To the Editor.—
We read with interest the recent article by Sahn et al.1 In addition to the two referenced patients we reported in 1988,2 we have now seen more than 20 women with muscle pain, joint pain, and swelling, pulmonary disease including pleural effusion3 infiltrates and reduced carbon monoxide diffusing capacity, dry eyes and mouth, dysphagia, bladder dysfunction, neurological disease, and skin disease including localized and diffuse sclerodermalike changes.We agree that rupture of a gel-filled prosthesis is the most likely event before systemic symptoms. In some of our patients the gel-filled prosthesis was intact, but amorphous material characteristic of silicon was identified by light microscopy in the surgically removed fibrous capsules. Two of our patients with muscle pain, joint pain, and swelling had only saline-filled silicon implants. In the one patient whose fibrous capsules were removed with the prosthesis, amorphous material compatible with silicon was
Vasey FB, Espinoza LR, Martinez-Osuna P, Seleznick MJ, Brozena SJ, Penske NA. Silicone and Rheumatic Disease: Replace Implants or Not? Arch Dermatol. 1991;127(6):907. doi:10.1001/archderm.1991.01680050153020
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