Risk of connective tissue disease and related disorders among women with breast implants: a nation-wide retrospective cohort study in Sweden

Abstract

Objective: To examine the relation between connective tissue disease and related conditions and breast implants. Design: Retrospective cohort study of all women in the Swedish national inpatient registry who underwent breast augmentation surgery with artificial implants during 1964-93, compared with women who underwent breast reduction surgery during the same period. Setting: Sweden. Subjects: 7442 women with implants for cosmetic reasons or for reconstruction after breast cancer surgery and 3353 women with breast reduction surgery. Main outcome measures: Subsequent hospitalisation for definite connective tissue diseases (rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, dermatomyositis, and Sjögren's syndrome) or related disorders. Results: 29 women with implants were hospitalised for definite connective tissue disease compared with 25.5 expected based on general population rates (standardised hospitalisation ratio 1.1 (95% confidence interval 0.8 to 1.6)). There were no diagnoses of systemic sclerosis, and no significant excess in risk for polymyalgia rheumatica, fibromyalgia, and several related disorders. Among women who underwent breast reduction surgery, 14 were hospitalised for definite connective tissue disease compared with 10.5 expected (standardised hospitalisation ratio 1.3 (0.7 to 2.2)). Compared with the breast reduction group, women with breast implants showed a slight reduction for all definite connective tissue disease (relative risk 0.8 (95% confidence interval 0.5 to 1.4)). Conclusions: This large nationwide cohort study shows no evidence of association between breast implants and connective tissue disease. Anecdotal reports have suggested that silicone breast implants may cause immunological disorders In a nationwide study of over 7000 Swedish women with breast implants and a control group of over 3000 women who had undergone breast reduction surgery, we found no excess risk for connective tissue disease Of the women with implants, 29 were hospitalised for connective tissue disease compared with the 25.5 expected from national hospital discharge rates, while, of those who underwent breast reduction, 14 were hospitalised compared with the 10.5 expected Direct comparison of the two groups of women showed that those with implants had a slightly lower risk of connective tissue disease There is little likelihood of an association between breast implants and connective tissue disease