Gel Bleed and Rupture of Silicone Breast Implants Investigated by Light-,

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https://www.clinmedjournals.org/article ... -3-087.pdf
Clinical Medical Reviews
and Case Reports
Research Article: Open Access
Kappel et al. Clin Med Rev Case Rep 2016, 3:087
ISSN: 2378-3656
ClinMed
International Library
Citation:
Kappel RM, Boer LL, Dijkman H (2016) Gel Bleed and Rupture of Silicone Breast
Implants Investigated by Light-, Electron Microscopy and Energy Dispersive X-ray Analysis of
Internal Organs and Nervous Tissue. Clin Med Rev Case Rep 3:087
Received:
December 29, 2015:
Accepted:
February 06, 2016:
Published:
February 09, 2016
Copyright:
© 2016 Kappel RM, et al. This is an open-access article distributed under the terms
of the Creative Commons Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are credited.
Volume 3 | Issue 1
Gel Bleed and Rupture of Silicone Breast Implants Investigated by
Light-, Electron Microscopy and Energy Dispersive X-ray Analysis of
Internal Organs and Nervous Tissue
R.M. Kappel
1
, L.L. Boer
2
and H. Dijkman
2
*
1
Plastic & reconstructive surgeon, Dr. Kappel Institute, Zwolle, The Netherlands
2
Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
*Corresponding author:
H.B.P.M Dijkman, Department of Pathology, Radboud University Nijmegen Medical Centre,
P.O. Box 9101, 6500 HB Nijmegen, The Netherlands, Tel: 31-24-3655297, E-mail:
[email protected]
various pieces of scientific information can give us insight. It is already
known that explantation of the implants can up to a certain point and
especially in the early stages cause an improvement of these complaints
[
5
,
6
] With regard to the silicone issue, EDX analysis has been performed
only once before, in excised lymph nodes [
7
]. In this study, with a novel
approach, the light microscopic presence of silicone droplets and plaques
in the various tissues (
Table 1
), are subjected to TEM and EDX analysis
for measuring Si-counts. This adds a new element to the already existing
knowledge with regard to silicone gel bleed from, and rupture of silicone
breast implants.
Materials and Methods
Patient
During autopsy, tissue samples of multiple organs and different
sections of brain and spinal cord areas were collected. The patient
received the silicone breast implants in 1985. In her medical files her
general practitioner reported in 1997 that she had developed “adverse
reactions to her implants”, without specifying what these reactions were.
In 2001 they were replaced by new silicone breast implants together with
a capsulectomy. At this operation the implants appeared to be ruptured,
thus leaving a near empty elastomer shell. Still in 2001 she developed
capsular contracture of the left breast and had a capsulectomy. At
that time the medical health complaints she had enumerated, such as
painful breasts, a burning sensation of the breasts, lymph packages in
the left armpit, severe memory function disorder, walking function
disorder, sleeping disturbances, complaints about bowel function and
skin disorders. She described an overall feeling of chronic illness and
complained of sudden numbness of the legs. In 2002 both her one-year-
old implants were removed. In June 2003 she developed a subcutaneous
swelling in her left armpit and subsequently axillary lymph nodes were
removed for histological examination. The pathologist reported that
he found extensive histiocytic reaction on small needle-like particles,
in concurrence with a reaction on silicon. Two weeks later the patient
developed enlarged lymph nodes in her left groin area. In 2004 she
developed an invasive ductal carcinoma of the left breast; however,
this might be coincidental and not linked to the silicone implants. Post
mortem, the same ductal carcinoma has been histologically found in
Abstract
Objective:
We studied a patient who died in 2008 at the age of
56 and had been exposed to gel bleed from her silicone breast
implants for 17 years. Tissue samples and nervous tissue could be
obtained for analysis.
Design:
During autopsy, a wide range of different tissue samples
were collected, frozen and embedded in paraffin and plastic
(Epon). The paraffin samples were stained with Hematoxylin and
Eosin (HE) as well as with Modified Oil O Red (MORO). Tissues
embedded in plastic (Epon) were sectioned and prepared for light
microscopy using toluïdin blue staining for Transmission electron
microscopy (TEM) and Energy Dispersive X-ray microanalysis
(EDX) to measure elemental Silicon (Si).
Results:
We found 2 types of silicone material in multiple tissue
and brain samples of this patient. The first is a droplet-like form.
EDX measurements demonstrated that the droplets are composed
of elemental Si. The second is a plaque-like form; these structures
are comprised of elemental Si and Ti (Titanium). Occasionally we
found that these plaques were located inside the tissue without a
lining and sometimes they were located inside the lumen of blood
vessels.
Conclusions:
The use of EDX analysis over light microscopic
examination only, is now a contributing factor for the establishment
of silicone bleeding and migration throughout the whole body in
high amounts.
Keywords
Silicone breast implants, Silicone gel bleed, PDMS, Si, TEM, EDX
Introduction
Some women, who have received silicone breast implants either for
breast augmentation or breast reconstruction, develop health problems
in different gradations over the years and a thorough explanation for this
has yet to be given [
1
-
3
] this is because this kind of research can only be
performed on living humans. In addition, as the existence of associated
complaints is still largely denied and neglected by the various medical
disciplines, they are not recorded in medical histories of the involved
women and thus do not appear in meta analyses [
4
] So, only combining

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