Autoimmune/auto-inflammatory syndrome induced by adjuvant (ASIA) in patients refusing breast implant explantation: two case reports and a review of the literature

Abstract

Autoimmune/auto-inflammatory syndrome induced by adjuvant (ASIA) is a pathological condition that could affect some women after breast augmentation surgery. ASIA presents with a large group of unspecific symptoms, which could deteriorate patients’ physical and psychological well-being. Herein, we present a mini-review of this condition and report two patients with autoimmune disturbances emerging soon after silicone breast implantation. Breast implants are safe for most women, but they could potentiate autoimmune reactions and provoke subjective complaints in a minor group of susceptible patients. It is unclear if the autoimmune reactions in our cases developed de novo after silicone placement or if the adjuvant had just potentiated an underlying subclinical autoimmune disease. The patients insisted on preserving their breast implants; therefore, immunosuppressive therapy was applied with beneficial effects on clinical symptoms. Identifying high-risk patients and ensuring appropriate medical monitoring is possible via screening for several antibodies, e.g. anti-nuclear and anti-phospholipid antibodies, rheumatoid factor and antistreptolysin-O titer, in all patients planning breast augmentation surgery. In the case of ASIA, short- or long-term medical treatment could be a practical approach in patients who refuse breast implant explantation. The proper education of women about the possible risks and benefits of breast implantation surgery is essential for making an informed choice.