Physicochemical and immunological basis of silicone pathophysiology

Silicones, model biomaterials with almost ubiquitous applications, are the focus of a contentious debate. In this review, we will consider both established physicochemical phenomena and immunological phenomena; and then consider the human clinical phenomena that relate directly to them. We will explore the two competing theories of the biological activity of silicones, and we will discuss the weaknesses in the various arguments that silicone is inert. We conclude that from a pathophysiological perspective, silicones should be expected to be bioactive materials and that the physicochemical and immunological data at the experimental level are compelling.