What is Breast Implant Illness?
Breast Implant Illness refers to a range of symptoms reported by some women who have breast implants. The symptoms are often described as systemic, meaning they affect multiple systems in the body. Many of the symptoms are also experienced by women with autoimmune disorders such as lupus and rheumatoid arthritis. Commonly reported symptoms include joint pain, muscle pain, fatigue, hair loss, skin rashes, memory loss, difficulty concentrating (brain fog), headaches, anxiety, depression, dry eyes, dry mouth, visual changes, breathing problems, and gastrointestinal problems.
Breast implant illness has also been referred to as Autoimmune/Inflammatory Syndrome Induced by Adjuvants (ASIA) and Adjuvant Breast Disease.
Diagnosis & Symptoms
Unfortunately, we do not have a test to specifically identify Breast Implant Illness. This can make the diagnosis of BII challenging as there are numerous symptoms that effect multiple body systems.
Breast Implant Illness patients should be approached in the same way as any other patient presenting with new symptoms. A differential diagnosis of all the possible causes for the symptoms is created and then a workup is performed to rule out the causes on the list. This may require referring the patient to other specialist to evaluate their symptoms. For example, if a patient with breast implants begins to suffer from headaches, dry eyes and joint pain, they may be evaluated by a neurologist for the headaches, ophthalmologist for the dry eyes and a rheumatologist for the joint pain. A methodical approach helps to ensure that alternate causes for symptoms are not missed.
For many patients experiencing Breast Implant Illness, their work up does not detect alternate reasons for their symptoms, leaving only the implants in question.
Some patients report symptoms within just a few months after having implants placed, while others can have implants for years before experiencing symptoms. At this time, we are uncertain as to why the timeline for developing Breast Implant Illness is so variable, but it does mean that a high level of suspicion needs to be maintained in all patients who develop symptoms regardless of how long they have had implants.
Survivor Testimonials
Voices of Resilience
“Surviving breast implant illness was shocking. I had no idea it even existed when I made the choice to have them in my body after my mastectomies. Ultimately because of the devastation it did to my body, there were no options to recover struct in other ways. I live with a concave chest. I love modeling grace and grit throughout my journey only as a means to share important information for others who came after. Breast implant illness exists. The only way to make the correct choices for our bodies is by equipping our minds with truth and knowledge.”
Christine Handy
“Breast Implant Illness??? What the heck is that? After many years of researching and having so many symptoms (Brain Fog, Hashimotos, Skin Issues, Weight Gain). I knew something wasn’t right. I finally put the 2 things together. It has to be my breast implants that were causing these issues. That day came in 2020 & I finally got my implants out. I made sure I found a doctor that would do my Explant with an En Bloc Capsulectomy (that was my 1 and only wish). I thank God everyday that I had my implants and capsules taken out. On my capsule they found ductal carcinoma in situ (DCIS). Having the En Bloc Capsulectomy is what saved my life! Trust Your Gut!”
Stephanie Lang
Explant, or removal of the breast implants, is the first step in treating Breast Implant Illness. In addition to implant removal, a capsulectomy is often performed to remove the capsule that forms around the implant. There is an ongoing debate regarding how much, if any, of the capsule needs to be removed. Many patients and practitioners are concerned that because the capsule can contain silicone and other implant components, that complete resolution of a patients’ symptoms may not occur without a total capsulectomy (removal of the entire capsule). En bloc capsulectomy refers to a total capsulectomy that is performed so that the implant is removed with the entire capsule intact. This prevents any fluid or implant contents from being spilled during removal of the implant and is my preferred capsulectomy technique for the treatment of breast implant illness.
Following a capsulectomy, the capsule should be sent to pathology for evaluation. Fungal and bacterial cultures are also performed to evaluate for a biofilm. Bacterial can attach to the surface of the implant creating a biofilm around the implant. The bacteria may not result in a detectable infection that causes redness of the skin or fevers, but rather linger resulting in a low-grade infection that causes chronic inflammation. Chronic inflammation from biofilms have been linked to capsular contracture (thickening of the implant capsule) and have been hypothesized as a cause for Breast Implant Illness.
The good news is that thousands of women have undergone explants and report resolution of their symptoms! Despite those overwhelming numbers, there are women who have had an explant and did not experience an improvement in their symptoms. This is an important part of the discussion prior to surgery.
When a breast implant is placed it will increase the size of the breast, fill the breast skin resulting in a rounder fuller appearance and can rotate/lift the nipple and areola higher on the breast. Removing an implant has the opposite effect. The breast will be smaller, the loss of volume will result in deflation and possibly the appearance of excess skin. The nipple and areola may also become ptotic or lower in position.
The options differ depending on whether you had a cosmetic breast augmentation versus a breast reconstruction following a mastectomy. Replacing the old implant with a new implant should be avoided for all cases of suspected breast implant illness to prevent recurrence of the symptoms. Click here to learn more about the options.
treatment & Recovery
Options to consider to restore breast shape after explant
For breast augmentation patients, the goal is to reshape the remaining breast tissue following an explant. If the nipple position becomes ptotic (too low) or if there is redundant breast skin, a breast lift, or mastopexy, is performed. A mastopexy will lift the position of the nipple and areola and tighten the breast skin/tissue to achieve a rounder, perkier breast shape. Mastopexy techniques (Peri-areolar vs Circum-vertical vs Wise/Anchor Pattern) are chosen based on breast measurements and degree of ptosis.
