Plastic Surgery : The Naked Truth about Breast Implant illness  and Breast Implant Safety

by

Let me preface the article by acknowledging that this is a highly emotional and controversial topic and has been such for more than twenty years.

Throughout this period of  controversy, I have had experience in cosmetic and reconstructive breast surgery following breast cancer treatment, and surgery for acquired deformities of the breast This includes previous surgery or treatments such as liquid silicone injections,  a common procedure in Asia during the 1960’s and 1970’s.

I also developed a great deal of experience in removing many silicone breasts implants during the silicone moratorium in the 1980’ and 1990’s.

“Silicone Poisoning” or  “silicone toxicity” as a distinct medical entity has been reported and published by a number of authors. On the other side of this controversy is more than twenty years of clinical and basic science research performed internationally.  The FDA has studied silicone for over 30 years to establish its safety. In 1999 after years of more than 100 clinic studies, the Institute of Medicine released a 400-page report prepared by an independent committee of 13 scientists.

The Institute of Medicine, now called the National Academy of Medicine is part of The National Academies, which attempt to obtain authoritative, objective, and scientifically balanced answers, The work is conducted by committees of leading national and international science experts. Every report produced by committee undergoes extensive review and evaluation.

All of this being noted, patients who have medical problems, signs and symptoms that cannot be diagnosed are left untreated, confused, upset , in pain, physically  and emotionally disabled. They have been left to consider the possibility of “silicone toxicity” also called “silicone disease” or “silicone poisoning”.

Doctors including Naturopathic Doctors, Chiropractors and others that practice Integrative or Holistic medicine are among those who advocate a variety of tests to determine illness due to silicone toxicity or “silicone poisoning”. There are also a number of Plastic Surgeons who have published articles and books describing various symptoms and illnesses related to silicone implants. 

According to these publications, women who are ill from silicone defective implants have various types of toxicity.  Silicone causes an autoimmune reaction in patients with certain HLA types. The (HLA) human leukocyte antigen system or complex is a gene complex encoding the major histocompatibility complex (MHC) proteins in humans. These proteins are responsible for the regulation of the immune system in humans.  HLA types are inherited and vary greatly from person to person

The interaction of auto immune disease, human biochemistry and the subsequent interaction of various proteins ris beyond the scope of this article. The publications on implant illness raise issues of patients who have existing genetic defects and certain HLA types There are known HLA types and HLA mutations that lead to autoimmune disease, difficulty with certain infectious disease, and other medical problems.

To confuse these issues even more, there is no evidence of an increase in autoimmune diseases such as Lupus, Rheumatoid Arthritis or Diabetes in women with breast implants.   Furthermore, there were no studies of women post explantation who were relieved of their medical problems that were statistically significant.

On the other side of this issue,  there are many anecdotal stories related to women who have developed a variety clinical signs and symptoms, various illnesses, at some point following placement of silicone or saline implants.  There are also many stories of women whose health improved after implant and capsule removal, some with additional medical treatments. 

As a physician, this conflicting information creates a difficult situation for ethical surgeons who must evaluate the pros and cons, risks and benefits of surgery.

Removal of breast implants can never guarantee that there will be improvement in a woman’s health.  There is no current consensus on laboratory testing to provide conclusive evidence.   Implant removal will possibly cause deformity or certainly a change in a patient’s breast size , shape and contours that may be physically and emotionally unacceptable.

The choice of surgery needs to be weighed against the current physical and emotional condition of a patient seeking a consultation.  Severe, debilitating medical conditions that cannot be diagnosed have no known treatment are emotionally, and psychologically incapacitating.

I believe that for the right patient, a trial of en-bloc silicone implant removal is a reasonable choice when all other evaluations have been exhausted. I want to be completely transparent with my patients regarding the issues discussed above, including current studies and the significant disagreements within the surgical and medical communities on the position of silicone poisoning, and silicone breast implant disease.  Silicone is a commonly used material in hundreds of medical devices; many are left in the body for a lifetime.  These include artificial fingers, heart valves, penile prosthesis etc.  The regulations for long term implantable devices are more stringent than non implantable or short term implantable devices.

I also have concerns for patients regarding a variety of predatory healthcare providers and laboratory services offered by many practitioners,  clinics or found on-line.

The website  QuackWatch.org  provides insight into many of these facilities that offer expensive evaluations and treatments to women suffering from poorly diagnosed medical conditions including Breast Implant Disease or Breast Implant Illness. These are not the best sources of testing or clinical care.  They often advertise with On-Line communities and Blogs that address these undiagnosed conditions. 

I believe that my training and clinical experience places me in an excellent position to evaluate patients who believe they are suffering from Implant Illness or Silicone poisoning. I am able to work together with my patients to devise the best evaluation and treatment plan that will meet their needs and concerns.

Article by
Orange County Plastic Surgeon