Periprosthetic bacteria and the breast implant patient with systemic symptoms

This report presents seven women with breast implants who experienced systemic symptoms which resolved rapidly after implant removal. A hypothesis is that these symptoms (which have been labeled "silicone poisoning" or "silicone adjuvant disease") may actually be caused by periprosthetic bacteria which have generally been considered innocuous, e.g., Staphylococcus epidermidis. In these cases, systemic symptoms such as malaise, fatigue, diarrhea, muscle aches, and arthralgia rapidly resolved after an antibacterial regimen plus implant removal without capsulectomy. Of cultures taken by swab in four patients, all were positive; of those taken by irrigation in three patients, one was positive. I believe that these patients' symptoms were real and offer the hypothesis that treatment of periprosthetic bacteria might explain rapid clinical improvement following explantation.