August 19th, 2019
Here are some of the most frequently asked questions we hear from our patients regarding Breast Implant Illness.
WHAT IS BREAST IMPLANT ILLNESS (BII)?
Breast Implant Illness (BII) is NOT an official medical diagnosis. Breast Implant Illness (BII) is a term that has recently been used by women who have
breast implants who describe a variety of symptoms that they feel are directly connected to their breast implants. Women who self-identify as having BII have either silicone or saline implants, either smooth or textured. Symptoms that are described as being attributed to BII include: fatigue, chest pain, hair loss, headaches, chills, photosensitivity, chronic pain, rash, body odor, anxiety, "brain fog", sleep disturbances, depression, neurologic issues and hormonal issues.
The recent increase in patients reporting Breast Implant Illness (BII) symptoms appears to be highly related to social media. There is one Facebook group alone with more than 70,000 members, many or all of whom report BII symptoms. This is not to say that social media is the cause of BII; however, it may account for the rapid increases in patient reporting.
ARE THERE ANY TESTS TO DIAGNOSE BREAST IMPLANT ILLNESS OR THAT SHOW A LINK BETWEEN SYMPTOMS AND BREAST IMPLANTS?
Currently, there are no tests to diagnose Breast Implant Illness (BII). There are numerous tests for autoimmune diseases that can be performed to evaluate for other potential causes of a patient's symptoms. There are patients with positive autoimmune testing who describe symptoms of BII and other patients with similar symptoms with testing that shows no abnormalities. BII is currently a focus of research of the Aesthetic Surgery Education and Research Foundation (the research arm of the ASAPS).
IS THERE ANY LINK BETWEEN SILICONE IMPLANTS AND ANY DISEASE
Medical grade silicone (actually, a chemical named polydimethylsiloxane) that is used in breast implants is different than the silicone that occurs in nature, and to date has not been proven to cause any disease.
IS THERE ANY SCIENTIFIC DATA SHOWING A LINK BETWEEN SILICONE IMPLANTS AND ANY DISEASE AT ALL?
In the 1990s, the Institute of Medicine Committee on the Safety of Silicone conducted an extensive review of the world literature and concluded that there was no clear link between silicone implants and any systemic disease. Breast implants themselves are the most researched medical device on the market. Studies on patients who have symptoms they attribute to breast implants have not shown consistent laboratory abnormalities to define a distinct syndrome.
DOES IMPLANT REMOVAL "CURE" A PATIENT OR IMPROVE THE SYMPTOMS OF SOMEONE WITH A MEDICALLY DIAGNOSED DISEASE (LIKE AN AUTOIMMUNE DISEASE)?
There have been no studies that show which symptoms may or may not improve with removal of breast implants, with our without removal of the capsule around the implant (capsulectomy). Additionally, there is no definitive evidence to link breast implants to any systemic disease. However, a lack of a proven scientific link does not mean that the symptoms or the disease is not real. It means that further investigation is required to determine if a link does exist, and in the case of rare or unusual diseases, a scientific conclusion can take years to reach.
The lack of a current, proven link between breast implants and any disease process also does not mean that the symptoms experienced by patients is not real; they deserve our attention and investigation to determine which of these symptoms, if any, may be the result of breast implants.
HOW DO WE ADDRESS A PATIENT'S COMPLAINTS OF BREAST IMPLANT ILLNESS (BII)?
Any patient's complaints or symptoms deserve to be investigated, especially since there is currently no way to prove or disprove any association between the symptoms and the presence of a breast implant. Current options include:
- Observation - see if things change over time
- Medical workup - referral to or evaluation by a rheumatologist
- Implant removal - with or without capsulectomy
- Implant removal with "en bloc" capsulectomy
WHAT IS AN "EN BLOC" CAPSULECTOMY?
Breast implant removal with "en bloc" capsuletomy is a treatment that has been popularized on social media as being "necessary" in cases where patients relate systemic symptoms to their breast implants. The reason this has been deemed "important" is that it is believed that this treatment removes all foreign material that could potentially cause symptoms. The merits of a true "en bloc" capsulectomy have not been adequately determined, and it is un-known whether this treatment offers any benefit over implant removal or implant removal with partial capsulectomy.
Capsulectomies are commonly performed with revision breast surgery, and almost every plastic surgeon who does these procedures performs some capsule removal with implant removals and/or exchanges.
It is important to understand that "en bloc" removal, while it does not have definitive benefits, does have very real and definable drawbacks. A larger incision is needed for an "en bloc" capsulectomy, and "en bloc" removal cannot be performed through periareolar or axillary incisions. Also, there is an increased risk of damage to surrounding structures - muscle, rib, lung - with "en bloc" capsulectomy due to the extensive dissection needed.
