How common is breast implant illness?

Question

I'm considering getting breast implants and I'm trying to be as informed as possible about any risks of the procedure. It's difficult to get objective information about "breast implant illness" since it's not currently a medical diagnosis but a constellation of symptoms women are reporting. I did join the facebook group for breast implant illness. I'm shocked how many members it has (120k+) and how horrible the stories are. Some doctors will not implant anymore. Are BI a ticking time bomb?

Ram Kalus, MD, FACS · Answer

Thank you for your question and you are prudent to being do your research. The complex subject of BII is not well understood, and I happen to be on staff at the very hospital in Tel Aviv, Israel where the immunologist who first coined the term and published on the subject is on staff and a colleague. We agree to disagree on several matters, as you might imagine.

That said, here is what we know today, and more importantly what we do not know. What we know is that there are millions of women the world over who have breast implants for for cosmetic and reconstructive purposes, the vast majority of whom are enjoying an improved quality of life because of their surgery. Virtually ALL implants (saline or silicone gel filled) have a silicone ('silastic") envelope whose inner contents may be either saline (salt water) or silicone gel. Silicone is a compound made up on one silicone atom ("Si") on the periodic table of elements and two oxygen atoms ("O") and its formula is therefore "SiO2". Silicon, the atom, is the second most common element on planet earth after carbon, and is everywhere in our environment, including our soil and our drinking water, not to mention nail polish, hair spray, many body lotions and facial creams, sun screen, etc. Oxygen doesn't need any explanations.

BIAI (Breast Implant Associated Illness), if such a diagnosis exists, consists of what appears to be a very long list of signs and symptoms that on their surface seem totally unrelated, but according to the immunologist, rheumatologist, and functional medicine community, may all be an indication of the body's immune response to an immune stimulant or trigger. We cannot state with any certainly that silicone is the culprit in any given patient, and more importantly, these symptoms are overall very rare compared to the number of women who have breast implants. More importantly, women can have many of these symptoms and signs without ever having had a breast implant in their body.

Therefore, as you can see, the subject is both confusing and complex and we certainly do not have all the answers. If you yourself are a highly allergic person, or have a family history of various autoimmune conditions such as lupus, rheumatoid arthritis, scleroderma, Sjogren's syndrome, etc. you may want to be very thoughtful about undergoing surgery since you might be one of those rare patients who develops odd symptoms after you  breast augmentation.

However, after doing all of your research on your own, it is probably best to consider a consultation with a board certified plastic surgeon who can advise you in person on all of your options. The take home message is that based on the statistics alone, a breast implant appears to be an extremely safe device that has improved the quality fo life for countless patients. Best of luck to you.

Kenneth Hughes, MD · Answer

The textured breast implants are linked to breast implant associated-anaplastic large cell lymphoma (BIA-ALC), a cancer of the immune system. The FDA reports that BIA-ALCL may develop in 1 in between 3,817 to 30,000 women with textured breast implants (Clemens et al, 2017; Loch-Wilkinson et al, 2017; De Boer et al, 2018). As of this date, the risk appears to be very small. In most cases, BIA-ALCL is found in the scar tissue and fluid near the implant but can be widespread. The most common test for ALCL is to take a biopsy of an enlarged lymph node and check it for lymphoma cells. After three years, 93 percent of BIA-ALCL patients are disease-free when the condition is detected and treated early, according to American Society of Aesthetic Plastic Surgery data. The human leucocyte antigens (HLA) test can be requested through your PCP and involves a standard blood sample using a small needle. The blood sample is then sent to a lab for analysis. If the blood results are HLA-B27 or HLA DR52 positive, it means you have a rare HLA gene and therefore you are very susceptible to autoimmune diseases from silicone exposure.

Michelle Zweifler, MD · Answer

Breast implant illness has becoming more recently discussed over the years with social media.  The exact incidence of Breast implant illness is not accurately reported.  Initially, when silicone implants were pulled from the market and prospective studies were performed; the data at that time showed autoimmune symptoms were similar for women augmented and not augmented.    With more time and studies, hopefully more data can be obtained.
Fat grafting to the breast is another option for breast enhancement in patients interested in smaller breast augmentation without implants.

Frank Lista, MD · Answer

Hi, thanks for your question. It is completely natural to have questions and concerns about any surgical procedure, and it's really important that you are doing all the research that you can about breast implants and breast augmentation.

With regards to breast implant illness (BII), you're right, it is not a recognized medical condition, and there are good reasons for this.

Recently, a very small percentage of breast augmentation patients have been complaining about being affected by a broad range of symptoms such as fatigue, hair loss, brain fog, depression, anxiety etc. I stress a small number of patients because this condition affects less than 1% of women who undergo breast augmentation surgery. These symptoms are being attributed to breast implants, but there is as of yet no medical evidence that correlates these symptoms with breast implants.

As surgeons, we recognize that the symptoms that these patients are experiencing are very real, but because symptoms vary from patient to patient it is very difficult to identify their root cause. Furthermore, there is no evidence that shows that removing the implants makes the patient better, in fact, in many cases it has not.

So while we believe this condition exists and we take it very seriously, we are unable to definitively prove that breast implants are the cause. We are working to get to the bottom of this. I have been appointed to a task force by the American Society of Plastic Surgeons to investigate BII.

That said, the majority of patients that get breast implants do not suffer from BII and are extremely happy with their result.

If you are thinking of getting breast augmentation surgery, I highly recommend that you book an in person consultation with a board certified plastic surgeon in order to discuss these and any other concerns you might have about this procedure, and to assess whether this is the right procedure for you and what you are looking to achieve. Breast augmentation is a wonderful surgery with amazing results but you need to feel 100% comfortable with your decision to go through with it.

Ronald J. Edelson, MD · Answer

How common this is depends on whether  you choose to believe it exists at all. Many plastic surgeons deny its existence and say that study after study has disproved it.  But those studies were done by plastic surgeons and implant manufacturers, who are not exactly unbiased. I have seen enough women who feel they have the illness and claim they got better after implants are placed. If you are worried about it there are two things you can do. Either not have implants or opt for saline.

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How common is breast implant illness?

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Everything you need to know about Breast Implants

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