Peters W, Smith D, Lugowski S, McHugh A, MacDonald P, Baines C
Division of Plastic Surgery, Wellesley Hospital, Toronto, Ontario, Canada.
Curr Top Microbiol Immunol. 1996;210:39-48. doi: 10.1007/978-3-642-85226-8_4.
Although a potential link between silicone gel breast implants and autoimmune connective tissue disease has been suggested, none has been proven. The potential role of silicone as an immune adjuvant remains very controversial. Currently available techniques do not easily allow precise measurements of silicone in tissues. However, all compounds containing silicon (which would include silicone) can be measured accurately. The present study was designed to measure silicon levels in the fibrous capsules of patients with silicone-gel breast implants, saline breast implants and silicone inflatable penile prostheses. Baseline control silicon levels were obtained from the breast tissue of patients undergoing breast reduction, who had no exposure to breast implants. All silicon measurements were carried out using atomic absorption spectrometry with a graphite furnace. The mean silicon levels in 16 breast tissue control samples from 8 patients undergoing breast reduction varied from 0.046 to 0.742 micrograms/g dry weight, with the median mean being 0.0927. The median silicon level in capsules from 6 patients with saline implants was 7.7 micrograms/g (range 36.6). The median silicon level in capsules from 5 patients with silicone inflatable penile prostheses was 19.5 micrograms/g (range 34.8). Although the levels of silicon in capsules of patients with saline breast prostheses and penile implants were higher than in control samples, they were much lower than those from the capsules of the 58 gel implants (median 9979 micrograms/g). Of the 58 silicone gel breast implants (from 20 patients with bilateral implant removal and 18 patients with unilateral removal) which had been inserted from 1974 to 1990, 28 were intact, 8 had pinhole leaks, and 22 were ruptured. Median capsule silicon levels and ranges for all 58 implants, for intact only, for leaking, and for ruptured were: 9979 (152,000), 10,477 (88,703), 6592 (65,396), and 9922 (152,387) micrograms/g respectively. There were no significant differences in silicon levels associated with implant status, duration in situ, or year of implantation. Capsule contracture was not associated with higher levels of capsule silicon. Capsule silicon levels were about 10(6) times higher than previously assayed blood silicon levels. This may be because silicone released from implants remains localized in capsular tissue, or because blood-borne silicone is quickly excreted. Using 29Si nuclear magnetic resonance spectroscopy, no detectable silicone was found in the blood of 7 control women and 7 women with silicone-gel implants (5 with known implant rupture).
尽管有人提出硅胶乳房植入物与自身免疫性结缔组织病之间可能存在联系，但尚未得到证实。硅胶作为免疫佐剂的潜在作用仍极具争议。目前可用的技术不容易精确测量组织中的硅胶。然而，所有含硅的化合物（包括硅胶）都可以准确测量。本研究旨在测量硅胶乳房植入物、盐水乳房植入物和硅胶可膨胀阴茎假体患者纤维包膜中的硅含量。基线对照硅含量取自接受乳房缩小术且未接触过乳房植入物的患者的乳房组织。所有硅含量测量均使用带石墨炉的原子吸收光谱法进行。8例接受乳房缩小术患者的16个乳房组织对照样本中的平均硅含量在0.046至0.742微克/克干重之间，中位数平均为0.0927。6例盐水植入物患者包膜中的硅含量中位数为7.7微克/克（范围36.6）。5例硅胶可膨胀阴茎假体患者包膜中的硅含量中位数为19.5微克/克（范围34.8）。尽管盐水乳房假体和阴茎植入物患者包膜中的硅含量高于对照样本，但远低于58个凝胶植入物包膜中的硅含量（中位数9979微克/克）。在1974年至1990年植入的58个硅胶乳房植入物（来自20例双侧植入物取出患者和18例单侧取出患者）中，28个完好无损，8个有针孔泄漏，22个破裂。所有58个植入物、仅完好的、有泄漏的和破裂的包膜硅含量中位数及范围分别为：9979（152,000）、10,477（88,703）、6592（65,396）和9922（152,387）微克/克。与植入物状态、在位时间或植入年份相关的硅含量无显著差异。包膜挛缩与包膜中较高的硅含量无关。包膜中的硅含量比先前检测的血液硅含量高约10^6倍。这可能是因为从植入物中释放的硅胶仍局限于包膜组织中，或者是因为血液中的硅胶会迅速排出。使用29Si核磁共振光谱法，在7名对照女性和7名硅胶凝胶植入物女性（5名已知植入物破裂）的血液中未检测到硅胶。
