Commentary

The controversy about a possible link between breast implants and the development of connective tissue diseases still smolders. Janowsky et al's meta-analysis includes 8 studies published since the previous meta-analysis in 1996. The method of identifying relevant studies and the inclusion criteria for the analysis were rigorous. The review discusses methodological issues associated with 1 very large study that is based on self reported and unverified disease.¹ The results of this study disagree with and show a stronger association than most of the results of the smaller studies, and because of its size, the large study swamps the results of the others. To help to resolve these issues, Janowsky et al present 2 sets of analyses: one that includes and one that excludes the large study. They conclude, mainly on the basis of the smaller, stronger studies (a choice with which I concur), that there is no evidence of increased risks for classical connective tissue diseases with silicone breast implants.

All breast implants are enclosed in silicone, and some contain silicone gel. Subanalysis of 6 studies (excluding the study by Hennekens et al ¹) that present data on silicone gel filled implants shows no association with all connective tissue disorders combined (summary adjusted relative risk 0.82, CI 0.46 to 1.46). Although the question about whether silicone breast implants are associated with connective tissue diseases may have been settled “beyond reasonable doubt,” 1 issue remains unsettled: do women who have had cosmetic breast surgery with or without implants experience a higher frequency of non-specific rheumatic and neurological symptoms?^{2, 3} If they do, then these may either be premorbid events in women who elect to have breast surgery or a consequence of the surgery.