Breast implant illness (sometimes referred to as “BII”) is an autoimmune disorder that affects a small number of women who have had breast augmentation. BII occurs when a problem with a breast implant causes side effects or immune system responses that affect your overall health and wellbeing. Breast implant illness may have many far-ranging symptoms of different severity. Common problems that patients with BII may experience include:1
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Breast Implant Illness is characterized by systemic symptoms that are often similar to other conditions and may even be attributed as part of the normal aging process. Illnesses and autoimmune diseases with similar symptoms include chronic Lyme disease, mononucleosis, Sjogren’s syndrome, fibromyalgia, and rheumatoid arthritis. So, how can you tell the difference between the symptoms stemming from your implant, or from other problems?
Here are some questions to help you discern if you might be suffering from breast implant illness:
Answering yes to any of these questions does not necessarily mean you have breast implant illness, but if you did answer yes and if you have any of the symptoms listed above, you should see a health care professional for a medical diagnosis.
Saline and silicone breast implants are medical devices, and although they are FDA approved for safety, they can occasionally develop issues such as ruptures or silicone leakage. The human body can also have an autoimmune reaction called Human Adjuvant Disease to foreign bodies and this can be an underlying cause of breast implant illness.
Breast implants can also become contaminated by biofilms (a collection of microorganisms, such as bacteria, that can grow on a surface); this can occur from the initial placement or from contamination at a later date, like during pregnancy or breastfeeding (period when the breasts may have a higher bacterial load).
When breast implants get old, the silicone can rupture. The ruptured silicone usually remains contained within the capsule, however, it can spread through the lymphatic system to other parts of the surrounding breast, muscle, and lymph nodes. Silicone is nonreactive in most people, but can cause inflammation, granulomas, and calcifications in sensitive individuals.
To correct this, the free silicone, tissue surrounding it, and the leaked silicone are removed to maximize the reduction of silicone particles and help prevent any future reactivity, which includes the capsule. Silicone can also spread to local lymph nodes in the axilla. We do not recommend removal of lymph nodes with silicone unless they are symptomatic.
Breast implant illness from biofilm occurs when the surface of the implant comes into contact with a bacteria that can cause biofilms. Biofilms stick to the implant and are embedded within an extracellular matrix that is composed of extracellular polymeric substances. Unfortunately, the bacteria that can cause biofilms are present on our skin, in the ducts of the breast, and can proliferate during breastfeeding.
If these bacteria contaminate the surface of the implant, they can populate the surface of the implant, and cause unwanted inflammation and autoimmune symptoms. To make the process even more complicated, biofilms can be present without inflammation. They can also be hard to grow out of culture, and therefore hard to diagnose. For that reason, we recommend every patient have a PCR performed on their capsule and implant surface (to help determine the type of biofilm) as well as the usual microbiological specimen. If breast implant illness is from biofilms, the removal of the capsule and the implant is necessary.
No, breast implant illness is an autoimmune condition that may be resolved by the removal of breast implants. There is a very rare type of cancer called breast implant-associated anaplastic large cell lymphoma (bia-alcl) that is caused only by specific types of textured silicone gel breast implants. The U.S. food and drug administration has worked with manufacturers to recall the specific types of implants associated with bia-alcl.
The plastic surgeons at Cassileth Plastic Surgery are highly skilled in multiple techniques for breast implant removal (explant surgery). If BII is from old, leaking implants or from biofilm, the implant should be removed as well as the entire capsule (a procedure called capsulectomy). The capsule, or the body’s own scar tissue that surrounds the implant, must also be removed, because the capsule can contain free silicone and will also contain all the biofilm, if present. When possible, we may perform explantation using a technique called en bloc, which keeps the entire capsule intact. After removal, we test the capsule for pathology, for microbiology, and for PCR.
The best cosmetic outcome for breast implant removal surgery is when the loss of volume is replaced and the pectoralis muscle is repaired at the same time as implant removal. For patients with submuscular implants, we remove the implant, and repair the pectoral muscle (which is cut during primary surgery).
Otherwise, the pectoral muscle is not connected correctly to the chest, which can result in a pectoralis motion deformity, also called “ pec flex” or “windowshading”. In addition, the hole left by the implant should be closed off to stop the breast from sagging, either with an internal lift, fat grafting, or with a mastopexy, depending on the patient, the amount of loose skin, the size of the implant, and the final desired breast size.
The surgery takes two to four hours, depending on the reconstruction. Some patients will require drains. Patients take the first week after surgery off, often require pain medications, and wear a post-surgical bra. Heavy lifting and aerobic exercise are prohibited. After one week, most patients have stopped the patient medication, but are still somewhat sore and require milder pain medications, like ibuprofen. After two weeks, most normal activity has resumed, but heavy lifting and high impact activities are still not advised until four weeks. It may take up to three to six months for the final appearance of the breast to resolve.
Some patients have a “light-switch” effect after their breast implants are removed, which is what we truly hope for with all patients. These patients are more likely to have specific types of bacteria and usually fit the typical onset profile for biofilms. Many more patients continue to have a tendency toward inflammation and have to regulate their bodies carefully, but feel that their bodies are healthier and easier to control, and tolerate more stress. A few patients feel there is no improvement from surgery and continue to have similar symptoms to preoperatively.
At Cassileth Plastic Surgery, we care deeply about women’s health. If you believe that you may be suffering from breast implant illness, we can help. Contact us with any questions or to schedule a consultation appointment.
1 The American Society for Aesthetic Plastic Surgery. Breast Implant Illness - Frequently Asked Questions/Talking Points. Available: https://www.surgery.org/sites/default/files/downloads/BII-Talking-Points-FINAL-1.15.19.pdf Accessed May 25, 2021.
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