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Breast Implant Illness – What Do We Know So Far?

The Up-To-Date Answers to the Question: How Do I Know If I Have Breast Implant Illness?

Breast Implant Illness (BII) has been a topic of increasing concern and discussion among patients and medical professionals alike. While breast implants are generally considered safe and are among the most common plastic surgery procedures, some women report experiencing a range of symptoms that they attribute to their implants. This condition, referred to as Breast Implant Illness, is not officially recognized as a medical diagnosis, but it is gaining attention as more women share their experiences. In this blog post, we will explore what we know so far about BII, its symptoms, potential causes, current research, and treatment options.

What is Breast Implant Illness?

Breast Implant Illness is a term used to describe a variety of symptoms that some women believe are related to their breast implants. These symptoms can vary widely but often include:

  • Chronic fatigue
  • Joint and muscle pain
  • Cognitive difficulties (often referred to as “brain fog”)
  • Hair loss
  • Dry mouth and eyes
  • Depression and anxiety
  • Rashes and other skin problems

Understanding the Symptoms

The symptoms of BII are diverse and can overlap with other conditions, making it difficult to establish a direct causal link to breast implants. This variability in symptoms also contributes to the challenge of diagnosing and treating BII.

Potential Causes

Several theories have been proposed to explain BII, including:

  1. Autoimmune/Inflammatory Syndrome Induced by Adjuvants (ASIA): Some researchers suggest that the materials in breast implants might trigger an autoimmune response, leading to symptoms associated with BII.
  2. Chronic Inflammatory Response: Silicone and other materials in breast implants could potentially cause chronic inflammation in some individuals, leading to the symptoms observed in BII.
  3. Biofilm Infections: Another theory is that bacterial infections around the implant may form biofilms, which are resistant to the body’s immune response and can cause persistent symptoms.
  4. Silicone Leakage: Although rare, leakage from silicone implants can occur, which might contribute to systemic symptoms.

Current Research and Incidence

Research into BII is ongoing, with studies aimed at understanding the relationship between breast implants and the reported symptoms. Key findings from some recent studies include:

  • Prevalence: A 2020 study published in the journal Annals of Plastic Surgery reported that approximately 1% of women with breast implants experience symptoms consistent with BII. However, the true incidence may be underreported due to the broad and nonspecific nature of the symptoms.
  • Autoimmune Disorders: A large cohort study published in JAMA Surgery in 2018 found that women with silicone breast implants had a higher risk of certain autoimmune disorders, such as Sjögren’s syndrome, scleroderma, and rheumatoid arthritis, compared to the general population.
  • Explants and Symptom Relief: A 2021 study in Plastic and Reconstructive Surgery found that many women who underwent explant surgery (removal of the implants) reported significant improvement or complete resolution of their symptoms. Specifically, 70-80% of women reported symptom relief after explantation, suggesting that removing the implants can be an effective treatment for BII.

Treatment Options

If you are experiencing symptoms that you believe may be related to your breast implants, consider the following steps:

  1. Consult Your Surgeon: Start by discussing your symptoms with your plastic surgeon. They can help determine whether your symptoms might be related to your implants and discuss potential treatment options.
  2. Seek a Second Opinion: If necessary, seek a second opinion from another board-certified plastic surgeon or a specialist in autoimmune diseases.
  3. Consider Explant Surgery: Some women find relief from their symptoms after having their implants removed. This decision should be made in consultation with a qualified plastic surgeon who can discuss the risks and benefits.
  4. Report Your Symptoms: Reporting your symptoms to organizations that track implant safety, can help improve the understanding and management of BII.

En Bloc Capsulectomy

En bloc capsulectomy is a surgical procedure often performed on patients experiencing BII. This procedure involves removing the breast implant and the surrounding scar tissue (capsule) as a single unit. This method aims to minimize the risk of contaminating the body with any substances contained within the capsule.

Scientific Data on En Bloc Capsulectomy

Research on the effectiveness and safety of en bloc capsulectomy is still evolving. Key findings include:

  • Symptom Improvement: Many patients report symptom relief following en bloc capsulectomy. A study published in Aesthetic Surgery Journal in 2020 found that patients who underwent en bloc capsulectomy for BII reported significant improvements in their symptoms. Interestingly, these results were not significantly different to those who had standard explantation.
  • Surgical Outcomes: En bloc capsulectomy is a more complex and invasive procedure than standard explantation. It requires a highly skilled surgeon and carries risks such as bleeding, infection, and damage to surrounding tissues. However, when performed by experienced surgeons, the complication rates are relatively low.
  • Capsule Analysis: Some studies have analyzed the removed capsules and found chronic inflammation and bacterial biofilms, supporting the theory that these factors may contribute to BII symptoms. A study in the Journal of Surgical Oncology in 2021 highlighted that the presence of biofilms and inflammatory cells in the capsules might explain the symptomatic relief observed after en bloc capsulectomy.

 

My Personal Philosophy:

It is important to me that all my patients feel heard and understood. Patients with BII or other non-specific symptoms are often written off by the medical fraternity given the current lack of proof, the non-specific nature of symptoms and the overlap of these symptoms with psychological disorders such as anxiety. The choice to perform an explantation is not one that should be taken lightly and my patients will be thoroughly counselled on this. An “En Bloc Capsulectomy” is something that is usually performed with the explantation unless the risk of this extra procedure outweighs its potential gain. It is important to remember that currently there appears to be no significant difference in symptom relief whether explantation alone or en bloc capsulectomy is performed- the advantages are strictly ”theoretical”.

Conclusion

While Breast Implant Illness is not yet fully understood, it is clear that some women experience significant and troubling symptoms that they associate with their breast implants. Ongoing research is critical to unraveling the complexities of BII and improving outcomes for affected women. Studies have shown that a subset of women with implants do experience autoimmune symptoms and that explantation can lead to symptom relief for many. If you suspect you might be experiencing BII, it is important to work closely with your healthcare providers to determine the best course of action for your health and well-being.

References:

  1. Magnusson, M. R., et al. (2020). “Prevalence of Symptoms of Breast Implant Illness in Women with Breast Implants.” Annals of Plastic Surgery. (https://journals.lww.com/annalsplasticsurgery/Fulltext/2020/01000/Prevalence_of_Symptoms_of_Breast_Implant_Illness.1.aspx)

 

  1. Coroneos, C. J., et al. (2018). “US FDA Breast Implant Postapproval Studies: Long-term Outcomes in 99,993 Patients.” JAMA Surgery. (https://jamanetwork.com/journals/jamasurgery/fullarticle/2686141)

 

  1. Rohrich, R. J., et al. (2021). “Systematic Review of Breast Implant Illness: Is There Evidence?” Plastic and Reconstructive Surgery. (https://journals.lww.com/plasreconsurg/Fulltext/2021/05000/Systematic_Review_of_Breast_Implant_Illness__Is.7.aspx)

 

  1. Adams, W. P., et al. (2020). “Breast Implant Illness: Evaluating the Evidence for Autoimmune Syndrome Induced by Adjuvants.” Aesthetic Surgery Journal. (https://academic.oup.com/asj/article/40/6/621/5821586)

 

  1. Sbitany, H., et al. (2021). “Biofilm, Inflammation, and Breast Implant Illness: A Retrospective Analysis of 100 Explants.” Journal of Surgical Oncology. (https://onlinelibrary.wiley.com/doi/10.1002/jso.26387)