To the Editor. —
I take issue with the conclusions drawn in the BRIEF REPORT by Dr Spiera1 regarding the incidence of scleroderma after silicone augmentation mammoplasty. The fact that five patients developed scleroderma, some 20 years after silicone augmentation mammoplasty, should in no way be inferred to reflect a causal relationship. How many of Dr Spiera's patients with scleroderma had had braces in childhood? If there were five, would this be significant? Of course not. The removal of breast implants and subsequent improvement of one patient again has no causal relationship, as patients who maintained their prostheses also improved. Do these five patients represent a statistically significant group of patients who undergo breast augmentation? Again, the answer is no.In fact, the existence of human adjuvant disease itself is highly controversial, as causal relationship of silicone implants and connective-tissue disease has yet to be proved. It must be
Wexler AM. Scleroderma After Silicone Augmentation Mammoplasty. JAMA. 1988;260(20):3008. doi:10.1001/jama.1988.03410200052024
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