Migration and biodegradation of free silicone from silicone gel‐filled implants after long‐term implantation

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Abstract
In vivo1H NMR chemical shift imaging (CSI), 1H NMR localized spectroscopy (STEAM) and multinuclear NMR spectroscopy 29sl, 13C, 1H) were used to characterize the aging process of silicone gel-filled implants in a rat model after long-term implantation. Although no significant changes could be observed in the implants or surrounding tissue by in vivo 1H chemical shift imaging, in vivo 1H localized spectroscopy of the livers from the longer term population revealed the presence of silicone. Ex vivo 29Sl spectroscopy of the liver, spleen, and the capsule formed around the 9 and 12 month implants clearly demonstrated and confirmed for the first time that a significant amount of free silicone migrates from silicone gel-filled implants. Also, these results show that silicones are not metabolically inert, and their biodegradation in tissue and within the implant can be monitored after 9 and 12 months by changes in the 29Sl chemical shifts seen in corresponding ex vivo spectra. The NMR findings are supported by those obtained by atomic absorption spectroscopy. Silicone aging changes not only the chemical composition of the gel, but also its proton T2 relaxation times, which increase with long implantation times. The three dimensional structure of the gel disintegrates (i.e., polymer chain rupture), increasing the molecular mobility of the polymer and, consequently, its protons T2 values. The relaxation data we obtained reflect this in vivo degradation, especially in the case of implant rupture. Additionally, small concentrations of fat in the silicone gel were found within the implants. The presence of these lipophilic substances also might increase the T2 values (plasticizer effect). These findings may assist in evaluating the implant integrity and disease symptoms related to their presence in humans.