Whether you have breast implants or are considering breast augmentation for the first time, it’s a good idea to educate yourself about breast implant illness (BII). This collection of unexplained immunological symptoms does not affect the majority of women with implants, but those patients who do develop these symptoms have come together, shared their stories online, and commanded the attention of the medical community. While there is still much to learn about BII, research to expand our understanding is currently underway.
As a female board-certified plastic surgeon who has helped many women with breast procedures including breast augmentation and breast implant removal, Dr. Katerina Gallus explains what we know about BII in 2022 below.
- What is breast implant illness (BII)?
- What are the symptoms of breast implant illness?
- Are certain implants more associated with breast implant illness?
- How do people get breast implant illness? What causes it?
- Are certain women more likely to get breast implant illness?
- How common is breast implant illness?
- Does everyone with breast implants get BII?
- How do I know if I have breast implant illness? How is BII diagnosed?
- Should I have my breast implants removed if I have breast implant illness?
- What are my breast implant removal options?
- What happens if you don’t replace breast implants?
What is breast implant illness (BII)?
The term breast implant illness describes a range of inflammatory symptoms that some women attribute to their breast implants. When these symptoms are not explained by another diagnosis, some women with BII choose to undergo breast implant removal, which may resolve symptoms for some patients.
What are the symptoms of breast implant illness?
Symptoms of breast implant illness vary widely from person to person. In general, signs of BII are similar to those of inflammatory or immune system disorders, such as lupus or rheumatoid arthritis, and may include:
- Joint or muscle pain
- Dry eyes or mouth
- Irritated skin or rash
- Hair loss
- “Brain fog” or difficulty with concentration/memory
- Nausea, constipation, diarrhea, or upset stomach
- Difficulty sleeping
- Depression and anxiety
- Respiratory issues
Symptoms range from mild to severe, may come and go, can appear whether the patient has had implants for a short or long time, and are sometimes difficult to pinpoint.
Are certain implants more associated with breast implant illness?
It is not clear if certain implants are more likely to be associated with breast implant illness. As such, in 2019, the FDA called for a national database of patients with breast implants which will be invaluable for researching this very question. We are hopeful that growing interest will lead to research that answers this and other specific implant-related questions.
How do people get breast implant illness? What causes it?
The cause of breast implant illness has not been clearly determined; however, recently published research suggests that it may be immunological in nature, and some doctors believe that breast implant illness may be an immune reaction to the implant, or autoimmune syndrome induced by adjuvants (ASIA).
ASIA is also referred to as “human adjuvant disease” or “Shoenfeld’s syndrome;” an “adjuvant” in the case of a breast implant is the components of the implant, namely silicone—which is part of all implant shells, regardless of their fill type. Previously, silicone was thought to be biologically inert. While ASIA is a recognized condition, more research is crucially needed to explore the connection between ASIA and breast implants.
Two analyses of long-term patient data have found a possible connection between having breast implants and self-reporting or being diagnosed with an immune disorder. These studies were published in 2018 and 2019, and suggest further avenues for research.
Are certain women more likely to get breast implant illness?
A 2019 study looking at a small sample of patients with autoimmune syndrome induced by adjuvants (ASIA) who also had breast implants suggests that women with a family history of autoimmune disease, those who smoke, and those with allergies are more likely to develop symptoms.
How common is breast implant illness?
Unfortunately, there are no studies that have specifically looked at the number of women with breast implants who have developed BII, and existing studies on implant safety do not definitively answer this question. With affected women sharing their experiences through social media, awareness of BII is growing, and more women are reporting their symptoms to the FDA and their surgeons.
Does everyone with breast implants get BII?
No. The vast majority of the millions of women with breast implants do not report experiencing symptoms of breast implant illness. Many breast augmentation patients have enjoyed having breast implants throughout their adult life without issues.
The vast majority of the millions of women with breast implants do not report experiencing symptoms of breast implant illness.
How do I know if I have breast implant illness? How is BII diagnosed?
Unfortunately, there is currently no diagnostic test or criteria that can definitively confirm that you have breast implant illness—but, by ruling out other possibilities, you may be able to conclude if your symptoms are breast implant-related.
