Scleroderma After Silicone Augmentation Mammoplasty

To the Editor.—  Dr Spiera¹ raises again the specter of silicone breast implants somehow being associated with autoimmune disorders, specifically, scleroderma. At first blush, the 4.4% of his patients with scleroderma who had implants contrasts dramatically with the 0.3% of his patients with rheumatoid arthritis who had breast augmentation and could possibly represent the first real documented connection. However, one must be wary of assuming causal relationships of two medical events merely because they are visible. There is too much confounding information available that casts doubt on this association.Certainly, gel-filled implants do bleed or sweat small quantities of silicone through the elastomeric envelope, and fine droplets of silicone are found in the scar capsule around the implant, axillary nodes, and possibly in minute but unmeasurable quantities throughout all body tissues. By the same token, there is probably no human in the civilized world whose body does not contain