What is Breast Implant Illness?
BII or Breast Implant Illness refers to a wide group of symptoms that women may develop within two to three years of having a breast augmentation. These symptoms include but are not limited to:
Because many of the symptoms are so diffuse, so varied, and often non-specific or associated with other systemic disorders, the diagnosis of Breast Implant Illness or an association of these medical problems with the patients’ breast implants has commonly been overlooked. However, numerous case reports have demonstrated correlations between breast implants and declines in patient health due to endocrine and immune system dysfunction.
The Science of BII
A number of case studies have found that children breast-fed by a parent with silicone breast implants were more likely to develop esophageal disease.
A 1992 clinical case study by Vojdani et al. found that patients with silicone breast implants had higher amounts of immune factors like killer T-cells when compared to patients with no breast implants. This implies that the body has produced an immune response to an “invader,” the implant, ultimately causing an autoimmune response. This autoimmunity may result in long-term autoimmune illnesses, leading to the symptoms of BII. These symptoms are also in line with connective tissue diseases.
A 2017 review by Cohen et al. references the fact that silicone, although thought of as body safe, has the ability to spread throughout the human body. It can spread to such an extent that in women with breast implants, silicone may be able to be detected in other body tissues and in the Central Nervous System. Cohen also notes similar immune dysfunction findings to Vojdani, explaining that the autoimmune responses caused by silicone implants may lead the patient to develop new allergies. There may also be a correlation between silicone breast implants and the development of lymphomas.
A clinical case study published in January 2019 by Khoo et al. found that patients with silicone breast implants were statistically significantly more likely to have symptoms of Fibromyalgia and Chronic Fatigue Syndrome.
The History of BII and Breast Implants
From 1992 till approximately 2003, the FDA announced a voluntary moratorium on the sale and distribution of silicone gel-filled implants. An advisory panel of the FDA had concluded that breast implant manufacturers had not provided sufficient evidence of safety for their products, and as a result pulled them from the market. During this time period, saline implants were still allowed. Eventually, certain changes in the protocols allowed for patients seeking reconstruction and revision to have access to all kinds of implants. By 2006, both Mentor and Allergan were allowed to sell their silicone gel-filled implants for all uses and agreed to additional ongoing post-approval studies to characterize the safety and effectiveness of these implants. In 2011, a “Safety Communication” was released by the FDA warning women that there is a small risk associated with breast implants of developing breast implant-associated anaplastic large cell lymphoma (BI-ALCL), a kind of T-cell lymphoma that occurs around breast implants.
Before, during, and after the FDA released their guidelines regarding silicone implants, many women continued to complain and suffer from the symptoms listed above. During this implant moratorium, our surgical practice in Los Angeles and Orange County, consisting of six board certified plastic surgeons, was overwhelmed by requests from women suffering from these symptoms who wished to remove their silicone implants.
At this time, it was still common for us to treat women who had silicone injected directly into their breast tissue, a very common cosmetic procedure in the 1960’s and 1970’s, especially in Asia. These patients often required subcutaneous mastectomies to remove all of the distorted, hard, lumpy breast tissue, which often suffered from inflammation or infection. En Bloc Explantation was often the easiest, cleanest way to remove encapsulated or broken implants. Images of these broken implants may be found on the websites: BreastExplantation.com, HorowitzMD.com, or PacificCenterPlasticSurgery.com.
Implant Choice: What’s Up With Silicone?
Although generally considered biologically inert, it is necessary to acknowledge that a silicone implant is still a manufactured product, which has been chemically treated. As such, some women have reported symptoms, which they believe to be caused by heavy metal poisoning as chemicals leak through the implant shell. While unlikely to result in any health damage, people seeking implants have the right to know what they are putting in their body. Some of the chemical ingredients of silicone implants include but are not limited to known carcinogens like Methyl 2-Cyanoacrylate ethylene oxide, Benzene, & Amine toluene dichloromethane as well as known neurotoxins like Methyl ethyl ketone, Urethane polyvinyl chloride, Chloromethane ethyl acetate, Phenol, & Xylene.
Implant Choice: Are Gummy Bear Implants Safer?
Unfortunately, there is no safe bet when it comes to implants. Women have reported symptoms of BII from all kinds of implants, whether saline, silicone, or gummy bear. Although each new generation of breast implant material becomes safer, and the new technology of cohesive gel/gummy bear implants are a far cry from the direct saline implants of the mid-20th century, there is never a guarantee of safety. Because of the chemicals used to create the cohesive gel implants, some women have reported illnesses as a result of heavy metal poisoning. The implants have also been known to rupture or leak.
BIA-ALCL: Breast Implant Associated Anaplastic Large Cell Lymphoma—What is it?
This condition is a type of lymphoma, but it is not a breast cancer. It is, however associated with breast implants, usually silicone gel, that have a rough or textured surface. It is slow growing and usually first presents as swelling of the breast caused by fluid around the implant. It may also first be noticed by swelling or a lump in the armpit, usually be an effected lymph node. This is a completely different issue than BII. It is a very well-defined medical problem with specific signs, symptoms and laboratory tests. Fortunately, it is a relatively small percentage of all women with breast implants. It is confined to textured implants, mostly from one specific company, usually silicone-gel implants. It is slow growing and completely treatable when diagnosed early.
What Are My Options?
You may be asking at this point, “What are my options?”
Maybe you are someone who is considering getting breast implants. If this is the case, the best thing you can do for yourself is research, research, research. Talk to a board-certified plastic surgeon frankly to decide which kind of implant is right for you, if implants are right for you at all. Every surgery comes with risks, and the relatively rare symptoms associated with breast implants should not deter you from getting them if when weighing the pros and cons, you truly believe your life will benefit from a breast augmentation or reconstruction.
Maybe you are someone with breast implants who thinks they have been having symptoms of BII. If this is the case, again, please talk about your symptoms with your primary physician and your board-certified plastic surgeon. They may be able to help you walk through your symptoms and decide which course of action you should take. You can deal with your symptoms and keep your implants as they are, you may try to replace your implants, or you may have them removed completely. Only you know what will be best for your body and your health in the long run.