You may have heard of Breast Implant Illness, a term used by women with breast implants due to a cosmetic augmentation or due to reconstructive surgery who experience a wide range of symptoms following the procedure. Although breast implant illness is not an officially recognized medical diagnosis, its occurrence is being increasingly reported by patients thanks to social medias.
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What is breast implant illness?
Breast implant illness refers to a wide range of symptoms reported by women who underwent breast augmentation or breast reconstruction with implants. The symptoms may be caused by what is known in medical literature as Human Adjuvant Disease (HAD), an autoimmune syndrome caused by prolonged hypersensitization to foreign materials which are injected or implanted in the body and which was first reported by Dr. Miyoshi in 1964; this syndrome is now also known as autoimmune/inflammatory syndrome by adjuvants (ASIA).
In the early days, the symptoms were associated with the injection of liquid paraffin or silicone for breast augmentation, a practice which is now abandoned due to the many known side effects and complications. Nowadays though, the reports come from patients with breast prostheses.
There is no definitive answer yet on whether the experienced symptoms are caused by breast implants or not; one theory is that some patients may be genetically predisposed to have their immune system overreact when exposed for long periods of time to foreign materials in their bodies. The outer shell of all implant is made of silicone and it has also been demonstrated that silicone particles may “bleed out” from implants even when the shell is intact, not just when it is ruptured; these particles then migrate into surrounding tissues and are captured by macrophages causing an immune reaction.
Is BII linked to breast cancer or to BIA-ALCL?
Breast implant illness is not linked to breast cancer nor it is linked to anaplastic large cell lymphoma (ALCL) a rare type of non-Hodgkin T-Cell lymphoma linked to textured breast implants (which is not cancer of the breast tissue). Unlike BIA-ALCL, breast implant illness is reported in patients with both smooth and textured implants from all manufactures and with both saline and silicone fill as they are both made with a silicone outer shell.
Symptoms of breast implant illness
The symptoms reported by women with breast implant illness may be caused by many other conditions such as menopause, underlying autoimmune diseases, thyroid disfunction and more. Although they cannot be said to be, as of now, related to breast implants, the symptoms are real and should in no case be dismissed or downplayed, but should be carefully evaluated and investigated. Many patients say that the symptoms they experience interfere with their ability to function and have a normal life. Reported symptoms include and are not limited to:
- Joint and muscle pain
- Headache
- Chest and breast pain or burning sensation
- Fatigue
- Memory, concentration or other cognitive issues
- Rashes or skin manifestations
- Dry mouth and/or dry eyes
- Hair loss
- photosensitivity
- Gastrointestinal issues
- Anxiety or depression
- Sleep issues
The onset of symptoms varies greatly as well with some patients reporting symptoms immediately after the procedure while others develop them after many years.
Some patients are diagnosed with autoimmune disorders such as lupus, rheumatoid arthritis or Sjögren’s syndrome, while others have no evidence of autoimmune disease processes.
Is there an actual link between breast implant illness symptoms and breast implants?
Since there is no diagnostic test for breast implant illness and the symptoms reported by BII patients are experienced by the general public on a regular basis, as of now there is no link between the so-called breast implant illness and breast implants, nor there is a calculated risk of developing it following breast augmentation.
There are several studies underway to better understand the symptoms and their possible cause or links.
According to a recent study it seems that silicone breast implants are associated with higher likelihood to develop an autoimmune/rheumatic disease, but more data and studies are needed for a definitive answer.
Tests for suspected BII
If you experience symptoms that you feel may be linked to your breast implants or that have no other explanation according to other specialists, you should book a consult with your plastic surgeon. The first step involves examining the breast and the implants to ensure their integrity. Some of the tests that are suggested when suspecting breast implant illness are:
- Full blood count (FBC)
- Urea and Electrolytes (U & E) and creatinine
- Liver function
- Thyroid function
- C reactive protein
- Erythrocyte sedimentation rate
- Iron and Ferritin
- Serum IgG and IgM
- Autoimmune disease markers, such as anti-Sjogren’s syndrome antibodies, anti-scleroderma antibodies, anti-Smith (anti-SM) antibodies, antinuclear antibodies (ANA), …
The treatment plan should be formulated only after a thorough medical evaluation and after discussing risks and benefits if considering implant removal.
Healing from breast implant illness
In the case of capsular contracture or implant rupture, the removal of the breast implant is indicated according to current guidelines. When it comes to breast implant illness, data currently available says that the removal may or may not improve the symptoms:
- Patients not diagnosed with autoimmune or rheumatic disease. In these patients, about 80% reported improvement in physical symptoms and about 90% reported improvement in psychological well-being following implant explantation.
- Patients with rheumatic disease, but no autoimmune disease. These patients report initial improvement which is deemed to be a placebo effect with recurrence of symptoms within 6-12 months following the implant removal procedure.
- Patients with autoimmune disease. These patients report no improvement in symptoms following the breast implant removal surgery; there is no improvement in antibody levels either.
According to a review of cohort studies and patients reports, about 75% of patients reported improvement after implant removal, but only 16% of patients diagnosed with autoimmune disease reported improvements (alleviation but not complete resolution).
The removal of the breast implant should be discussed with your plastic surgeon: a total or near total capsulectomy may be considered in some cases, while en bloc capsulectomy is currently discouraged and should be reserved only for confirmed breast cancer.
Ultimately, the choice on how to proceed is up to the patient, but it is highly advised to stick to current medical evidence and to the advice of a surgeon with experience in treating breast implant illness patients.
Sources
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N Tanna – Plastic and Reconstructive Surgery, Apr 2021
DOI: https://doi.org/10.1097/prs.0000000000007784 - Breast Implant Illness: A Way Forward.
MR Magnusson – Plastic and Reconstructive Surgery, Mar 2019
DOI: https://doi.org/10.1097/prs.0000000000005573 - Silicone-induced human adjuvant disease?
CM Baldwin – Annals of Plastic Surgery, Apr 1983
DOI: https://doi.org/10.1097/00000637-198304000-00002 - A Case of Human Adjuvant Disease After Augmentation Rhinoplasty.
A Shiba – Aesthetic Plastic Surgery, May 1999
DOI: https://doi.org/10.1007/s002669900265 - Breast Implant Illness – Frequently Asked Questions
American Society of Plastic Surgery (ASPS), Aug 2019
https://www.surgery.org/sites/default/files/BreastImplantIllness_8-21-2019_FINAL.pdf - Statement from FDA Commissioner Scott Gottlieb, M.D. and Jeff Shuren, M.D., Director of the Center for Devices and Radiological Health, on efforts to evaluate materials in medical devices to address potential safety questions.
US Food and Drug Administration (FDA), Mar 2019
https://www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-and-jeff-shuren-md-director-center-devices-and-3 - Silicone breast implants and the risk of autoimmune/rheumatic disorders: a real-world analysis.
A Watad – International Journal of Epidemiology, Oct 2018
DOI: https://doi.org/10.1093/ije/dyy217 - Silicone breast implants and autoimmune rheumatic diseases: myth or reality.
JW Cohen Tervaert – Current Opinion in Rheumatology, Jul 2017
DOI: https://doi.org/10.1097/bor.0000000000000391
