Breast Augmentation Concerns for Patients with Ulcerative Colitis

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!

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.

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.

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. 

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

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.

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.

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.

The literature does not support any association of UC or autoimmune disorders with Breast augmentation. I recently placed a tissue expander for breast recontruction in a breast cancer patient that has UC. She already has an implant in her uninvolved breast and will have a permanent implant placed in the expande breasts in the next few months.

There are no scientific evidence to suggest that UC will get worse when you get breast implants. There are few reports related to fibromyalgia and gel implants. For your peace of mind you might want to go with saline implants. Good luck,