Dr. Saber’s Blog
Most of us are aware that breast implants are not 100% foolproof. Chances are you’ve seen a sensationalized picture showing a breast implant rupture, or one that got displaced to an odd position. And before I ever do a breast augmentation, I make sure to discuss the possibility of capsular contracture or other complications with all my potential patients.
Most of these complications are relatively easy to explain, and even to see from the outside. But that’s not the case for Breast Implant Illness (BII). This much rarer condition has a loose definition and pretty elusive symptoms. As a result, it’s notoriously hard to diagnose – even though it can cause a lot of pain for women who develop it.
Breast implant illness is not a typical disease, where we have a well-defined cause that directly causes a group of symptoms. Instead, it refers to a group of symptoms that sometimes appear together after getting breast implants, whether silicone or saline-filled ones. In many cases, these symptoms also disappear after having an explant surgery (breast implant removal).
The problem is – we don’t know much about the mechanisms that cause BII. We don’t have a specific test for it and it’s pretty rare: breast implant statistics show that less than 1.5% of women with breast implants develop these symptoms. And yet, that’s already often enough for us to have named the condition.
The symptoms of breast implant illness are what we call “systemic symptoms.” This means they are not confined to a specific part of the body. For example, a capsular contracture would cause very specific, confined pain around the breasts. Instead, BII symptoms often affect tissues around the body.
The most common BII symptoms are:
These symptoms can make it very hard to lead a normal life, but they also often appear disconnected from one another. They can easily be mistaken for thyroid disease, chronic depression, or chronic connective tissue disease.
In severe (but extremely rare) cases, some women may develop more serious conditions following breast implant surgery. For example, skin rashes can grow into scaly or thick patches of skin (scleroderma). Dry or itchy eyes, alongside a chronically dry mouth, may grow invasive enough to turn into Sjogren’s syndrome. Chronic joint pain or inflammation may feel very similar to rheumatoid arthritis.
We’re not 100% sure. One of the most common theories is that BII is an autoimmune condition — specifically, an autoimmune/inflammatory syndrome induced by adjuvants (ASIA). This means it’s caused by the body’s immune system attacking itself.
Proponents of this theory point out that, in some cases, the silicon in the implants gets mistaken for an invading organism – such as a virus or bacteria. This triggers a body-wide inflammatory reaction, progressively attacking muscles, joints, or other body parts.
The strongest evidence for this? Many autoimmune diseases, such as Lupus, Lyme disease, or fibromyalgia share the same symptoms as BII. However, where lupus causes a visible spike in some inflammatory markers, which we can measure on a blood test, BII often doesn’t. Many patients often experience a wide range of symptoms, but all their tests come back as normal.
There may also be a psychological component to BII. As a result, there are currently many pages out there claiming that “breast implant illness is a lie.” This is a bit of a radical statement that ignores the very real experience of a growing number of women who endure real, chronic pain.
Currently, there is no single blood test, body scan, or exam that can tell us conclusively that a patient’s symptoms stem from their breast implants. However, we can usually tell with relative ease if you don’t have BII.
Some conditions that are often confused with BII include:
This is when hardened scar tissue forms around the implant and starts to squeeze it. According to the U.S. Food and Drug Administration (FDA), this is one of the most common “serious complications” that can stem from silicone implants.
Although very painful, capsular contractures cause very defined and unmistakable symptoms. The pain will be confined around the implants, and you may even be able to “feel” the hardness around them. This makes for a pretty straightforward diagnosis.
Silicon is usually regarded as a hypoallergenic material, which is why we use it in a large number of medical devices. As a result, we now use silicone in anything from menstrual cups to cooking utensils.
With that said, silicone allergies do exist, and their effects are usually strong and immediate – especially when we place the silicone inside of you. But as silicone is now used so widely, it would be extremely rare for someone to reach adulthood without knowing about it. Plus, a quick allergy scratch test can usually clarify the issue quickly.
This is an extremely rare form of cancer that’s been linked to an older model of rough-textured implants known as Allergan Biocell implants.
BIA-ALCL can cause swelling in or around the breast, as well as fever, rashes, weight loss, and the appearance of a lump on the side of the breast or near the armpit. These symptoms partially match those of BII, which is scary – but unless you had Allergan implants, you’re most likely in the clear.
Nowadays, we no longer use textured breast implants, although they were once considered “easier” for women who’ve had reconstructive surgery after a full mastectomy, or as part of gender affirmation surgeries. This is because textured implants were more likely to stay in place, even if they were not surrounded by breast tissue.
Textured implants were eventually recalled by the FDA, and plastic surgeons no longer use them. As a result, cases of BIA-ALCL will continue to get rarer.
As we have no definite test for BII, many plastic surgeons are hesitant to make an “official diagnosis.” Instead, women usually come to see us several years after their original breast surgery, and usually after seeing several specialists for all their unexplained symptoms.
This is what healthcare providers call “a diagnosis of elimination;” basically, we’ve ruled out most other culprits, and we move down the list of likely causes. Whether spurred by social media or referred by their rheumatologist, we only have one way to treat BII: removal of the implant and potentially the surrounding capsule.
Once again, here experts disagree a bit: some surgeons believe that once the silicone and capsule are out, the symptoms will disappear. Others believe that it should be done as an “en bloc capsulectomy” – or removing everything in one piece. This prevents any silicone from possibly “spilling” or being left behind, where it would continue to cause issues.
However, this is a pretty complex procedure, requires a large cut, and often causes more bleeding or pneumothorax (air leaking into the chest). It’s not pretty, it will require a hospital stay, and overall, I prefer not to do it unless there’s no choice.
Following implant removal, replacing the implants is rarely an option because it would defeat the entire purpose of the surgery. In some cases, you can try a breast reconstruction using fat from somewhere else in the body. In my experience, women plagues with breast implant illness rarely see this as an immediate priority – but after healing, and especially if your original symptoms disappear, it may be worth considering.
Dr. Sepideh Saber, MD, FACS is one of LA’s leading plastic surgeons. Stanford-trained and board-certified, she combines an empathetic approach to her patients with a deep knowledge of surgical technique and input from the latest research in the field.
Her training in reconstructive surgery has allowed her to help hundreds of women who are recovering from breast cancer, are going through a larger transformation, or are dealing with the many effects of silicone implant illness.
To get in touch, call (877) 205-4100 or schedule a consultation online.
The practice of Dr. Saber is located in Encino, CA for patients throughout the Los Angeles area. We are also convenient to Encino, Woodland Hills, Sherman Oaks, Calabasas, Burbank, Glendale, Hidden Hills, Agoura Hills, Northridge, North Hollywood, Malibu, Topanga, Canoga Park, Reseda, Valley Glen, Chatsworth, West Hills, Winnetka, Universal City, Bel Air, Beverly Hills, Downtown Los Angeles, Silverlake, and Echo Park.