: basic concepts. Mediterr J Rheumatol. 2017;28(2):64-9.
Jara LJ, Garcia-Collinot G, Medina G, Cruz-Dominguez MDP, Vera-Lastra O, Carranza-Muleiro RA, et al. Severe manifestations of autoimmune syndrome induced by adjuvants (Shoenfeld's syndrome). Immunol Res. 2017;65(1):8-16.
Shoenfeld Y. Video Q&A: what is ASIA? An interview with Yehuda Shoenfeld. BMC Med. 2013;11:118.
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):981-93.
Cohen Tervaert JW, Kappel RM. Silicone implant incompatibility syndrome (SIIS): a frequent cause of ASIA (Shoenfeld's syndrome). Immunol Res. 2013;56(2-3):293-8.
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): 1423-37.
Bridges AJ, Vasey FB. Silicone breast implants. History, safety, and potential complications. Arch Intern Med. 1993;153(23):2638-44.
Zandman-Goddard G, Blank M, Ehrenfeld M, Gilburd B, Peter J, Shoenfeld Y. A comparison of autoantibody production in asymptomatic and symptomatic women with silicone breast implants. J Rheumatol. 1999;26(1):73-7.
Janowsky EC, Kupper LL, Hulka BS. Meta-analyses of the relation between silicone breast implants and the risk of connective-tissue diseases. N Engl J Med. 2000;342(11):781-90.
Surgery TASfAP. National Plastic Surgery Statistics Editor 2009 [Available from: https://www.surgery.org/.
Brown SL, Middleton MS, Berg WA, Soo MS, Pennello G. Prevalence of rupture of silicone gel breast implants revealed on MR imaging in a population of women in Birmingham, Alabama. AJR Am J Roentgenol. 2000;175(4):1057-64.
Yang N, Muradali D. The augmented breast: a pictorial review of the abnormal and unusual. AJR Am J Roentgenol. 2011;196(4):W451-60.
Caskey CI, Berg WA, Anderson ND, Sheth S, Chang BW, Hamper UM. Breast implant rupture: diagnosis with US. Radiology. 1994;190(3):819-23.
Ikeda DM, Borofsky HB, Herfkens RJ, Sawyer-Glover AM, Birdwell RL, Glover GH. Silicone breast implant rupture: pitfalls of magnetic resonance imaging and relative efficacies of magnetic resonance, mammography, and ultrasound. Plast Reconstr Surg. 1999;104(7): 2054-62.
Soo MS, Kornguth PJ, Walsh R, Elenberger C, Georgiade GS, DeLong D, et al. Intracapsular implant rupture: MR findings of incomplete shell collapse. J Magn Reson Imaging. 1997;7(4):724-30.
Fuzzard SK, Teixeira R, Zinn R. A Review of the Literature on the Management of Silicone Implant Incompatibility Syndrome. Aesthetic Plast Surg. 2019;43(5):1145-9.
Mizuno Y, Imoto H, Takahashi N, Ichikawa C, Nishioka H. Pleuritis and Pericarditis Following Silicone Breast Implants as Part of Autoimmune Syndrome Induced by Adjuvants. J Clin Rheumatol. 2018;24(7):404-6.
Shaik IH, Gandrapu B, Gonzalez-Ibarra F, Flores D, Matta J, Syed AK. Silicone Breast Implants: A Rare Cause of Pleural Effusion. Case Rep Pulmonol. 2015;2015:652918.
Dagan A, Kogan M, Shoenfeld Y, Segal G. When uncommon and common coalesce: adult onset Still's disease associated with breast augmentation as part of autoimmune syndrome induced by adjuvants (ASIA). Clin Rheumatol. 2016;35(6):1643-8.
Copyright (c) 2021 Archives of Breast Cancer
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright©. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International License, which permits copy and redistribution of the material in any medium or format or adapt, remix, transform, and build upon the material for any purpose, except for commercial purposes.