Raynaud's phenomenon and scleroderma associated with silicone gel breast implants: An example of Asia syndrome

Silicone-gel breast implants (SBI) have been widely used for breast augmentation. Although silicone is generally considered an inert substance, there has been much debate recently on its role in inducing chronic inflammation and systemic connective tissue diseases. The case of a young woman affected by Raynaud's Phenomenon (RP), worsening of vitiligo and of autoimmune thyroiditis following SBI is reported in this paper. Removal of SIN led to temporary RP remission; however, despite notable clinical improvement, nailfold capillary microscopy showed progressive microcirculatory abnormalities consistent with a diagnosis of early scleroderma. Follow-up of the patient led to the diagnosis of Systemic Sclerosis (SSc) with pulmonary hypertension. The development of SSc after SBI is described, a condition that falls into the recently recognized "ASIA" (Autoimmune/inflammatory Syndrome Induced by Adjuvants) syndrome. Nailfold capillary microscopy is a valuable tool in early SSc diagnosis, in monitoring disease activity and in establishing the risk of an aggressive course of connective tissue disease following silicone breast implantation. The relationship between silicone and the immune system requires further reports and investigation in order to determine the main individual risk factors predisposing to the wide spectrum of adjuvant-induced responses.