Breast surgery, particularly the breast augmentation procedure, is one of my areas of expertise and a bedrock of my practice. I love how it can literally transform a woman’s entire torso, sense of herself and outlook on life. Being able to help you feel like the best version of yourself is one of the main reasons why I became a plastic surgeon in the first place, and why I am such a fan of body contouring. My first goal with any aesthetic procedure is patient safety. A huge component of my practice philosophy has always been rigid honesty. You can trust that I will let you know whether or not I think a particular procedure will actually deliver on your goals as well as any potential risks. For this reason, it has been incredibly frustrating to myself and my fellow Board-Certified plastic surgeons to not fully understand what causes a patient to develop Breast Implant Illness (BII). The American Society of Plastic Surgeons (ASPS) is devoting serious resources to understanding this rare yet complex condition.
What is Breast Implant Illness (BII)?
Breast Implant Illness (BII) is the name for a cluster of symptoms that some women may develop in reaction to their implants. What makes BII so challenging is that it doesn’t seem to follow any rules. It can occur with both saline and silicone implants as well as smooth or textured implants. Some women manifest symptoms immediately after surgery. For others, it can take years. Furthermore, the symptoms themselves are wide ranging, and mimic those of other common conditions such as menopause, auto-immune disease, hormone imbalance and chronic pain syndrome. The most common symptoms that BII patients complain about are:
- Joint pain
- Brain fog
- Trouble sleeping
- Chronic pain
- Chest pain
- Hormone issues
- Hair loss
- Sensitivity to light
- Body odor
- Neurological issues
This makes positively diagnosing BII virtually impossible. My colleagues and myself who are studying BII believe it to be an allergic-type reaction to the shell of the implants. Similar reactions have been seen in patients with cardiac, joint and abdominal wall implants. The only way to find out whether or not your breast implants are the root cause of your problem is to remove them and see if your symptoms improve. My general approach is that if a patient feels her implants are making her sick, I take them out.
BIA-ALCL stands for breast-implant associated anaplastic large cell lymphoma. This cancer is extremely rare, and also quite real. Found, to date, only in patients with textured implants placed at some point in their lives, BIA-ALCL is an uncommon cancer that is not in the breast tissue itself, but in the capsule of scar tissue that forms around your breast implant. If diagnosed and treated early with a removal of the capsule (capsulectomy) and removal of the implants, BIA-ALCL has an extremely high cure rate. This is good news especially considering the fact that, in this country, textured implants have historically been used for breast reconstruction following breast cancer.
In light of the link between textured implants and BIA-ALCL, they have been taken off the market. Personally, I now only use smooth implants, and they’ve been my predominate implant of choice throughout my career. If you currently have textured implants and are not experiencing any changes such as swelling or pain, you do not need to have them removed. Some patients decide to do so for their own peace of mind, and I support any patient’s personal choice. The important thing to keep in mind if you have breast implants is to pay attention to any changes in the look and feel of your breasts, and to make certain that you see your breast surgeon annually to have them examined even if you feel fine.
What is ASPS Doing About BII?
As discussed, ASPS has devoted serious resources to understanding BII, and will soon publish a list of the symptoms most frequently associated with the condition. This will not only help us to address patient concerns, but also provide evidence-based care so that any prospective patient can understand her risks. We are also working to establish a database where patients can report their symptoms and register their breast implant:
- Device or brand name
- Adverse reaction and/or surgical intervention
Knowledge is power. The more evidence that can be accrued regarding BII, the more we can help our patients to stay safe.
FDA Now Requires Patient Decision Checklist on All Implants
I want to reiterate that most breast augmentation patients experience no issues. Breast implants are one of the most studied medical devices in the world, and their safety has been proven in multiple medical studies. However, BII and BIA-ALCL must be considered. This is why the FDA now requires that all breast implant manufacturers include a product-specific Patient Decision Checklist with every device. It includes all current information on known or reported risks. When you come in for your breast augmentation pre-op exam, we will review this list together. I have always reviewed these issues with my patients before surgery, but this document helps keep the information nicely organized. It’s a great opportunity for you to ask questions and for me to ensure that I’ve addressed all of your concerns so that you are fully aware of your risks. You must then sign this checklist before surgery. I think having this checklist is an important step in creating the safe, exemplary outcome that we both desire. To find out more about a breast augmentation with Dr. Sean Doherty at his Boston or Brookline office, contact us today or call (617) 450-0070 to schedule a consultation.