Breast Implant Illness: an Emerging Trend and a Clinical Conundrum

Breast implant illness is an often-cited but poorly understood phenomenon. Like the word “pornography”, a lot of people understand what breast implant illness is as a concept, but when asked to define it, it becomes a bit of a challenge. Breast implant illness (BII), is a concept almost as old as implants themselves.

Breast implants have been around for more than half a century, in some form or another. And during that time, myriad studies failed to show any association between breast implants, and difficulty with nursing, or psychiatric disease, cancer, and even autoimmune disease. More recently, we have identified an association between breast implant-associated lymphoma (BIA-ALCL) and certain types of macro-textured implants, but this appears to be related to a manufacturing process, not having implants, per se.

Simply put, no scientific studies have shown definitive evidence that having breast implants puts you at risk for more than typical complications of surgery. In fact, there even studies supporting the health benefits of implants.

Recently, a prospective patient asked via our Instagram forum why some women get breast implant illness and others do not. This is a great question. A similar question might be: why do some women get capsular contracture, and others do not? Or, why do some women get keloids and others do not? Why do some women get infections, and others do not? I ask these hypothetical questions because there is so much that can contribute to the possibility of getting breast implant illness, that it is hard to pinpoint a single cause.

Our videographer even captured me tried to tackle this question and this can be seen on YouTube. For instance, some women may have a genetic predisposition to autoimmune disease that is triggered by having surgery, a foreign material implanted in them, or even the anesthesia associated with surgery- or the antibiotics taken thereafter. It is impossible to pinpoint a single trigger and is even more difficult to imply that the implants themselves are a source of the problem.

BREAST IMPLANT ILLNESS

Even more difficult is to define what breast implant illness (BII) exactly is. Some women describe fatigue. Other women describe depression, anxiety, and other mood disorders. Still, other women described general puffiness, malaise, and itchiness. There is a whole spectrum of potential symptoms and signs of this well documented but poorly described constellation of symptoms that collectively constitute a single disease. Because of this lack of specificity, it is particularly hard to pinpoint who gets the disease, why they get “it”, and how to treat “it”.

In other words, what is “it”? If we were to deconstruct BII into specific diseases and complications: breast cancer, breast feeding difficulties, psychiatric disease, autoimmune disease, I think we would have an easier time identifying what it is about implants that can send you down one pathway or another. For example, a lot of women who have capsular contracture, or scarring around their implants, are concerned that they have breast implant illness or possibly something worse.

They describe generalized pain on the affected side as well as overall lethargy. What they may be describing in many cases are the symptoms associated with capsular contracture, not necessarily an overall inflammatory state. But this really varies on a case to case basis. Other women describe lethargy, weight gain, and depression. It may not help that we are amid the worst pandemic we have ever seen. The change in our lifestyles has been quite jarring.

We all face a lot of emotional and personal stressors that we have never experienced. So many of us have become more isolated because of bans, restrictions, and the sort. Online forums and social media have become increasingly powerful as we sit in our relative silos reaching out not to friends and family- but the world at large- for answers.

As we identify more and more like-minded and like-experienced people across the global stage, we are becoming more aware of new postoperative issues and diseases; breast implant illness is no exception.

SO WHY DO SOME WOMEN GET BREAST IMPLANT ILLNESS AND OTHERS DO NOT?

Simply put, I do not know. We do not know.

We need to determine what it is that defines breast implant illness, or at least specify it to a satisfactory degree before anyone can answer this question with conviction. What can we do as plastic surgeons is to minimize the likelihood of breast implant illness? We can be meticulous surgeons who plan our operations well. We can avoid the possibility of bleeding that leads to capsular contracture. We can avoid the possibility of infection that leads to capsular contracture. We can carefully select patients who have not had previous surgeries and complications.

Most importantly we, as surgeons, can inform patients about the possibility of breast implant illness. We can identify potential triggers and support groups for patients who are suffering from breast implant illness. And even if we cannot attribute breast implant illness to the implants themselves, with certainty, we will always offer implant removal as an option for patients with sufficient concern.

Even if breast implant illness is not truly caused by implants, it may be worthwhile to determine that definitively by removing the implants and their surrounding capsules.

If you feel better after surgery after we do this, great. There certainly are alternatives to breast implants if you miss the volume. If not, it is possible that something else is going on and that the implants may be a confounder, not a direct cause.

I have removed implants from women who report improvement of symptoms, generalized improvement of swelling and inflammation, and overall better quality of life. Unfortunately, I have also treated patients who did not notice a difference after their implants of been removed. Of course, the possibility exists that breast implant illness cannot be cured by removing breast implants, because we could not clearly define what breast implant illness was and we certainly could not determine whether or not implants were the cause of this ill-defined disease.

If you or a loved one are concerned that you may have breast implant illness (BII), the next step would be to discuss with your board-certified plastic surgeon. Dr. Zelken would be happy to discuss with you if your plastic surgeon is unavailable or you would like another opinion. Please call (949) 432-4730 to schedule an appointment.