Breast Augmentation Concerns for Patients with Ulcerative Colitis

I am having my Breast Augmentation done on Feb 11th but one thing still concerns me. I can't seem to find anyone else with my condition.  I have Ulcerative Colitis which is an autoimmune disorder and I was wondering if my body will be more prone to reject the implants or if I am worried for nothing. I have researched so much my head is spinning. I don't know whether to believe all those horror stories because had I got implants prior to developing UC I probably would have blamed them. Honest opinions and answers are appreciated.

Doctor Answers 14

You and your plastic surgeon involve your internist and gastroenterologist in your care.

Ulcerative colitis is a form of inflammatory bowel disease (IBD). Ulcerative colitis is a disease which affects the large intestine or colon that is manifested by open sores or ulcers in the colon. The main symptom of the active disease is usually constant diarrhea mixed with blood and cramping. Ulcerative colitis is a systemic disease that affects many parts of the body outside the intestine. It is important that your disease is under medical control. Your gastroenterologist and medical internist should be involved in the decision making process to determine whether you are a reasonable candidate for breast augmentation. Treatment typically consists of anti-inflammatory drugs, immuno-suppression and dietary control, all of which needs to be taken under consideration.

In general, you are at risk for prolonged wound healing and infection; however, there is no data to support that you are at risk for “rejection of the implants”. In 1999, the Institute of Medicine concluded that silicone implants do not cause any major health problems. Research and reports from the last decade have shown that silicone gel-filled implants do not pose additional risks to women’s short-term or long-term health. Silicone implants were approved by the FDA and are considered safe.

In summary, I must stress that you and your plastic surgeon involve your medical doctors…internist and gastroenterologist… in your care. I wish you the very best during this exciting time in your life. Thanks for your question. I hope this helps!

Stephen A. Goldstein, MD

Englewood Plastic Surgeon

Ulcerative Colitis and Breast Augmentation

Thanks for the question.

You're right to ask questions and do your research. Breast augmentation is a serious consideration.

Ulcerative colitis occurs in less than 0.1% of the population. There are many causative theories regarding UC and there is a presumed genetic component to susceptibility. Most believe that active symptoms in a susceptible person can be triggered by environmental factors. And most recent research does not conclude that UC is an autoimmune disease even though its treatment is similar to other autoimmune diseases. It is not clear that UC is autoimmune mediated.

And there's the rub.

UC can be treated with medications that fall into the following categories:

Aminosalicylates (like sulfasalazine)
Corticosteroids (prednisone)
and Immunosuppressives (azothioprine, methotrexate)

It's the last two categories that can be problematic.

The problem is, things that are implanted in your body do not have a natural blood supply and thus are more prone to infection and less able to clear infection once one has started.

Corticosteroids and immunosuppressives change your bodies ability to fight infection. Around the time of the operation they can cause significant infection issues. Most plastic surgeons would exercise caution in performing an elective cosmetic operation involving implanted material if you were actively being treated with steroids or immunosuppressives.

There can be long term issues too. While the infection risks are greatest during the surgery and in the first month or so post-operatively those medications can cause infection problems even in breast augmentations that have healed (though the numbers are significantly lower).

There are other manifestations of UC that could be of issue.

Thromboembolic events have been reported with UC and any general surgery can cause clots to form in veins and should be actively prophylaxed against during surgery and potentially afterwards.

The above would be the primary concerns I would discuss with my patients. Issues of autoimmune disease being triggered by implants are anecdotal and do not seem to be supported by evidence at this time.

For your particular situation a close discussion with a board certified plastic surgeon in addition to your GI doctor would be recommended.

Good luck!

Steven H. Williams, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 49 reviews

Breast Augmentation Concerns for Patients with Ulcerative Colitis

Thank you for the question.  Assuming the inflammatory bowel disease is well-controlled, elective breast surgery is not necessarily contraindicated.

You are, however wise in being cautious about undergoing elective surgery given that you have an inflammatory bowel condition. As you likely know, some of the medications used to treat autoimmune disorders such as  inflammatory bowel disease are anti-inflammatory medications;  their use may increase your chances of infection.

  I would suggest that you   communicate your goals with your gastrointestinal physician  who knows you best. He/she, will be able to evaluate your “risk profile” much better than online consultants will be able to do. Then, your gastrointestinal physician will be able to communicate with your  chosen plastic surgeon in regards to optimal timing of the breast augmentation surgery;  perioperative management of specific medications may also be part of this communication. Best wishes. 

