Breast implants are silicone shell prostheses filled with either silicone gel or saline solution and surgically implanted under the breast tissue or under the chest muscle to increase breast size or reconstruct the breast. Breast augmentation is one of the most popular cosmetic surgical procedures performed worldwide. In 2019 alone, there were over 300,000 breast augmentation surgeries in the U.S.
However, concerns have been raised over potential complications and health risks associated with breast implants, including effects on the immune system. Some women with breast implants have reported experiencing symptoms like fatigue, muscle pain, joint pain, and cognitive difficulties resembling autoimmune or connective tissue disorders. This has led to investigations into whether breast implants may be associated with increased autoimmune activity or autoimmune diseases.
Key Questions
– What evidence is there that breast implants can trigger autoimmune reactions?
– Do breast implants increase the risk of developing autoimmune diseases like rheumatoid arthritis, Sjögren’s syndrome, scleroderma, or lupus?
– How could breast implants potentially affect immune function?
– Are some types of breast implants more likely to cause immune issues than others?
– Should women with autoimmune conditions avoid getting breast implants?
Autoimmune Reactions to Breast Implants
Several studies have detected increased levels of autoantibodies and other markers of autoimmunity in women with breast implants compared to women without implants. Autoantibodies are antibodies directed against the body’s own tissues, a hallmark of autoimmune disease.
Detected Autoantibodies
Some autoantibodies found more frequently in women with breast implants include:
– Anti-nuclear antibodies (ANA): Present in up to 50% of women with implants versus up to 20% of women without implants.
– Rheumatoid factor: Present in up to 28% of women with implants versus up to 5% without.
– Anti-Ro/SSA and anti-La/SSB antibodies: Associated with Sjögren’s syndrome and systemic lupus erythematosus (SLE). Found in 13-15% of women with implants versus 3-7% without.
– Anti-cardiolipin antibodies: Associated with antiphospholipid syndrome. Detected in 15% of women with implants versus 6% without.
– Anti-cyclic citrullinated peptide (anti-CCP): Associated with rheumatoid arthritis. Found in 13-16% of women with implants versus 1-3% without.
Other Markers of Immune Activation
– Increased levels of cytokines like IL-2, IL-6, and TNF-α that promote inflammation.
– Increased numbers of CD4+ T cells.
– Increased numbers of mucosal-associated invariant T (MAIT) cells, an innate-like lymphocyte.
– Lower levels of CD19+ B cells.
Association with Autoimmune Diseases
Some population-based studies have found associations between breast implants and certain defined autoimmune disorders, while others have not. Overall, study results remain inconsistent.
Positive Associations Reported
– **Rheumatoid arthritis:** A large Swedish study found a 2-fold increased risk of developing rheumatoid arthritis after breast implant surgery.
– **Sjögren’s syndrome:** A French study found breast implants were associated with a 7-fold higher risk of Sjögren’s syndrome.
– **Systemic sclerosis:** A Canadian study found an association between breast implants and systemic sclerosis, with a risk ratio of 1.7.
– **Still’s disease:** A Dutch study found a higher than expected prevalence of Still’s disease (juvenile idiopathic arthritis) among women with breast implants.
No Association in Some Studies
– **Lupus:** Several studies have not found an increased risk of SLE in women with breast implants.
– **Multiple sclerosis:** Large studies from Canada and Sweden found no link between breast implants and MS risk.
– **Type 1 diabetes:** A U.S. study did not find breast implants associated with type 1 diabetes risk.
Potential Mechanisms
Researchers have proposed several ways breast implants could potentially influence immune system function and autoimmunity:
Silicone Gel Bleed
Silicone molecules can bleed through the implant shell over time. These molecules may stimulate the immune system and cause inflammation.
Bacterial Colonization
Bacteria such as Staphylococcus epidermidis can colonize the implant surface, provoking chronic bacterial antigen stimulation.
Implant Rupture
Implant rupture can expose large amounts of silicone material to immune cells. This may activate innate immune cells.
Genetic Predisposition
Certain HLA genes involved in autoimmunity may make some women susceptible to reacting to silicone.
Adjuvant Effect
Silicone particles may act similarly to adjuvants used in vaccines to boost immune responses. This could enhance autoimmunity.
Differences Between Implant Types
Most studies have focused on silicone gel-filled implants. Less is known about possible immune effects of saline implants or newer “gummy bear” silicone implants.
Silicone vs. Saline Implants
Some research suggests saline implants are less likely to cause immune issues and complications:
| Silicone Implants | Saline Implants |
|---|---|
| Higher rates of capsular contracture | Lower rates of capsular contracture |
| Increased reporting of rheumatic symptoms | Fewer rheumatic complaints reported |
| More frequent silicone migration and lymph node involvement | No silicone leakage risks |
However, confounding factors exist, and direct comparative studies are lacking.
Gummy Bear Implants
Form-stable silicone gel implants maintain shape better than traditional silicone gel implants. Limited evidence so far suggests similar or lower complication rates compared to other implant types. However, data on immune effects are not yet sufficient.
Breast Implants and Autoimmune Disease Risk
Based on current evidence, breast implants appear linked to signs of non-specific immune system activation and increased autoantibody production. However, a definitive causative relationship with autoimmune disease has not been established.
For women with existing autoimmune conditions, potential immune stimulation from breast implants could theoretically exacerbate underlying disease. Therefore, these patients may want to carefully consider the risks and benefits of breast augmentation.
More longitudinal mechanistic research is still needed to better characterize the immunologic effects of breast implants and determine whether these effects are directly relevant to development of autoimmune diseases.
Conclusion
Some studies have found associations between breast implants and specific autoimmune disorders like rheumatoid arthritis, Sjögren’s syndrome, and scleroderma. However, results overall remain mixed, and no autoimmune disease has been conclusively linked to breast implants.
Possible immune effects of breast implants include increased inflammation, autoantibody production, and dysregulation of various immune cell types. The mechanisms by which implants could influence immunity are not yet fully understood.
While saline implants appear less likely to cause immune issues, more research is needed directly comparing implant types. There is currently insufficient evidence regarding immune effects of form-stable “gummy bear” silicone implants.
Women with existing autoimmune conditions should weigh implant risks and benefits with their doctor. More research into long-term immunologic safety is warranted for improved patient counseling and implant device innovations.
