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,
                      Southfield, Michigan

                      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
                    breast implants.

                        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