The authors measured the adjuvancy of three silicone gels taken from commercial mammary prostheses. There are several issues that, until resolved, mitigate against accepting the conclusions as presented. We address these in turn.
Literature review
The very charged atmosphere associated with the breast implant controversy puts an onus on researchers in the area to try objectively to place their research in context. Unfortunately, the authors have made a case for their proposal by being rather selective in their presentation of background information. For example, contrary to the author's claim, the evidence to suggest that silicone gels are "potent" humoral adjuvants is limited. While such gels do enhance antibody production to some extent, most reports have found that these materials are, at best, classified as weak adjuvants. On the basis of the so-called potency of silicone gels, the authors then note that such gel is an adjuvant in a collagen-induced arthritis model in DA rats. However, they fail to point out that it is well established that this rodent strain has a genetic predisposition to develop arthritis when inoculated with collagen in almost any vehicle. By using these two pieces of information, the authors then attempt to connect the adjuvanticity of silicone to the development of autoimmune diseases in women with silicone breast implants while at the same time ignoring the fact that silicone gels are weak adjuvants only when vigorously emulsified with antigen and inoculated into certain animals under selected conditions. We feel the inclusion of this element of the debate in the context of the material provided was entirely inappropriate. The notion of associating autoimmune disease with silicone gels at least should have been tempered with reference to the human epidemiological studies that suggest little or no association between implants and autoim-mune disease. The data subsequently provided by the authors in the paper are completely meaningless in helping to determine any association between autoimmune disease and the presence of silicone breast implants.