González Alan, Ortega-Muñoz Laura, Quibano-Ordoñez Daniela, Moreno Pedro A, Vélez-Varela Patricia E
CareMe 360 Institute S.A.S., Barranquilla, Colombia.
Integrim S.A.S. Bogotá DC, Colombia.
JPRAS Open. 2024 Nov 1;43:67-73. doi: 10.1016/j.jpra.2024.10.017. eCollection 2025 Mar.
The impact of breast implants on the immune system has been debated since their introduction in the 1960s, linking silicone to systemic autoimmune diseases. Recent studies have shown that silicone gel can migrate from the implant capsule, triggering immune responses by proliferating immune cells and releasing cytokines, affecting T-cell function. Silicone particles can induce the release of IL-1β and activate the NALP3 inflammasome and B cells, causing an imbalance in regulatory T cells, responder T cells, and Th17 cells. A 41-year-old female patient with a history of breast implants presented with hyperpigmented, irregular, expanding lesions and was diagnosed withmorphea in 2017. The patient also experienced symptoms such as headaches, vertigo, polyarticular pain, dry skin, and fatigue. The medical history included silicone breast implants in 2005 (PIP brand, 395 cc) and 2014 (Silimed brand, 325 cc). The patient was diagnosed with psoriasis and Sjögren's syndrome in 2018, and ASIA syndrome in 2021 and subsequently underwent implant removal, leading to clinical improvement. The patient exhibited poliautoimmunity, with multiple autoimmune conditions. Postsurgery, the patient experienced controlled polyarticular pain, with no new skin plaques and improved clinical status. The temporal correlation between implant placement and autoimmune symptoms, alongside clinical improvement post-breast implant removal, supports the hypothesis that implants function as immune adjuvants. Genetic susceptibility and environmental factors, such as silicone exposure, likely contribute to this pathology. This case highlights the potential for silicone implants to act as immune adjuvants and highlights the importance of multidisciplinary approaches in diagnosing and treating patients with autoimmune manifestations and exposure to adjuvants.
自20世纪60年代乳房植入物问世以来,其对免疫系统的影响一直存在争议,有人将硅胶与全身性自身免疫性疾病联系起来。最近的研究表明,硅胶凝胶可从植入物包膜中迁移出来,通过使免疫细胞增殖并释放细胞因子来触发免疫反应,从而影响T细胞功能。硅胶颗粒可诱导白细胞介素-1β的释放,激活NALP3炎性小体和B细胞,导致调节性T细胞、反应性T细胞和Th17细胞失衡。一名有乳房植入史的41岁女性患者出现色素沉着、不规则、不断扩大的皮损,于2017年被诊断为硬斑病。该患者还出现了头痛、眩晕、多关节疼痛、皮肤干燥和疲劳等症状。病史包括2005年植入硅胶乳房植入物(PIP品牌,395毫升)和2014年植入(Silimed品牌,325毫升)。该患者于2018年被诊断为银屑病和干燥综合征,2021年被诊断为ASIA综合征,随后接受了植入物取出手术,临床症状得到改善。该患者表现出多自身免疫性,患有多种自身免疫性疾病。手术后,患者的多关节疼痛得到控制,没有出现新的皮肤斑块,临床状况有所改善。植入物放置与自身免疫症状之间的时间相关性,以及乳房植入物取出后的临床改善情况,支持了植入物起免疫佐剂作用的假说。遗传易感性和环境因素,如接触硅胶,可能导致了这种病理状况。该病例突出了硅胶植入物作为免疫佐剂的可能性,并强调了多学科方法在诊断和治疗有自身免疫表现且接触佐剂的患者中的重要性。