Breast implant illness is a hot topic. You cannot read the news or social media without seeing someone posting about how their implants made them sick and how they are so much better now that the implants are removed. I do a ton of breast implant removal, also known as explant surgery. And I do see patients feel better. But not all my explant patients have breast implant illness symptoms. Some of my patients who do have BII symptoms do not see them improve after explant.
Breast implant illness is real, though with 300,000 women getting breast augmentation yearly, many women have breast implants and do not have issues. I have been a plastic surgeon for 25 years. If BII was in all women, or a common occurrence, we would not still be doing the procedure. I do think we have made big strides in the past decade in understanding how to reduce risk. Biofilm, a chronic low grade infection of the implant which leads to chronic inflammation, is a leading contender for why breast implants make people feel sick. Biofilm is also associated with capsular contracture, when an implant “turns hard,” and I think likely is also associated with the rare cancer ALCL seen in textured breast implants. There are techniques to limit biofilm, and if you choose to do a breast augmentation, you should make sure your surgeon is employing everything they can to minimize risk.
Chronic inflammation is bad. Avoid biofilm.
There is enough data showing breast implants can cause issues that there is now a new FDA recommendation for a black box warning that breast implants may cause breast implant illness symptoms and a rare cancer (ALCL- only associated with textured implants which have been removed from the market- and very rare). When choosing to do breast augmentation, you need to go in eyes wide open as to the risk.
But what are other theories of why people get breast implant illness? When I was blogging about a new journal study on BII and biofilm, they had an interesting review of what the other theories of BII are out there- these being non infectious theories of breast implant illness. What are they?
- Direct chemical toxicity. Industrial silicone is made by platinum used to cross linked. This led people to hypothesize that platinum was an issue. Platinum chemo agents cause neurotoxicity. Findings? “repeated studies have failed to show this.” “The quantity of platinum in implants is in the parts per million range in the unoxidized form, making biologically reactivity unlikely.” They conclude there is no evidence associated with neurotoxicity or autoimmune disease with silicone gel.
- Autoimmune syndrome induced by adjuvant. This is the theory that something triggers the body to start an autoimmune reaction. This one has mixed results. There is a syndrome called ASIA syndrome- read my blogs on the subject. In ASIA, any “adjuvant” – could be a breast implant, a viral infection, a hip prosthesis- triggers the body to be sensitized, leading to autoimmune issues. Blogs HERE.
- Human Leukocyte Antigen Subtype Incompatibility. One series found higher HLA-DR23 subtype in symptomatic patients with implants. There was also an overlap with fibromyalgia. No other studies have been done with other types of implants like pacemakers or joint devices.
- Somatization Disorder. Many used to think that BII may be psychosomatic, amplified by the shared experience of social media. Elevated anxiety scores were seen in women with BII. This does not explain things like rashes or remission of autoimmune issues after implant removal. For sure when women are worried about the implants may be making them sick, removing the breast implants gives relief.
My thoughts?
Foreign objects can irritate your body. Period. It doesn’t matter if it is an artificial hip, an IUD, or a breast implant. Your body walls off these foreign objects with a capsule. But before the capsule forms you are at risk for biofilm. I am a big believer in biofilm and chronic low grade infection leading to chronic inflammation being a cause for breast implant illness. It explains why removal makes people feel better. If you read my blogs you can see I drank the anti-biofilm tea a long time ago.
I do think sometimes people do something or have something where it “triggers” the body to go into autoimmune overdrive. I have a relative who became celiac at age 8. Totally could eat gluten until then with no issue. Had a simple GI virus / cold at age 8, and after that – BOOM – could no longer eat gluten. It makes sense a breast implant could be a trigger for some. So I believe in ASIA syndrome, and in those patients you can see antibody formation.
But I haven’t gotten to the place where I would never put in implants. After doing this surgery for over 20 years, the strong majority of my patients are happy. They do not report any body issues after having implants. I have had a rare patient who has been concerned they have BII, and after removal of the implant, some improved and some did not. To try to minimize risk when I do breast augmentation surgery, I keep adding more and more layers of precautions . I totally do things differently today than I did even a few years ago.
But I have been a surgeon long enough to be humble about what we just do not know. Breast implant illness is real for some women. When I consult with patients I talk about these risks. They are real, and you can do “everything right” and still have an issue. But as the occurrence of BII in my patients still appears to be rare, I have continued to do breast augmentation. I tried to replace breast augmentation with implants by doing fat transfer breast augmentation instead, but there are real issues with fat. For a very small change in a patient with looser skin, fat transfer can be great. But fat transfer to the breast has issues: It can calcify, turn hard, make mammograms difficult to interpret, fat survival is variable, you cannot do it when skin tone is tight, it does not reshape the breast well, and it cannot do large volume change (anything over 200cc is difficult in one surgery). So the breast implant remains a tool in our toolbox.