Abstract
Purpose: To examine the post explantation clinical course in symptomatic recipients of silicone gel-filled breast implants. Design: Solo private practice-based evaluation. Materials and Methods: 156 patients who developed a systemic illness following insertion of silicone gel-filled breast implants underwent removal of these devices. Mean implantation time was 12 years, and subsequent follow-up averaged 2.5 years. Results: 76/156 (49%) of patients noted amelioration of their disease starting an average 9 months after gel device removal. Longer durations of implantation were related to less clinical improvement, the latter declining from 67% of those with final surgery after 7.5 years to 31% at 14.5 years. Improvement was unaffected by prior rupture or multiple surgeries, and could not be predicted by age, unilateral implant, or subsets of clinical features. In 112/156 patients who opted for final gel device removal without saline exchange, 10% of all improved patients experienced paradoxical and simultaneous disease progression with the appearance of new symptoms and signs. This phenomenon was unaffected by prior rupture, multiple surgeries or prolonged implantation time, but had a risk nearly five times as great in any of the 44/156 patients who improved after gel for saline exchange. Transverse rectus abdominis myocutaneous (TRAM) flap surgery performed after final gel device removal was associated with a 50% incidence of panniculitis in the breast areas and/or abdominal site. Self-worth issues, usually via support groups, often needed to be addressed simultaneously with ongoing medical evaluation in order to effect explantation efforts in some seriously ill patients. Conclusions: In this cohort of symptomatic breast implant recipients, disease amelioration following explantation provides additional supportive evidence for the existence of a novel illness triggered by silicone gel-filled devices. The demonstrated improvement of systemic phenomena following implant removal was more likely to occur if these devices were in place for less than 12 years. Saline implants appeared capable of perpetuating systemic disease progression following an initial gel-induced disorder.