Breast Implant Illness (BII)
Breast implant illness is a completely separate entity from the BIA-ALCL that we talked about with our previous blog. BII is a term used by women who have breast implants and are experiencing a varied range of symptoms that they feel are related to their implants. These symptoms include fatigue, chest pain, rash, body odor, anxiety, ‘brain fog’, sleep disturbance, depression and hormonal concerns, neurologic conditions, and a myriad of other non-specific systemic symptoms. Women often research their symptoms and self-identify as having BII. These people include women with saline, silicone, smooth and textured implants – therefore, no specific type of implant is implicated. Many of these symptoms are vague and can be associated with other unrelated medical conditions and also are often the product of the aging process. To date, there is no existing medical diagnosis of BII. Researchers and doctors are hesitant to label this situation as a distinct medical condition without supporting evidence.
The Aesthetic Surgery Education and Research Foundation, which is the research arm of The American Society for Aesthetic Plastic Surgery, is currently focusing on this issue given the increasing attention it is getting in the press and on social media. So far no specific test has been identified to predict who could suffer from these symptoms. Immunologic tests and other lab tests on patients who experience symptoms do not show consistent abnormalities to define a distinct syndrome. There is no current definitive epidemiological evidence to support a direct link between these symptoms and any specific disease process. This does not mean that future studies may not shed some light on the relationship, but to the best of our knowledge and research at this point, there is no evidence to support the existence of BII. Research is ongoing.
This does not mean that the symptoms these women experience are not real and they definitely do need to be addressed. Whether the symptoms can or cannot be attributed to the implants directly is not important since there is no way to prove or disprove any association. We do feel a full medical assessment should be done prior to decision making about explantation. The fact that explantation may not resolve their symptoms also needs to be discussed. Since there is no known scientific link, we cannot promise that removal of implants will cause resolution of all the various symptoms. Having said that, I know that all of us plastic surgeons have had patients who had their implants out and did get better (I even had someone who never complained of symptoms and said how much better she felt and how much more energy she had after surgery). There just is not enough scientific proof at this time to guarantee a good result.
If removal is chosen, there is also controversy over how aggressively to pursue this. Some patients just want their implants out while others insist on complete or ‘En Block’ removal of the scar tissue or capsule around the implant. Removing all of the capsule is quite a bit bigger surgery and potentially more damaging of a surgery than just removing the implants. There is a risk of injury to the muscles, nerves, ribs, and even the lung. To do the full removal also requires making a much larger incision (10-15cm or 4-5inches across the fold of the breast). This makes for a much worse scar and influences the blood flow to the tissue if a lift is done at the same time. Most plastic surgeons agree that removal of any thickened or abnormal capsule is helpful in getting a better result, but there is no evidence that aggressively removing all of the capsule has any medical benefit and does increase the risk to the surrounding tissue as described above. There is nothing inherently abnormal about scar tissue or capsule, it just forms around any foreign object in the body. If capsule is left behind it is reabsorbed by the body and does not cause any trouble. It is hard to justify risking damage to your normal tissue and muscles if no benefit can be guaranteed.
Again, we realize that people complaining of symptoms of BII have real symptoms…they just do not conform to any of the known disease processes. Continued research is needed to better identify patients who would benefit from implant removal. Until all the evidence is gathered, I tell my patients first to look for other treatable causes of their symptoms. If they are still suffering, I am willing to remove the implants, but I cannot guarantee it will improve their symptoms. If nothing else, it may help to ease their minds that their implants are no longer there potentially causing harm.
Hopefully, reading the facts about BIA-ALCL and BII will help you to better understand any symptoms you may be experiencing. If ever in doubt, it is always best to contact your plastic surgeon to rule out any concerns and assess the situation.