After getting breast implants, some women experience symptoms including fatigue, hypothyroidism, gastrointestinal problems, autoimmune symptoms, joint pain, and more. Only some of these women have capsular contracture and are visibly "reacting" to their implants, and we see many of these women who decide to have their implants removed.
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As a group, we are dedicated to working with these patients to uncover the underlying cause of the BII. More than 50 percent of these patients carry biofilms, and specimens taken from these patients at the time of surgery are positive for different varieties of bacteria. Keep in mind this is not an infection, but bacteria that are living on the implant surface.
Despite that the bacteria are not causing an abscess, fever, or pus, they can cause inflammation and burden the immune system, especially in patients prone to inflammation and oxidative stress. To diagnose the biofilm, cultures are obtained during surgery using a sterile technique from a direct capsule specimen that did not touch the skin surface. Note there is a lot of P. Acnes, which is usually known for its involvement in facial acne. It's notorious for causing inflammation, so we are not surprised to find it in some of our most symptomatic patients.
Surgical removal of the implant for BII (breast implant illness) involves removal of the entire capsule (capsulectomy). There has been a debate about whether this is necessary or not, but those of us who are veterans in the field have found positive cultures in capsule remnants where implants have been removed with prior surgery. Therefore, it is important to remove the whole capsule.
We find Biofilms on about 45% of BII patients' capsules. Some of them we consider extra "bad", like C. Acnes, as it causes inflammation. The removal of the implant and the capsule has a "lightswitch" effect in C. Acnes patients where they feel better right away. However, some patients have no biofilm and no silicone and don't feel much different after removal. We can't usually tell these patients apart in surgery, so it is best to remove the capsule in all Bii patients so in case of a positive biofilm (grows usually 2-20 days after surgery) there is no chance of capsule retention and no bacteria can possibly remain. No blood testing will show this specifically, unfortunately, at this time.
We also frequently find silicone and silicone granulomas in capsules—even in patients who do not have ruptured implants.
Typically, the incision is made under the breast (in the inferior mammary crease), although the areola can be used as well. Removal can be "en bloc" (which involves a larger incision) or whole component (which means the implant is removed, then the capsule is removed). Most patients prefer the smaller scar of the component removal, which can be performed without spillage of implant or capsule contents.
With implants placed under the pectoral muscle, the pectoral muscle must always be repaired. Leaving the pectoral muscle with the cut from the original augmentation can result in pec flex deformity. Reconnecting the pectoral muscle with the rib surface both repairs and strengthens the muscle to its original position.
For women who want to maintain fullness in the breast, we often combine fat grafting with implant removal or an internal lift to maintain fullness and create and restore beautiful, natural breast shape.
Many of our patients with BII find that their symptoms improve after removal of their implants.
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