It is interesting that you would ask this question because I am actually involved currently in a really interesting discussion with a number of my colleagues about this very topic in a thread on another message board for surgeons. Someone asked a question about "silicone toxicity," and from that evolved a discussion about isolated reports of allergic and other similar phenomena involving all types of implants, including saline filled ones. Let me first summarize a few pertinent points from this discussion. First, although your question pertains to your saline implants, for completeness, I want to just say that everyone was pretty much in agreement that all of the available medical literature has shown that SILICONE GEL does not seem to cause any systemic diseases or disorders or other similar medical conditions. Having said that, we also all agreed that there is more to a breast implant than just the fill type; there is an outer shell, which is virtually the same for saline and silicone implants for all manufacturers, and that shell has many components including silastic rubber, small amounts of trace metals, usually platinum used in the rubber curing process, and the like. The shell, at least in an intact implant, is what is actually in contact with your tissues. A number of doctors, myself included, reported odd-ball occurrences of allergic type symptoms arising in patients with saline implants over the years, but we didn't know what to attribute them to since they were saline implants and felt to be "safe." Dr. Robert X. Murphy, the immediate past president of the American Society of Plastic Surgeons pointed out that he actually published a report in the literature (which I have in fact researched and read) that demonstrates with patch testing of a piece of the implant shell, just like a patch test for any other allergen, that his single patient did in fact have a type of allergic response to SOME component of the rubber implant shell. Her implant was removed, and her symptoms resolved. A couple of specific things to note from that case are that the symptoms involved dermal findings like skin rash and irritation, and they occurred very soon after the implant was put in. We know that, rare as they are, allergies to things like metals, including nickel, and rubbers can occur, and this demonstrates that a similar thing can occur with the rubber of a breast implant, at least in this one isolated case it seems to have. Now, we have to be very careful about what this means, because it is a case report of a single isolated anecdotal experience, and it SHOULD NOT be extrapolated to the population as a whole at this point, nor should we start saying that "breast implants can give people allergies," because we don't know EXACTLY what specific component caused the response that was demonstrated, and this was only one isolated case, and not a well controlled series demonstrating statistical significance or any definite cause and effect relationship. In fact, just to demonstrate how truly complex this issue can be and why we, as scientists, need to do a lot of detailed work before drawing any conclusions about any of this, I can offer one criticism and oversight on the part of the authors of that published report that, based on other similar reports, needs to be clarified. They used a textured Mentor implant, which is made by imprinting a sheet of polyurethane foam rubber into the soft silicone rubber of the surface of the shell before it cures. The polyurethane is then pulled away leaving an imprint, but it is also possible (and likely) that it leaves behind very minute remnants or trace amounts of the polyurethane. This is significant because a number of other reports of these kinds of allergic phenomena occurred with textured polyurethane coated implants, and thus, it may have been some of the residual polyurethane in that case that caused the reaction, and not the silicone rubber itself at all. But this wasn't addressed in their report, and I think that's a significant oversight only because it leaves out one potential piece of the puzzle that we need to investigate to arrive at the truth. However, in situations like this, the occurrence must still be acknowledged and the findings cannot be denied. The best thing that can be said about your particular situation in relation to this is that if these rare things occur, they are probably more likely to occur earlier than at the 14 year point. But we just don't know for sure. If, after a thoughtful and thorough evaluation, no other reason for your symptoms can be identified such as the more commonly seen things like capsule contracture, periprosthetic seruma or infection, coincident costochondritis and other surrounding chest wall inflammatory conditions, and if the symptoms are severe enough to warrant it, removal of the breast implants, drastic as it may seem, is always an option for you. I am not necessarily telling you to do this, because I believe that just based upon pure statistics alone the chances of this type of allergic phenomenon specifically related to your implants being responsible for your particular symptoms are extremely low, and I would also make that same disclaimer to all ladies with implants, saline or silicone gel. But nobody can tell you with certainty that your implants aren't in some way responsible for your symptoms either. While we are working this issue out in the big picture, and while we have reports of isolated experiences like these, they are VERY rare, and I would use the analogy of taking aspirin or motrin here, in that we know in certain rare instances people can experience allergic or other adverse effects from taking them, but they still do so in order to enjoy the benefits. If you are one of the unfortunate few who experiences an adverse response to a medical treatment, we simply treat the response. That doesn't mean that the risk is prohibitive and nobody should undergo the treatment. Everything has risk involved; we just try to balance the risk with the statistical chances of reward. What you are talking about is more of the art and judgment of medicine which must take over at those times when our science has not fully elucidated a situation. This is a daily occurrence for us as physicians, and it is important that you find a responsible and thoughtful board certified plastic surgeon who will carefully examine all available information and literature on this subject, perform a thorough investigation of your symptoms and condition, and then work with you to arrive at the best plan to address your specific situation given your problems and the options for addressing them. Good luck.
