Cosmetic Surgical Procedures and Connective Tissue Disease: The Cleopatra Syndrome Revisited

During the past 30 years, numerous authors have reported single patients as well as case series of patients with presumed and well-defined connective tissue diseases after cosmetic surgical procedures. These include reports of the development of systemic sclerosis and other connective tissue diseases after augmentation mammoplasty with injections of paraffin and silicone, as well as placement of silicone gel-filled breast prostheses, and a dermatomyositis or polymyositis-like syndrome after bovine collagen implants.

The case series reported by Bridges and colleagues, in this issue of Annals, is another series of patients referred to rheumatologists interested in a potential silicone-rheumatic disease link, for evaluation of musculoskeletal complaints and emphasizes that most of these women do not have evidence of a well-defined connective tissue disease. The case series reported by Cukier and colleagues, also in this issue of Annals, includes a statistical analysis that strongly supports an association between bovine collagen implants and a dermatomyositis- or polymyositis-like syndrome. Their statistical model, however, is based on assumptions that may not be valid, and its robustness cannot be adequately judged given the available data. Well-designed epidemiologic studies are needed to examine the validity of these putative associations; until such data are available, clinicians need to be aware that the benefit-to-risk ratios of these cosmetic surgical procedures for their patients are not yet known.

In 1964, Miyoshi and colleagues [1] reported the first patient with presumed connective tissue disease after a cosmetic procedure. Numerous single case reports and case series of patients with presumed and well-defined connective tissue diseases developing after cosmetic surgical procedures have appeared in the literature during the past 20 years; notable are the reviews by Kumagai and colleagues [2], Weisman and colleagues [3], and the recent comment by Germain [4]. In 1992, I reviewed reports of 85 such cases occurring …