The FDA has changed the black box warning for breast implants. You are going to see a lot of education on breast implant issues. Breast implant illness is real, but we think we know some of the cause for it. Please read all my blogs on the subject for a better full picture.
“Understanding Breast Implant illness,” is the title of a new journal article in the December 2021 Aesthetic Surgery Journal. They did a study looking at 60 women with self reported breast implant illness (BII) and 60 women who had undergone breast implant removal and 60 women who did not report having BII. They then compared the groups
Study:
- 189 recruited patients via Facebook and Instagram ads
- Data was deidentified during analysis.
- They were asked questions: physical and psych problems after breast augmentation with implants, the nature/onset/and course of symptoms, the perceived cause of symptoms, beliefs about recovery/the doctor/online support, lifestyle changes they did to manage the symptoms.
- Demographics: average age 42 (range 20-76), 61% married, 75% had children, education 23% high school/55% university, full time job 40% / part time 15%.
Findings:
- women with BII were significantly older than those without BII
- Those with BII were less likely to have implants removed if they had lower educational level and were more likely to be out of work due to sickness and disability
- 80% of implants were under the muscle
- 70% were silicone implants
- Mentor and Allergan were the majority of the implants
- BII women had surgery longer ago
- No differences in implant or incision placement
90% of the women with BII had a medical condition diagnosed. 98% of women with BII accessed online sources for support via social media (90%), webpages (69%), and web searches.
Those with BII with the implants still in had more severe symptoms across every symptom assessed except convulsions and seizure.
Those with BII with implants still in had significantly higher scores of depression and anxiety and rated their health as “fair” or “poor.”
When did the symptoms start?
- 51% had onset within 1 year after surgery, and 67% within 2 years post surgery
- 80% said their symptoms changed over time.
Who did they turn to for help?
- 99% sought help
- 87% from their general doctor, 67% from their plastic surgeon, 40% from naturopaths, psychologists
- Lifestyle changes with diet, less alcohol, change in physical activity, supplements, and medications
Beliefs
Most believed their symptoms were due to the body’s immune response to fight a foreign object. 30% thought it was from toxic chemicals in the shell of the implant itself.
Discussion
Generally they found onset of BII symptoms within two years of implants, that the severity worsened with time. Those with BII had more severe body symptoms, higher depression and anxiety, more medical conditions, higher rates of smoking, higher BMI. When they turned to areas for support, this largely came from online – which they went to daily frequently- or seeing their general doctor or plastic surgeon.
When discussing the social media sites, they said the women with BII higher overall health anxiety correlated with online searching. They worry social media platforms may be exacerbating the health anxiety.
When BII patients did explants, they did not return to the levels of the non-BII breast implant patients. They still had higher anxiety, physical symptoms, and mental health. This suggested to them that explant may not be a cure for BII.
Beliefs did factor into things, with BII websites listing a variety of causes of BII. The two most common were heavy metals as ingredients in implants, which leached into the bloodstream, or that implants are being rejected as a foreign body, weakening the immune system. (Neither of these has been supported in the studies, see my other blogs).
My thoughts?
This is a loaded topic. I do believe BII exists. I also believe I have many patients with implants who have no issues. I really believe in the chronic inflammation of biofilm being a root cause. Read my many blogs on the subject and how to prevent biofilm. I think it is interesting that for many of the BII patients, the symptoms started within 2 years after implant. So if you were fine for a decade, and are now not fine, it may not be your implant.
I also think there is a lot of bad information mixed in with true information on the internet and all patients are not equal. If you are in a chatroom with someone who has BII- do you have the same incisions? did they use triple antibiotic soak? is it under the muscle? do you have capsular contracture? was it done in an accredited OR by a board-certified plastic surgeon? One of my explant patients used to come in and say, “I’ve been on the dark web again” when she was in a chatroom with other patients worried about BII and would come in with higher anxiety after being in the dark web.
More to come. This study was biased in that it was self selected- people signed up. Generally, that errs to the two extremes- those that are really unhappy and those that are really happy. They acknowledge that older patients had more symptoms. But were they due to the implants or due to aging? They did not ask for thyroid status, and they state thyroid issues mimic many of BII issues.
Again, we know BII is real, but not everyone who feels bad and has an implant has BII. More studies are needed. I’m glad they are getting done.