Smith Jade E, Taritsa Iulianna C, Stigliano Michael, Foppiani Jose, Lee Daniela, Raska Otakar, Suszynski Thomas, Choudry Umar, Lin Samuel J
Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, Boston, MA, 02215, USA.
Drexel University College of Medicine, Philadelphia, PA, USA.
Aesthetic Plast Surg. 2025 May 16. doi: 10.1007/s00266-025-04900-1.
Breast implant illness (BII) has raised concerns about breast implant safety, with some suggesting that heavy metals released from implants could contribute to systemic symptoms. This systematic review examines the presence of metal residues in breast implants and surrounding tissues, and their potential role in BII.
A systematic literature search following PRISMA guidelines was conducted using EMBASE, Web of Science, and PUBMED for studies published until January 2024. Inclusion criteria targeted material science and clinical research on metal residues in patients with breast implants. Data on metal concentrations, detection techniques, sample types, and clinical outcomes were extracted.
Our search identified 304 titles, from which seven unique studies met inclusion criteria. Platinum, the most frequently detected metal, was detected in implant gel, capsular tissue, and systemic samples (blood, urine, and hair), in concentrations ranging from 0.001 to 125.27 μg/g. No consistent correlation was identified between metal levels and BII symptoms. Tin, aluminum, arsenic, and zinc were detected at low levels, below established toxicity thresholds, and often attributed to environmental exposure due to their presence in control groups. Inconsistencies in metal concentrations across studies were linked to variations in metal detection techniques and sample preparation.
We highlight the presence of metal residues, particularly platinum, in breast implants and adjacent tissue, but without a definitive link to BII. Current evidence does not support heavy metal toxicity as a primary justification for total capsulectomy in BII management. Further evidence-based clinical guidelines are needed to better inform management of BII.
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 .
乳房植入物疾病（BII）引发了对乳房植入物安全性的担忧，一些人认为植入物释放的重金属可能导致全身症状。本系统评价研究了乳房植入物及其周围组织中金属残留物的存在情况，以及它们在BII中的潜在作用。
按照PRISMA指南，使用EMBASE、Web of Science和PUBMED对截至2024年1月发表的研究进行系统文献检索。纳入标准针对乳房植入物患者金属残留物的材料科学和临床研究。提取了金属浓度、检测技术、样本类型和临床结果的数据。
我们的检索共识别出304篇标题，其中七项独特研究符合纳入标准。铂是最常检测到的金属，在植入物凝胶、包膜组织和全身样本（血液、尿液和头发）中均有检测到，浓度范围为0.001至125.27μg/g。未发现金属水平与BII症状之间存在一致的相关性。锡、铝、砷和锌的检测水平较低，低于既定的毒性阈值，且由于其在对照组中的存在，通常归因于环境暴露。各研究中金属浓度的不一致与金属检测技术和样本制备的差异有关。
我们强调了乳房植入物及其周围组织中存在金属残留物，尤其是铂，但与BII没有明确联系。目前的证据不支持将重金属毒性作为BII治疗中全包膜切除术的主要依据。需要进一步基于证据的临床指南，以便更好地指导BII的治疗。
证据水平III：本刊要求作者为每篇文章指定证据水平。有关这些循证医学评级的完整描述，请参阅目录或作者在线指南 www.springer.com/00266 。
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