Breast Implant Silicones and B Cell-Mediated Immune Responses: A Systematic Review of Literature

Abstract

Introduction: Breast implants are under recent scrutiny owing to concerns about their potential for inducing immunological diseases, namely breast implant-associated anaplastic large cell lymphoma and breast implant illness. However, the impact of silicone on biologic systems remains unclear. Therefore, we performed a systematic literature review to evaluate the information available on silicone breast implants and their effect on one arm of the adaptive immune response-B lymphocytes and antibody formation.

Methods: We conducted a systematic review in EMBASE/PUBMED in accordance with the PRISMA guidelines, with search entry terms requiring discussion of silicone and immunity. The initial review returned 1079 citations. Manual screening was performed to include studies that were specific to the humoral response after exposure to silicone. Secondary full text review was performed. The extracted data included animal models and findings pertinent to B cells/antibodies in response to breast implant silicones.

Results: In total, 39 studies on B cells/antibodies and breast-implant-associated silicones were identified. Among them, 23 studies were in humans, 14 in animal models, and 2 were in vitro. Common themes included identification of antisilicone antibodies in women with breast implants, anticollagen antibodies, presence of activated B cells or immunoglobulin G in implant capsules, and sensitization of lymphocytes to silicone in vitro.

Conclusion: Despite controversial findings in the literature, there is evidence that silicone breast implants activate B cells in the breast implant capsule and may have systemic effects on the production of autoantibodies and/or sensitization of B lymphocytes to silicone. Further research is needed on how breast implants impact other arms of the immune system to understand their long-term biological impact.

Keywords: B cells; Breast; Immune system; Implants; Lymphocytes; Silicone.

Figure 1

Search strategy. Attrition diagram depicting the search strategy, including manual and computer search results.

Figure 2

Effect of silicone on B cell immune response. An illustrated example of positive findings in the literature. Findings on the effect of silicone differed in the immediate breast capsule versus that in the serum/blood stream. Notably, 12 of the studies (∼1/3^rd) reported negative findings (no B cell activation or response to silicone breast implants).