Posted July 31, 2020 in Breast Augmentation
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Breast Implant Illness (BII) is a term used by women who have breast implants and who self- identify and describe a variety of symptoms including autoimmune issues, muscle aches, joint pain, fatigue, hair loss, headaches, photosensitivity, chronic pain, rash, anxiety, brain fog, sleep disturbance, depression, neurologic issues and hormonal issues that they feel are directly connected to their saline or silicone breast implants.
The recent increase in patients reporting Breast Implant Illness (BII) symptoms appears to be related to increased awareness based on social media and presence of breast implant associated anaplastic large cell lymphoma (BIA-ALCL). There is one Facebook group alone with more than 50,000 members, all of whom report Breast Implant Illness (BII) symptoms. This is not to say that social media is the cause of Breast Implant Illness (BII) however, it may account for the rapid increases in patient reporting. BII is not an official medical diagnosis.
There is no diagnostic testing specifically for Breast Implant Illness (BII). This is one of the current areas of focus for the Aesthetic Surgery Education and Research Foundation, the research arm of the American Society for Aesthetic Plastic Surgery. There are tests for autoimmune diseases that can be performed to evaluate for potential causes of a patient’s symptoms. There are patients who have symptoms they attribute to Breast Implant Illness (BII) with positive immune testing and others with all laboratory tests which show no abnormalities.
In 1999, The Institute of Medicine Committee on the Safety of Silicone conducted an extensive review of the available literature and concluded there was no demonstrated clear link between silicone implants and any systemic illness. There have been studies of many different sizes and design to look at the safety of breast implants themselves. These have looked at specific autoimmune disorders and diseases. These studies show little to no links between breast implants and any disease. Studies of patients who have symptoms that they have related to their breast implants have not shown consistent laboratory abnormalities to define a distinct syndrome. To-date, there has been very little in the way of research into this entity that has been labelled Breast Implant Illness (BII) by women with breast implants.
Does implant removal improve patient’s symptoms or cure a patient who has a medically diagnosed disease entity like an autoimmune disease?
Various studies show different degrees of improvement in patient symptoms after removal of their breast implants, some of which are temporary, and some showing permanent resolution of symptoms. There are no studies which specifically show which symptoms may or may not improve with implant removal with or without capsulectomy.
There is no current definitive epidemiological evidence to support a direct link between breast implants and any specific disease process. There are many factors that can affect the interaction between a patient and her breast implants. Further study is required to determine the best way to potentially screen patients prior to breast implant surgery and to determine which of the multitude of reported symptoms might improve with implant and capsule removal.
A lack of a direct, proven scientific link does not mean that the symptoms experienced by these patients are not real. Some patients have legitimate concerns about a potential link between breast implants and symptoms. For individuals who have breast implants and complains of Breast Implant Illness (BII) symptoms options can include: further medical work up with or without the consultation of a rheumatologist, observation without medical work up, implant removal without capsulectomy, exchange with or without capsulectomy, removal with total capsulectomy, or removal with en bloc capsulectomy.
As there is no definitive link between the often subjective and divergent list of symptoms, and no means for testing, there is no ‘known’ risk. Many of the symptoms described by breast implant patients are experienced by the general public on a regular basis with or without implants.
There are many medical inaccuracies perpetuated by the internet. BII patients tend to believe that a total capsulectomy is necessary to remove all causative agents and they prefer it en bloc, oftentimes without having a full understanding of what size incision is necessary for en bloc.
If a patient wishes to undergo capsulectomy, it is important to explain that it is not always possible to remove all of the capsule. Sometimes a portion of the capsule must be left behind or is disintegrated with the use of electrocautery to prevent significant damage to muscle, rib or lung. If a patient had an axillary approach or periareolar approach for breast implant placement, an en bloc capsulectomy cannot be performed through those incisions. It is recommended to reinforce that there are increased surgical risks associated with en bloc capsulectomy which requires a complete dissection of all the tissues surrounding the breast implant and, that we do not have enough collective data to guarantee any improvement in their symptoms they have labelled Breast Implant Illness (BII).
Dr. Messa is board certified by both the American Board of Plastic Surgery and the American Board of Surgery, an active member of the American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and a Fellow of the American College of Surgeons. He is a recognized expert in cosmetic plastic surgery and has achieved Allergan’s Black Diamond Award as one of the top 1% of plastic surgery practices in the country by volume. Dr. Messa has also achieved Chairman status with Medicis and Mentor Corporation. This award honors distinguished leaders in cosmetic surgery for demonstrating expertise and excellence through a high volume of aesthetic product procedures. The certification is awarded to leaders in the field of medical aesthetics and demonstrates their commitment to innovation, excellence, and the highest level of patient care.