Sick After Breast Implants? Breast Implant Illness is Real.

287,000 women had breast augmentation surgery in 2019 across the United States. That figure dipped considerably during the pandemic, but many women are choosing to have this type of surgery without being fully informed as to the possible complications.

Increasingly, many of the women who have chosen to have breast implants – whether due to losing a breast through cancer or simply wishing to have a fuller figure – have come to believe that their implants are causing them harm, and they are determined to have them removed.

Are they crazy? They may feel as though they are because for many of these women, a strange constellation of physical symptoms have been visited upon them which they later discovered were more than likely caused by their breast implants.

If you have been sick after having breast implant surgery, this article is for you. You may have not made the connection between having a weird variety of symptoms and the fact that you have breast implants, but there may be one so I hope you will find this article helpful.

What is Breast Implant Illness?

Breast Implant Illness (BII) is a relatively new term for a variety of conditions that have not as yet been fully defined – and not officially recognized by the medical profession until very recently.

BII refers to a wide range of symptoms that can develop after having breast reconstruction surgery or cosmetic augmentation with breast implants.

BII is often misdiagnosed as an autoimmune condition such as rheumatoid arthritis, lupus, scleroderma or some form of strange inflammatory syndrome or connective tissue disorder.

Breast Implant Illness can occur with ANY type of breast implant, including silicone gel-filled, saline-filled, smooth surface, round or teardrop shaped, and textured surface – one brand known as Biocell was recalled by Allergen, its maker, in July 2019 due to the fact that there was mounting evidence that these textured implants increased the risk of breast implant-associated anaplastic large cell lymphoma – BIA-ALCL, a rare type of non-Hodgkins lymphoma. Biocell implants were found to be 14.11 times more likely to lead to BIA-ALCL. [1]

Some of the Many Symptoms of Breast Implant Illness

Breast Implant Illness can be difficult to diagnose because it can manifest as a cluster of symptoms that, taken together, can be quite confusing to the physician. Women with BII can experience a wide variety of symptoms including:

anxiety
breathing issues
breast or chest pain – unexplained
chills
chronic fatigue and lethargy
depression
dry eyes, dry mouth
gastrointestinal disturbances
hair loss
headaches
hormonal disturbances
joint and muscle pain
light sensitivity
memory and concentration problems
painful scars
pain or swelling around breast implant
scleroderma
skin rashes
sleep disturbances and insomnia
slow wound healing

Symptoms may appear at any time after implant surgery with some patients developing symptoms almost immediately post-surgery, while others only developing symptoms years afterward. Unfortunately, at present BII is not officially recognized as a medical diagnosis and in many countries there is no diagnosis code for it. Many doctors are completely unaware of it, and this makes diagnosis quite difficult.

In May 2019, the United States Food & Drug Administration (USFDA) released a statement that the agency was “taking steps to better characterize breast implant illness and its risk factors, and are considering ways to help to ensure women have all of the information they need to make informed decisions about whether to obtain breast implants or to remove existing breast implants in an effort to reverse systemic symptoms.”

In October 2019, the USFDA published a draft of recommendations to breast implant manufacturers requiring new labeling for breast implants. The agency recommended that manufacturers include information about the risk of symptoms to patients considering implants.

I had a look at the USFDA’s article “Things to Consider Before Getting Breast Implants” which states (among other things) “The longer you have breast implants, the more likely you are to experience local complications and adverse outcomes, which may be cosmetically undesirable and irreversible.” [2]

Chilling.

Women are increasingly reporting BII symptoms to their doctors and to the USFDA. Part of that may be because there are more social media groups joining women together to raise awareness of BII. A cursory search on Facebook just now revealed over 87 groups on the topic of Breast Implant Illness. One such group had 154,000 members.

EIGHTY-SEVEN Facebook groups on BII alone. That certainly indicates there’s a problem brewing.

Possible Risk Factors for Breast Implant Illness

According to some of the Functional MDs and plastic surgeons who have been treating patients with BII, it appears that those who have a family history or a personal history of autoimmune conditions, or pre-existing conditions like irritable bowel syndrome, chronic fatigue, fibromyalgia, allergies or migraines are far more likely to suffer from BII.

However, it’s entirely possible to suffer from BII and NOT have any of those risk factors.

