Mustafá Jessica C R, Fleury Eduardo de Faria Castro, Dijkman Henry B P M
UEMS Universidade Do Estado Do Mato Grosso Do Sul, Campo Grande, Brazil.
Centro Universitário São Camilo, Curso de Medicina, São Paulo, Brazil.
Front Glob Womens Health. 2022 Apr 25;3:730276. doi: 10.3389/fgwh.2022.730276. eCollection 2022.
Silicone implants have been used since the 1960s for aesthetic purposes and breast reconstructions. During this period, many women have reported up to 40 similar symptoms, including fatigue, the emergence of autoimmune diseases, Raynaud Phenomenon, arthritis, arthralgias, and hair loss, among others. However, most of the time, these symptoms are neglected by doctors across different specialties and are most often considered a psychosomatic disease. Since 2017, many women suffering from the same complaints have formed social media groups to report their histories and subsequently describe the disease as Breast Implant Illness (BII). The phenomenon of gel bleed and silicone toxicity is known and accepted in literature, but silicone migration into the extracapsular space is still poorly demonstrated, due to the difficulty of monitoring its particles and access to patient data.
This work demonstrated the presence of silicone through pathological examination in post-explant breast capsules and in the synovial tissue of the right wrist, detected with special Modified Oil Red O (MORO) staining in a patient with a history of BII. The pathological results were compared to the breast MRI imaging files.
The MRI images show the permeability change of the implant shell diagnosed as a water-droplet signal. It was also possible to diagnose the gel bleeding as the silicone-induced granuloma of breast implant capsule (SIGBIC) in both implants. Silicone gel bleed and migration of silicone were detected with MORO staining in and outside the capsule and in the synovial tissue of the right wrist.
In this case study, we showed that silicone migration is possible cohesive silicone gel breast implant leakage. The accumulation of silicone in the synovial tissue of the right wrist suggests local silicone toxicity and defects.
自20世纪60年代以来，硅胶植入物一直用于美容目的和乳房重建。在此期间，许多女性报告了多达40种类似症状，包括疲劳、自身免疫性疾病的出现、雷诺现象、关节炎、关节痛和脱发等。然而，大多数时候，这些症状被不同专科的医生忽视，最常被认为是一种心身疾病。自2017年以来，许多有相同症状的女性组建了社交媒体群组来讲述她们的经历，并随后将这种疾病描述为乳房植入物疾病（BII）。凝胶渗漏和硅胶毒性现象在文献中是已知且被认可的，但由于监测其颗粒和获取患者数据的困难，硅胶向囊外间隙的迁移仍缺乏充分的证据。
这项研究通过病理检查，在一位有BII病史的患者的取出乳房后的包膜以及右手腕滑膜组织中，用特殊的改良油红O（MORO）染色检测到了硅胶的存在。将病理结果与乳房MRI成像文件进行了比较。
MRI图像显示植入物外壳的渗透性变化被诊断为水滴信号。在两个植入物中也有可能将凝胶渗漏诊断为乳房植入物胶囊的硅胶诱导肉芽肿（SIGBIC）。通过MORO染色在囊内、囊外以及右手腕滑膜组织中检测到了硅胶凝胶渗漏和硅胶迁移。
在本病例研究中，我们表明硅胶迁移可能是粘性硅胶凝胶乳房植入物渗漏所致。硅胶在右手腕滑膜组织中的积累表明存在局部硅胶毒性和缺陷。
