Clinical Characteristics of ASIA Syndrome in Patients with Silicone Breast Implants: A Scoping Review.

Background: Adjuvant-induced autoimmune syndrome (ASIA), described in 2011, includes autoimmune reactions triggered by environmental adjuvants, such as silicone breast implants (SBI). Symptoms include fatigue, sleep disturbances, appetite changes, muscle pain, fever, among others, with pathophysiology involving a combination of genetic predisposition and adjuvant exposure, leading to abnormal immune responses. We aimed to define clinical profiles and outcomes of patients with SBI, clarify ASIA's clinical implications, and guide future research.

Methods: Using the PRISMA-ScR framework, a scoping review was conducted to identify clinical profiles, preexisting conditions, prosthetic anomalies, and outcomes of patients with ASIA syndrome associated with SBI. Searches were performed in Medline, Scopus, Lilacs, and Google Scholar to locate relevant studies.

Results: Of 35 selected studies, 21 were case reports, 6 case series, and 8 cohort studies, identifying 848 patients, predominantly from the Netherlands (n=513), with an average age of 45-47 yr. Common medical histories included autoimmune diseases and breast cancer, while frequent implant-related anomalies were capsular contracture and rupture. Musculoskeletal symptoms and fatigue were the most prevalent, and implant explantation was the primary treatment, resulting in symptom improvement for most patients.

Conclusion: This review highlights the clinical features of ASIA syndrome in patients with SBI, particularly musculoskeletal symptoms, fatigue, and the presence of positive antinuclear antibody as a potential marker. However, the relationship between SBI and ASIA remains controversial. Despite limitations in current evidence, ongoing clinical monitoring and further research are crucial to better understanding and managing ASIA syndrome in patients with SBI.