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Breast implant augmentation surgery in patient with UC (ulcerative colitis)

Many of the myths associating breast implants with auto-immune disease (human adjuvant disease) have been debunked by studies conducted by respected academic institutions. There is always a concern about performing ANY implant surgery in an immunocompromised individual and these should be discussed with your rheumatologist and plastic surgeon.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

No correlation between collagen vascular disease and breast implants

There is no correlation between breast implants and the diseases that derailed their use in the 1990's. Perhaps more than any other products, these reports have been studied to excess. Breast implants can have risks, but these are not some of them.

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 33 reviews

Breast implants and ulcerative colitis

As you know, ulcerative colitis is considered an autoimmune disease. The entire controversy in the 90's centered around silicone breast implants and their direct causative link to autoimmune diseases. That was a nightmare to live through with a lot of media hype and not much scientific data. I would have a frank discussion with the immunologist that manages your ulcerative colitis and perhaps get a second opinion and then make your decision. As far as I know you are at no greater risk for infection or capsule contracture if you UC is under control, which I presume it is. Rejection, per se, is an immunology term and would not be used normally under these circumstances. I could not agree more with your statement concerning getting the implants and then developing UC. That was at the heart of the debacle in the '90's. Best of luck.

Talmage J. Raine, MD, FACS
Chicago Plastic Surgeon
4.6 out of 5 stars 9 reviews

Ulcerative colitis shouldn't preclude augmentation

Ulcerative colitis is an autoimmune disorder which causes abdominal cramping and diarrhea. The key to management is reducing the episodes and maintaining a healthy life style and good nutrition. You may periodically take steriods to help control the flareups and regular colonoscopy may be important as color cancer rates may be higher.

Ulcerative colitis, while and autoimmune diease will not cause a rejection of your breast implants. You can safely have and enjoy breast augmentation with either a saline or a gel breast implant. You should plan augmentation of course when you are well and off medication, and you are at your best.

There is not a large amount data concerning breast implants in individuals with inflammatory bowl conditions, however drawing from other patients who have heart valves, or hip replacements, you may wish to discuss with your gastoenterologist the benefit of antibiotics during a severe flareup, during colonoscopy, or during higher doses of steriods to protect them from circulating bacteria.

All of us have limitations in life. I hope yours is the best it can be.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

Here's an honest opinion...

Yes, this is a difficult situation since I have personally not placed breast implants in a patient with ulcerative colitis. It is true that you have an autoimmune condition, but that does not automatically mean you will "reject" your implant. The implants today are very non-immunogenic. In addition, your body covers the implant in a shell called a "capsule." This inhibits further contact with your immune system as well. If, for some reason, you were to get an auto-immune response to the implant, in the sense of redness, swelling, or further infection, then you could have the implants removed. However, I do not feel that it would result in more complications for a patient with ulcerative colitis. It would be best for you to talk to your internist and/or an allergy/immunology physician prior to your procedure. Good luck.

Sirish Maddali, MD
Portland Plastic Surgeon
2.0 out of 5 stars 1 review

Breast Augmentation should be safe if UC is under control

Hi there,

I understand your apprehension and concerns.

As long as your UC is under good control, the procedure should be reasonably safe for you. In other words, talk to your GI doctor and be sure they don't disagree with your decision to place implants.

The real risk is not that you will be at higher risk of "rejecting" your implants, but that if medications are required for your UC that depress your immune system, the implants may become infected, and implant infections in patients whose immune systems are not normal can be very serious. I would emphasize to you though, that this is only a serious concern if you need to be on medicines that affect your immune system.

As long as your immune system is functioning normally, the fact that you have UC should not necessarily increase your risks for implant surgery.

I would review these with your GI doctor and your plastic surgeon.

Armando Soto, MD, FACS
Orlando Plastic Surgeon
4.8 out of 5 stars 157 reviews

I wouldn't worry from an autoimmune standpoint

Having UC shouldn't specifically predispose you to an increased risk of autoimmune conditions if you undergo a breast augmentation. The only issue I can think of would be a slight increased risk of implant infection if you should have a flare up and develop microabsesses in the colon from which the bacteria could travel in the blood stream and infect an implant.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.