An Auto-Augmentation should also be performed to preserve any redundant breast tissue. During an Auto-Augmentation, excess breast skin and tissue is preserved and repositioned to a more central location on the breast to enhance the breast shape and maximize volume.
Fat grafting can also be performed to add volume to the breast. During fat grafting, liposuction of other areas of the body is performed, typically from the abdomen or thighs. The fat is processed to remove excess fluid and is then injected into the breast to increase the breast size without using an implant. A portion of the fat may be resorbed. Fat grafting can be performed more than once to achieve the patient’s desired breast size.
Breast reconstruction patients also have options following an explant. For those who want to maintain a breast reconstruction, transitioning to a natural tissue (autologous) reconstruction is an excellent option. Autologous procedures utilize a patient’s own tissue for reconstruction by transferring skin and fat from one area of the body to the breast. The gold standard for autologous reconstructions is the DIEP flap. During a DIEP flap skin and fat from the abdomen are transferred to the breast along with its blood supply, the Deep Inferior Epigastric Perforating vessels. Using microsurgical techniques, the DIEP vessels are connected to vessels in the chest to restore the blood supply to the newly transplanted abdominal tissue. Nerves can also be repaired during the procedure to increase sensation to the reconstructed breast. The same concept can be applied to moving tissue from the thighs (TUG/PAP flaps), the buttocks (GAP flaps) or lower back (LAP flaps).
Autologous reconstructions also have several advantages over implants including:
- Flaps do not leak, rupture, or have to be replaced
- Always soft and warm
- MRI’s are not required for monitoring
- No risk of capsular contracture, breast implant illness or BIA-ALCL.
For patients who no longer want a reconstruction, an Aesthetic Flat Closure is also an option. Simply removing a breast implant and closing the skin would allow the excess breast skin to fold and bunch up on the chest wall. An Aesthetic Flat Closure is not a breast reconstruction, but rather a thoughtful closure of the breast skin with the goal of leaving smooth, flat chest wall closure. An Aesthetic Flat closure can also make wearing an external prosthesis more comfortable.
FAQs
When any foreign material is implanted in the body, the immune system will recognize that implant as foreign and attempt to separate it from the body by surrounding it with a capsule of fibrous tissue. This will occur with all implants, including facial implants, orthopedic implants and yes, breast implants. Any source of continued inflammation around the implant can cause the capsule to become thickened, a process known as capsular contracture.
You can begin with a consultation with a board-certified plastic surgeon. A detailed history should be taken including the type of implants you have (silicone? textured? size?) and a thorough review of the symptoms that you are experiencing (When did they start? Did you experience the symptom before implants? Does anything trigger the symptoms?) A physical exam should be performed including a breast exam, and an evaluation for capsular contracture and signs of implant rupture. The aesthetics of the breast should also be assessed including nipple position, quantity of breast tissue, scars and skin quality. This will help to identify your options to optimize the breast shape after an explant. Additional referrals to other specialists may be necessary to properly evaluate symptoms. As with any medical issue, be your own advocate. Do your research and be comfortable with your doctors. If you feel like your concerns are not being properly addressed, seek a second opinion.
Both! In fact, every variation of breast implants has been explanted in patients experience breast implant illness. That includes saline, silicone, smooth, and textured, from the first generation implants to today’s modern day cohesive implants.
Yes. Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA_ALCL) is a cancer of the lymphatic system that develops in the capsule surrounding breast implants. BIA-ALCL is almost exclusively associated with textured implants. The most common presentation is the development of a fluid collection around the implant months to years after the implant was placed, although some patients do experience other symptoms such as enlargement of the breast, breast pain, and skin changes. A definitive diagnosis of BIA-ALCL can be made by a pathologist after examining fluid sampled from around the implants. Flow cytometry of the sampled fluid will be CD30 marker positive and ALK marker negative in patients with BIA-ALCL.
The treatment for BIA-ALCL begins with removal of the implant and a total capsulectomy. The capsule is evaluated by a pathologist and a consultation with an oncologist is often recommended, though additional treatment is usually not required.
Over the years, thousands of women have experienced symptoms of Breast Implant Illness and have achieved relief following an explant. The numbers are too staggering to dismiss as some type of placebo effect. Research is needed to help identify risk factors and aid in diagnosis. In the meantime, education and awareness is key, not only for women who are considering or have implants, but also for the medical community. Without knowledge of BII, medical practitioners are unable to consider BII as a possible cause for a patient’s symptoms.
Doctor's Perspective
David Light, MD, FACS
Plastic Surgeon & Breast Reconstruction Specialist, Medical Advisor, Learn Look Locate
“In order to properly educate patients and maintain their trust and respect, plastic surgeons need to have an honest conversation regarding implant risks prior to surgery, including the risk of breast implant illness.”
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