ASIA syndrome is an autoimmune syndrome caused by an “adjuvant.” This adjuvant can be a vaccine, a flu, or in the case of plastic surgery, a breast implant. The thought is that an event occurs which hypersensitizes your body, so it overreacts, causing the autoimmune issues.
What are the symptoms seen in ASIA syndrome? There was a retrospective study over the past 30 years of 200 patients from the Netherlands and Houston. In the study they found the most common symptoms:
- Fatigue
- Joint pain
- Muscle aches
- Cognitive impairment
- Pyrexia
- Sicca (dryness)
Of the 200 patients, 54 of them had their implants improved, and 50% of those had improvement in symptoms after explant surgery (removal of the implant). OF NOTE: I think an issue with this study is it doesn’t look at the other cause of chronic inflammation- biofilm. This study does not cite if the implants were subglandular or subpectoral, if they have capsular contracture, what the site of the incision was, if the implant was textured or not.
True ASIA syndrome is rare. When doing a scientific search, you will see case reports, not series of patients with the symptoms.
- There are some studies in the Rheumatology and Immunology literature which indicates there are people at higher risk, who should avoid silicone gel implants. These are women with previously diagnosed autoimmune disorders or with genetic preponderance for hyperactive immune systems.
- There are studies which indicate low Vitamin D levels may increase the risk of forming autoantibodies and ASIA syndrome.
There is some indication this may be genetic. There was a study where three sisters with the BRCA gene all got the same symptoms after having breast reconstruction with silicone breast implants.
- all three sisters had joint and muscle pains, sleep issues, and fatigue.
- They all had the silicone implants removed, and were replaced with non silicone gel implants called “Monobloc Hydrogel”, after which all complaints resolved.
Many of these vague symptoms could be caused by BIOFILM.
I think it is important when evaluating these symptoms that we stratify the groups.
- Many of these ASIA case reports were ruptured silicone implants.
- Were they cohesive gel? Who was the manufacturer? (Off brand or mainstream respected brand?)
- Did the women have their implants placed behind the muscle? (lower biofilm risk)
- What incision was used? (Inframammary has lowest biofilm risk)
- What antibiotics were used? antibiotic soak? Post operative antibiotics?
- Was there a capsular contracture? (likely evidence of biofilm and inflammation)
It is not that I don’t think there are real cases of illness from implants. But in trying to find scientific rules to guide us, we must try to find out what it is the root cause. All implants are not created equal. Some doctors take many more precautions when placing the implant (Keller funnels, antibiotic soaks, no touch techniques) than other doctors do.
I like to read literature outside of Plastic Surgery to try to get a more measured view of what is going on. I get that my journals may have an inherent bias. There are clearly some patients where their implants are sensitizing them and leading to autoimmune issues.
Breast Implant Illness is when people feel sick, and wonder if it is from their implants. Is it? And why?
But is it ASIA syndrome or Biofilm? Biofilm is not a genetic/predisposition thing. It is a technique thing, where when we place the implant we contaminate the implant with bacteria. Those bacterial slowly grow and colonize. This creates a low grade state of inflammation. ASIA syndrome is an autoimmune issue. This is where your body is sensitized, and starts attacking itself because it is hyper.
The questions for me as a plastic surgeon are:
- Are there patients who for sure should not do silicone implants? Who are they? How can we tell?
- Is it really ASIA syndrome, or are these patients sick because of biofilm? (This may be something we could study by looking at antibody levels)
- Are there other things (like low Vitamin D levels) which increase the risk of the issue?
- What is the timing? Is there a way to predict the cause by the timing of symptoms?
- There has been a global rise in allergies and autoimmune issues period. What is the incremental increase in women with implants?
- Are there techniques we can do as plastic surgeons (like all the biofilm things I do) which will lower the risk of ASIA syndrome?
To evaluate some of the scientific articles on the subject, you can read many of them at the link HERE.