Risk of connective tissue disease and related disorders among
women with breast implants:
a nation-wide retrospective cohort study in Sweden

Olof Nyrén, Li Yin, Staffan Josefsson, Joseph K McLaughlin, William J Blot,
Martin Engqvist, Lars Hakelius, John D Boice Jr, Hans-Olov Adami


Objective: To examine the relation between connective tissue disease and related conditions and breast implants.
Design: Retrospective cohort study of all women in the Swedish national inpatient registry who underwent breast augmentation surgery with artificial implants during 1964-93, compared with women who underwent breast reduction surgery during the same period.

Setting: Sweden.

Subjects: 7,442 women with implants for cosmetic reasons or for reconstruction after breast cancer surgery and 3353 women with breast reduction surgery.

Main outcome measures: Subsequent hospitalisation for definite connective tissue diseases (rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, dermatomyositis, and Sjögren's syndrome) or related disorders.

Results: 29 women with implants were hospitalised for definite connective tissue disease compared with 25.5 expected based on general population rates (standardised hospitalisation ratio 1.1 (95% confidence interval 0.8 to 1.6)). There were no diagnoses of systemic sclerosis, and no significant excess in risk for polymyalgia rheumatica, fibromyalgia, and several related disorders. Among women who underwent breast reduction surgery, 14 were hospitalised for definite connective tissue disease compared with 10.5 expected (standardised hospitalisation ratio 1.3 (0.7 to 2.2)). Compared with the breast reduction group, women with breast implants showed a slight reduction for all definite connective tissue disease (relative risk 0.8 (95% confidence interval 0.5 to 1.4)).

Conclusions: This large nationwide cohort study shows no evidence of association between breast implants and connective tissue disease.

Department of Medical Epidemiology,
Karolinska Institute,
PO Box 281,
S-171 77 Stockholm,
Olof Nyrén, associate professor
Li Yin, statistician
Staffan Josefsson, programmer

International Epidemiology Institute,
Joseph K McLaughlin, senior scientist
William J Blot, senior scientist
John D Boice Jr, senior scientist

National Board of Health and Welfare,
Martin Engqvist, register coordinator

Department of Plastic and Hand Surgery,
University Hospital,
Lars Hakelius, professor

Department of Epidemiology,
Harvard School of Public Health,
Hans-Olov Adami, adjunct professor

Correspondence to: Dr Nyrén

email: Olof.Nyren@mep.ki.se

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