More Problems Associated with Breast Implants

Silicone breast implants have been utilized since the 1960s. The earliest implants had smooth surfaces, however, many women experienced a complication called “capsular contracture”. This is due to scar tissue forming around the implant which squeezes the implant, creating pain and discomfort as well as deformation of the implant which is clearly visible. These early implants could also flip after implantation, which required subsequent surgery to adjust or remove them.

In the late 1980s, some manufacturers of breast implants began making them with rougher surfaces – called textured implants – with the hope of reducing capsular contracture and improving the ability of the implants to stick to the surrounding tissue better, and stay in place. The surface of the implant was manufactured with “peaks” extending up to hundreds of microns above the surface (in comparison, these days manufacturers are creating textured implants with a maximum of only 4 microns above the surface of the implant).

These rougher textured implants came at a cost. Researchers found that rougher implants tend to rub against the surrounding tissue and cause irritation. One variety in particular, the aforementioned Biocell by Allergan, was found to be 11.14 times more likely to cause a rare form of lymphoma. The hypothesis is that some of the implant texture may slough off and get trapped in nearby tissue, thus provoking chronic inflammation which may be the initiation factor for the lymphoma. [1]

The Research on Breast Implant Illness

Many websites I researched said it is not known exactly why some women with breast implants develop BII. However, a number of doctors have studied the possible links between breast implants and autoimmune illnesses since the early 1990s. They have made some interesting findings – some people may be predisposed to having an immune reaction to the materials that are used to construct breast implants which can create inflammation that leads to symptoms such as rashes, joint and muscle pain, headaches, gastrointestinal problems, etc.

We do have studies that have shown that silicone and other ingredients inside breast implants may “bleed” through an intact implant into the surrounding tissues. [3], [4]

Silicone, platinum and other substances inside implants may also spread within the capsule of scar tissue surrounding the implant – or to other areas of the body because an implant has ruptured. The immune system then reacts to the silicone polymers and other substances as being “non-self” and it mounts an immune defense.

In a 2017 review of medical studies [5], researchers in The Netherlands made some interesting findings. They found that explantation of silicone implants improved silicone-related complaints in 75 percent of patients. However, in patients with autoimmune diseases, they found that only 16 percent of patients improved with explantation when they did not also have additional immunosuppressive therapies. Also discussed were several possibilities as to why patients improved after explantation such as reduced inflammatory response and removal of the nociceptive stimulus (nociception is the detection of pain by the central nervous system)

In a 2018 study [6], a team of researchers looked at the medical records of just under 100,000 women who had implants and were enrolled in long-term safety studies required by the USFDA. The researchers found that compared to women in the general population, women with silicone gel-filled implants were eight times more likely to be diagnosed with a condition known as Sjögren syndrome, which is an autoimmune disorder characterized by dry eyes and dry mouth; seven times more likely to be diagnosed with scleroderma, a group of autoimmune disorders that cause the skin and connective tissue to become hard and tighten; and almost six times more likely to be diagnosed with rheumatoid arthritis. The study wasn’t the gold standard in that some of the diseases were reported by patients themselves and not necessarily diagnosed by a doctor; outcomes were collected by more than one protocol; and a significant number of patients dropped out before the end of the study, however compelling nonetheless.

In another 2018 study [7], researchers examined the health records of 123,255 Israeli women, 24,651 of whom had silicone gel-filled breast implants. The records were kept for up to 20 years. Researchers found that the women with silicone gel-filled breast implants were significantly more likely to be diagnosed with autoimmune or rheumatic disorders, namely Sjögren’s syndrome, systemic sclerosis and sarcoidosis.

According to a 2020 study [8], the silicone present in breast implants represents “an external non-self, chronic stimulus that may lead to hyperstimulation of the immune system in genetically predisposed individuals, the appearance of non-specific subjective clinical manifestations, and autoantibody production, which might precede the development of autoimmune diseases, and rarely, lymphoma.”

Among the various BII hypotheses that have been explored to date, one leading theory is that some people may be genetically predisposed to developing an immune reaction to the materials used in breast implants, as I mentioned above. This theory has been given a name: autoimmune/inflammatory syndrome induced by adjuvants (ASIA). ASIA is a recognized condition, and the pattern of widespread symptoms seen in ASIA are caused by a systemic reaction to adjuvants such as silicone. Many experts believe that ASIA is a better term, or explanation, for BII. [8]

How to Know if You Have Breast Implant Illness

Have a look at all of the symptoms (above) associated with BII. Because there are so many symptoms – and because these symptoms can be so potentially debilitating – you may find yourself going to multiple doctors with your odd array of symptoms, doctors who have no idea what to do for you. They run a battery of tests, and no clear picture results of what’s wrong with you.