The symptoms of BII resemble those caused by many other ailments, so it’s absolutely critical to work with qualified doctors to rule out any other underlying condition, such as Lyme disease. As medical providers, we do not want to miss another condition by rushing to a BII diagnosis. After excluding other possible causes, you may decide to pursue breast implant removal.
Symptoms of BII resemble those caused by many other ailments, so it’s absolutely critical to work with qualified doctors to rule out any other underlying condition.
Should I have my breast implants removed if I have breast implant illness?
Today, many women diagnosed with BII choose explantation (breast implant removal) for greater peace of mind. However, before planning explantation surgery, it is important to understand there is no guarantee the procedure will resolve all symptoms and there is not yet enough research to make implant removal the treatment standard for all women experiencing BII-like symptoms.
Current research does suggest explantation may be effective for many patients, however. A very promising yet small 2020 study of 750 patients with presumed BII examined the effect of breast implant removal on 11 specific symptoms commonly reported with BII—including chronic fatigue, difficulty breathing, memory loss/cognitive problems, and joint and/or muscle pain. The study found that all symptoms showed significant, sustained improvement after implants were removed. Additionally, a few previous studies (including these from 2013 and 2017) found that at least half of presumed BII patients may achieve BII symptom resolution after breast implant removal.
What are my breast implant removal options?
Your breast implant removal options include removing only the implant, removing the implant plus some or all of the natural scar tissue (“capsule”) around the implant, and removing the implant intact inside the capsule. They are defined as follows:
- En bloc capsulectomy: Removes the capsule intact with the implant inside
- Total capsulectomy: Removes the implant, then removes the capsule
- Partial capsulectomy: Removes the implant and part of the capsule, leaving a portion in place
- Explant without capsulectomy: Removes the implant alone
Many breast implant illness patient advocates say that women with BII symptoms are best served with an en bloc capsulectomy—but, while en bloc capsulectomy is an appropriate surgery for some patients, it is not always advisable, and in many cases, would be unsafe. (A total capsulectomy is an excellent alternative when en bloc capsulectomy is not feasible.) It also requires a much longer scar than other methods. Finally, current research does not support en bloc capsulectomy over total or partial capsulectomy, so you should make this choice with an understanding of these facts.
It is important to find a trustworthy, board certified plastic surgeon who has experience with all methods of breast implant removal. They should do everything they can to help you achieve resolution of your symptoms and peace of mind, while also educating you on the science of breast implant illness and breast implant removal surgery. At Restore SD Plastic Surgery, we believe in giving you options and empowering you with the latest science on the subject. Learn more about breast implant removal »
Aesthetic considerations with breast implant removal
If you have small natural breasts and had a large implant placed, you may require a breast lift and/or a fat transfer to the breasts to achieve a natural-looking breast shape and volume. However, you may choose to first have your implants removed and decide later if a breast lift or fat transfer is right for you; some women like to take care of implant removal and see how their tissues respond postoperatively. We will discuss your likely aesthetic outcome if you are considering breast implant removal, sharing before-and-after photos of previous patients and discussing all procedure options that may achieve a natural, aesthetically pleasing breast appearance.
What happens if you don’t replace breast implants?
While most manufacturer warranties on breast implants last about ten years, plastic surgeons generally agree that it is not necessary to replace your implants on a regular basis unless you have a complication, such as rupture, or if you want to change the appearance of your breasts. Many patients’ implants last twenty years or more with no issues.
Many patients’ implants last twenty years or more with no issues.
It is, however, important to visit your plastic surgeon to have silicone gel-filled implants examined with an MRI or ultrasound to regularly check for any complications. The FDA recommends your first check 5-6 years after your breast augmentation and follow-ups every 2-3 years after that. Generally, symptoms of breast implant illness are more likely to appear in patients who have had implants for a longer period of time.
Choose San Diego plastic surgeon Dr. Katerina Gallus for attentive care and unmatched expertise
If you have unexplained symptoms and believe they may be breast implant illness, we understand that you want to find a compassionate doctor who is also well-informed on the latest research and prepared to help you find relief. As a board certified plastic surgeon with many years of breast surgery experience, San Diego plastic surgeon Dr. Katerina Gallus is here to educate you on your options and help you find a safe, appropriate solution. You may schedule a consultation by calling (858) 224-2281 or contacting us online at our San Diego plastic surgery practice.