To the Editor.
—I read with interest the report by Drs Levine and Ilowite.1 Unfortunately, no description of the site of the breast implants was included.Because breast implants can be placed subglandular (superficial to the pectoralis musculature) or submuscular (deep to the pectoralis musculature), at least two additional clinical subsets exist that could significantly affect the theory of "silicone contamination of breast milk."In the situation where the implant lies in the subglandular position, it is essentially surrounded by breast parenchyma. The submuscular position, however, interposes a significant layer of muscle tissue and fascia (although variable at times) between the implant and the breast parenchyma.
Levine MD. Sclerodermalike Esophageal Disease in Children of Mothers With Silicone Breast Implants. JAMA. 1994;272(10):769. doi:10.1001/jama.1994.03520100031025