This can be frustrating and expensive but hang in there. Because there are no diagnostic tests or criteria for BII, you will need to be your own advocate. Find a doctor or plastic surgeon who has successfully treated many other patients with BII – they are your best route for deciding whether or not you have it (or ASIA).

Is There a Treatment for Breast Implant Illness?

If your doctor can rule out other potential causes of your symptoms, either through testing, unsuccessful treatment measures, or both, you may want to consider implant removal (explantation).

Most doctors or plastic surgeons who have experience treating BII will recommend that the implants be removed and not replaced. They also generally recommend removing any surrounding scar tissue capsules.

According to breastcancer.org [9], some plastic surgeons recommend a procedure called an “en bloc capsulectomy” which involves removing the implant and the capsule in one piece. The reason for this is to help prevent silicone, biofilm (released by bacteria to help it stick to a surface and escape detection by the immune system), and other substances that are in or around the capsule from escaping into the body. Completely removing the scar tissue capsule in this type of surgery may also decrease the risk of fluid collecting in that area after surgery (known as a seroma). Some plastic surgeons may recommend a total or complete capsulectomy, which involves removing both the implant and the capsule, just not in one piece as is performed in the en bloc capsulectomy.

Research on Implant Removal

While we do not appear to have a lot of research on outcomes after implants have been removed, we do have a couple of studies that you might find helpful.

A small study published by researchers in the Netherlands in 2013 [10] investigated 80 women with silicone gel implants having autoimmune symptoms. They found that symptoms improved in 69 percent of the women after implant removal surgery.

A small study of 100 patients reported in August 2019 by The American Society for Aesthetic Plastic Surgery [11] showed that 89 percent of patients who had their implants removed and capsulectomy experienced improvement in some of their symptoms within three months of surgery. The symptoms that improved included cognitive problems, fatigue, burning pain in chest wall and breast, dry eyes, anxiety, and joint pain.

If you are considering explant surgery to address your BII symptoms, be sure to ask your plastic surgeon about the risks and benefits of the various surgical treatment approaches.

As a health coach, I would recommend seeing either a naturopath, integrative doctor, a Chinese medicine doctor or a Functional MD to help you after you have your implant(s) removed. By employing such sensible things as fresh air, excellent nutrition, supplements, herbal medicine, acupuncture, stress abatement and other forms of natural medicine, you can soon begin feeling much more yourself.

Please see your doctor immediately if you notice any changes in your breasts (implants or not) or your health.

References:

[1] Article August 2, 2019 – An Update on BIA-ALCL: What Patients Should Know About Allergan’s Recall of Textured Breast Implants –
https://www.americanboardcosmeticsurgery.org/cosmetic-medicine/an-update-on-bia-alcl-allergan-recall-of-textured-breast-implants/

[2] USFDA Web Article: Things to Consider Before Getting Breast Implants – https://www.fda.gov/medical-devices/breast-implants/things-consider-getting-breast-implants

[3] Silicone toxicology – https://pubmed.ncbi.nlm.nih.gov/7801134/

[4] Silicone breast implants and autoimmune rheumatic diseases: myth or reality – https://pubmed.ncbi.nlm.nih.gov/28379860/

[5] Is explantation of silicone breast implants useful in patients with complaints? – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5406477/

[6] US FDA Breast Implant Postapproval Studies: Long-term Outcomes in 99,993 Patients – https://pubmed.ncbi.nlm.nih.gov/30222598/

[7] Silicone breast implants and the risk of autoimmune/rheumatic disorders: a real-world analysis – https://pubmed.ncbi.nlm.nih.gov/30329056/

[8] Classical Examples of the Concept of the ASIA Syndrome – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600067/

[9] Article October 29, 2020: What Is Breast Implant Illness? – https://www.breastcancer.org/treatment/surgery/reconstruction/types/implants/special-report/breast-implant-illness

[10] Women with silicone breast implants and unexplained systemic symptoms: a descriptive cohort study – https://pubmed.ncbi.nlm.nih.gov/24394743/

[11] American Society for Aesthetic Plastic Surgery. Breast Implant Illness – Frequently Asked Questions/Talking Points. August 2019. Available at: https://www.surgery.org/sites/default/files/BreastImplantIllness_8-21-2019_FINAL.pdf