A Nationwide Study of Connective Tissue Disease and Other Rheumatic Conditions Among Danish Women With Long-Term Cosmetic Breast Implantation
Introduction
Since their development in the 1960s, millions of women around the world have received breast implants (1). In 2004, approximately 335,000 women in the United States alone underwent breast implant surgery for cosmetic reasons (80%) or for reconstruction after surgery for breast cancer (20%) (2). In Denmark, breast implant surgery was introduced in the 1970s. Similar to that in the United States, most breast augmentations (≥70%) are currently performed for cosmetic reasons (3).
To date, more than 20 epidemiologic studies have examined the relation between breast implants and connective tissue diseases (CTDs) (4). Herein, we report on an extension of our earlier cohort study on the relation between breast implants and CTDs in Denmark (5). The current study updates the follow-up period by an additional 5 years, through 2001, to provide longer follow-up for CTD risk after breast implantation.
Section snippets
Study Cohorts
The identification of the study cohorts is described in detail elsewhere (5). In brief, the study was conducted in Denmark among women who underwent cosmetic breast implant surgery at public hospitals between 1977 and 1992 (n = 1,135) and at eight private clinics between 1973 and 1995 (n = 1,653). The public hospital cohort was identified through the Danish National Hospital Register (NHR), which, beginning in 1977, covers about 99% of all discharges from non-psychiatric hospitals in Denmark,
Results
Characteristics of the four study cohorts are shown in Table 1. A total of 2,761 women underwent breast implant surgery, 1,653 at a private clinic, 1,135 at a public hospital, and 27 at both places. The comparison cohort comprised 1,736 women from the private clinics and 7,071 women from the public hospitals. There were 37,084 person-years of follow-up in the combined implant cohort and 128,437 person-years of follow-up in the combined comparison cohort. The median age of women in the private
Discussion
The results of this extended follow-up study of breast implants and CTDs are consistent with the overwhelming epidemiologic evidence indicating that there is no association between implants and CTDs either individually or in combination. Numerous meta-analyses, weight-of-the-evidence, and critical reviews are in agreement that there is no evidence to support an association between breast implants and CTD 1, 4, 10, 11, 12, 13, 14, 15, 16, 17, 18. Since publication of the latest literature review
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