Gel Bleed and Rupture of Silicone Breast Implants Investigated by Light-, Electron Microscopy and Energy Dispersive X-ray Analysis of Internal Organs and Nervous Tissue

Abstract

Abstract Objective: We studied a patient who died in 2008 at the age of 56 and had been exposed to gel bleed from her silicone breast implants for 17 years. Tissue samples and nervous tissue could be obtained for analysis. Design: During autopsy, a wide range of different tissue samples were collected, frozen and embedded in paraffin and plastic (Epon). The paraffin samples were stained with Hematoxylin and Eosin (HE) as well as with Modified Oil O Red (MORO). Tissues embedded in plastic (Epon) were sectioned and prepared for light microscopy using toluïdin blue staining for Transmission electron microscopy (TEM) and Energy Dispersive X-ray microanalysis (EDX) to measure elemental Silicon (Si). Results: We found 2 types of silicone material in multiple tissue and brain samples of this patient. The first is a droplet-like form. EDX measurements demonstrated that the droplets are composed of elemental Si. The second is a plaque-like form; these structures are comprised of elemental Si and Ti (Titanium). Occasionally we found that these plaques were located inside the tissue without a lining and sometimes they were located inside the lumen of blood vessels. Conclusions: The use of EDX analysis over light microscopic examination only, is now a contributing factor for the establishment of silicone bleeding and migration throughout the whole body in high amounts.