Do Ruptured Implants Make a Difference in the Immune Response to Breast Cancer Antigens Vis-a-Vis Intact Implants

Goals/Purpose: There is controversy regarding breast implants and cancer risk. While there are clear subsets of patients who develop rare lymphomas and squamous cell cancers, the larger body of epidemiologic evidence suggests that women with breast implants have a lower overall risk of breast cancer. Prior studies we have performed have shown that there are heightened immune responses to select breast cancer antigens in patients with breast implants. There is a paucity of data looking at the impact of implant rupture on this same immune response. Accordingly, we endeavored to evaluate the immune response in patients with and without silicone implant rupture.

Methods/Technique: Healthy, female patients with cosmetic breast implants undergoing breast revision were recruited. Blood was collected at the time of surgery and separated into sera. Sera was tested via enzyme-linked immunosorbent assay (ELISA) for antibody responses to common breast cancer proteins, as well as tetanus for a control. Silicone implant rupture was determined by imaging or intra-operative findings at the time of implant exchange. Antibody responses were recorded as OD450 values and compared between rupture versus non-ruptured patients with Mann-Whitney test (non-parametric data) or unpaired t-test (normally distributed data). Tissue was collected, stored, processed, and total RNA was isolated. RNA samples from 4 implant rupture patients and 4 non-rupture patients were further processed and underwent bulk-RNA sequencing.

Results/Complications: 51 patients were characterized as having silicone implant rupture or non-rupture. 12 patients (23.5%) and 18 breasts (17.65%) presented with silicone implant rupture. Among the 51 patients with silicone implants, average age was 45.55 years (SD 14.15) and average BMI was 23.85 (SD 4.94). Implants were in place for an average of 6.07 years (SD 5.41) at the time of blood collection. There was no significant difference in antibody responses between ruptured and non-ruptured cohorts to the following breast cancer proteins: MUC-1 (p=0.1239), mammaglobin-A (p=0.7842), CEA (p=0.561), ER (p=0.9171) or tetanus (p=0.1447). There was a significant difference to HER-2 (p=0.0434). Among women with smooth implants only, there was no significant difference between the two cohorts to MUC-1 (p=0.0907), mammaglobin-A (p=0.2949), CEA (p=0.3528), ER (p=0.7681) or tetanus (p=0.443). There was a significant difference to HER-2 (p=0.0481). Analysis of transcriptomic data from bulk-RNA sequencing revealed that out of 28,300 genes, 28,288 (99.96%) were shared between the two cohorts.

Conclusion: Women with ruptured silicone breast implants do not have elevated antibody levels to breast cancer proteins MUC-1, mammaglobin-A, CEA, ER or control tetanus. Moreover, there are minimal transcriptional differences between women with silicone implant rupture versus without. Taken together these data indicate that silicone implant rupture does not generate a stronger immune response to breast cancer antigens, nor does it stimulate significant transcriptomic differences.