Department of Plastic and Reconstructive Surgery, Northern Health Melbourne, 185 Cooper Street, Epping, VIC, 3076, Australia.
The University of Melbourne Medical School, Grattan Street, Parkville, VIC, 3010, Australia.
Aesthetic Plast Surg. 2019 Oct;43(5):1145-1149. doi: 10.1007/s00266-019-01407-4. Epub 2019 May 29.
Silicone implant breast augmentation has been routinely performed since the 1960s. Emerging literature suggests the existence of a clinical syndrome, silicone implant incompatibility syndrome (SIIS) resulting from silicone implants. Autoimmune reactivity develops, with subsequent symptoms including myalgias, arthralgias, chronic fatigue, sleep disturbance and cognitive impairment. While the existence of a clinical entity is currently being established in the literature, there are currently no guidelines on management.
Literature review was conducted using Medline and PubMed databases with key terms searched for, prior to hand-searching and bibliographical review until February 2019. The relevant literature was reviewed to determine whether consensus exists on the most appropriate management strategy.
Forty-nine articles relevant to SIIS were identified with twenty-one of these specifically outlining treatment. Of these, only five provided data on larger cohorts, three provided conclusions from literature reviews, and the remainder were small case series or isolated case reports. Improvement in symptoms was obtained by medical management of their immune response, by explantation and by simply counselling on the condition itself.
A new clinical condition is being described that appears to suggest a link between silicone implant use and various symptoms in a cohort of patients. The subsequent treatment of SIIS is yet to be agreed upon. Further research is required to establish guidelines for diagnosis and ensure evidence-based treatment, and that patients and clinicians have a more refined understanding of the potential risks of silicone breast implant use.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
自 20 世纪 60 年代以来，硅胶植入乳房增大已常规进行。新出现的文献表明，存在一种由硅胶植入物引起的临床综合征，即硅胶植入物不相容综合征（SIIS）。自身免疫反应发展，随后出现肌痛、关节痛、慢性疲劳、睡眠障碍和认知障碍等症状。虽然目前文献中正在确立这种临床实体的存在，但目前尚无管理指南。
使用 Medline 和 PubMed 数据库进行文献回顾，使用关键词搜索，然后进行手工搜索和文献复习，直到 2019 年 2 月。回顾相关文献，以确定是否在最合适的管理策略上达成共识。
确定了 49 篇与 SIIS 相关的文章，其中 21 篇专门概述了治疗方法。其中，只有 5 篇提供了较大队列的数据，3 篇提供了文献综述的结论，其余的都是小病例系列或孤立的病例报告。通过对免疫反应进行药物治疗、通过取出植入物以及对病情本身进行简单咨询，症状得到改善。
正在描述一种新的临床情况，该情况似乎表明在一组患者中，硅胶植入物的使用与各种症状之间存在联系。随后对 SIIS 的治疗尚未达成共识。需要进一步研究以制定诊断指南并确保基于证据的治疗，并使患者和临床医生更深入地了解硅胶乳房植入物使用的潜在风险。
证据水平 III：本杂志要求作者为每篇文章指定一个证据水平。有关这些循证医学评级的完整描述，请参阅目录或在线作者指南 www.springer.com/00266 。
