Michael R Harbut
Brenda C Churchill*
IJOH; 1999; 3:73-82.
From: Center for Occupational and Environmental Medicine; Wayne State University,
School of Medicine, Detroit, Michigan, and *Department of Internal Medicine, Providence Hospital,
Address for correspondence: Michael R. Harbut MD , MPH; Wayne State
University School of
medicine, Detroit, Michigan, and Center for Occupational and Environmental Medicine, 22255 Greenfield;
Southfield, Mi. 48075
The following study is of 8 breast implant patients evaluated because of
respiratory systems, pruritus and rhinorrhea. The presence of
hexachoroplatinate in the implants was noted and support for the hypothesis
that this contaminant was related to the symptoms experienced by the
patients is presented. Cases of implant related asthma were defined by
episodic dyspnea, cough, or breathlessness with onset or worsening after
implant placement and objective evidence of reversible airways obstruction,
either during the presence or after the removal of the devices.
All eight patients were found to have asthma, with airway hyper-reactivity
demonstrated by methacholine challenge testing performed in seven patients
and by partially reversible obstruction after nebulized administration of a
beta-agonist in one patient. Eight patients had urticaria and seven had
rhinorrhea. Eight of eight breast implant patients evaluated had findings
consistent with asthma. Hexachloroplatinate, a potent sensitizer and
component of breast implants, is identified as the likely primary etiologic
agent in view of findings consistent with platinosis in these patients, and the
demonstration of the leaching of hexachloroplatinate from even intact silicone
Human illness as a result of toxicity of silicone gel breast implants is an
evolving and controversial area of medical investigation. The nature of any
toxicity has not yet been fully characterized, but at least in part it appears to
be consistent with a hypersensitivity process. The medical community is
moving away from early reports of an autoimmune process, but has not yet
offered a clear explanation for complaints registered by patients who have
had the devices placed. There is also significant uncertainty with respect to
any responsible agents of toxicity.
Silicone breast implants consist of a shell encasing a gel. Both the shell
and gel are complex formulations that include carbon and silicone and traces
of many other elements. Saline implants are comprised of a saline fluid
contained in a silicone shell casing. From an Occupational Medicine
perspective, notable among the agents present in both gel and shell are the
metals chromium, nickel, aluminum and platinum. The presence of platinum
in the implants occurs as a result of its use as a catalyst in its hexasolvent
form (H2PtCl6) in the production of gel and shell. (1). All three metals are
known to be associated with occupational asthma. Hexachloroplatinate,
however, is the most potent of sensitizers reported.
There is an extensive medical literature related to the occupational
disease entity platinosis and airways reactivity, caused by exposure to
complex platinum salts. Respiratory problems in platinum refinery workers
were reported as long ago as 1911 and are extensively reviewed in the World
Health Organization Monograph of the Internal Program of Chemical Safety.
(2). Platinosis or platinum allergy historically
refers to the triad of asthma, dermatitis and rhinitis in workers exposed to
platinum. Pruritis has also been reported. Platinosis is highly prevalent in
workers exposed to platinum with a cumulative prevalent rate 50% or more.
The potency of platinum is such that the *TLV-TWA for platinum salts is 2
mcg/cubic meter of air.
(6). As a comparison, the TLVs for two other toxic metals, lead and arsenic