For Breast Implant Illness, what removal is best?

Hello,
And thank you for the question.
Breast implant illness (BII) is a term that is used to describe a wide range of symptoms that can develop after undergoing reconstruction or cosmetic augmentation with breast implants. They include, but are not limited to, fatigue, problems with memory or concentration (“brain fog”), joint and muscle pain, hair loss, weight changes and anxiety/depression.
Although some women report improvement or resolution of symptoms following removal of the implants (with or without en bloc capsulectomy), the cause of the symptoms and the degree to which they may be related to the implants are unclear at the current time. Research continues to be performed to better understand any potential association with breast implants.
Currently, however, BII is not recognized as a formal medical diagnosis and there are no specific tests or recognized criteria to define or characterize it.
I suggest that you seek an in person consultation with a Board-Certified plastic surgeon specializing in breast implant removal to further discuss your options, specific techniques, concerns and expectations.
Best, Dr. Karanetz
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

Removal of breast implants, intact or ruptured, may have positive implications if patients are symptomatic. A constellation of symptoms associated with breast implant illness, and autoimmune disease are considered when treating patients who have breast implants and are concerned about foreign body reaction. In our office, we begin this journey with a consideration of symptoms and exclusion of obvious autoimmune problems. In many of our patients, en bloc removal of breast implants with capsulectomy is important and beneficial. Further clinical evidence about breast implant illness is evolving and will continue to guide treatment. I would suggest removal if there is a possibility of foreign body reaction.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Thank you for your questions. It is recommended to have the capsules removed with implant if you are having symptoms related to BII I suggest a consultation with a board certified plastic surgeon to go over the options that best address your goals. Best of luck!

Dhaval Patel MD
Double Board Certified Plastic Surgeon
Chicago
South Barrington
Oakbrook
Orland Park

Dear christinem04,
if your capsules are thick then they should be removed together with implants. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

The recommended treatment for BII is removal of the implant, and removal of the surrounding scar capsule/preserving any natural/normal tissue of the breast. While some patients may find relief with implant removal alone, it is thought that it is the interplay between the body's tissues and the device that is ultimately responsible. Sending the scar capsule for pathology exam, microbiology cultures, etc., may provide additional information to the patient and surgeon.
Best wishes,
-Dr Hoy

If your implants are ruptured, or if your capsules are thick or causing issues they should be removed along with your implants. If this is not the case and your capsules are thin, it is an option to have them removed or leave them behind. I encourage you to speak to your surgeon about your concerns to determine what is best for you.

Thank you for your insightful question. Board certified plastic surgeons are adept to performing an explantation procedure. Typically the approach is through the inframammary fold. Capsulectomy whether partial or complete will be at the discretion of your surgeon and dependent on your physical exam, implant location, and safety concerns. A recent study (peer reviewed, double blinded) posted by the research arm of our aesthetic society (ASERF) and spearheaded by female plastic surgeons demonstrated: “The type of capsulectomy; intact total, total, or partial all showed similar symptom improvement with no statistical difference in the reduction of symptoms based on the type of capsulectomy.”
Please feel free to review study and discuss with your board certified plastic surgeon. This is an open access paper so available to public.
Part 1: Impact of Capsulectomy Type on Post-Explantation Systemic Symptom Improvement: Findings From the ASERF Systemic Symptoms in Women-Biospecimen Analysis Study Caroline Glicksman, MD, MSJ, Patricia McGuire, MD, Marshall Kadin, MD, Marisa Lawrence, MD, Melinda Haws, MD, Jill Newby, PhD, Sarah Ferenz, James Sung, MD, FCAP, Roger Wixtrom, PhD

If you have textured implants or thick capsules, the capsules should try to be removed along with the implants. Many women have improved with just removing the implants and leaving thin capsules intact, especially with saline implant. For old gel implants, prior to 1992, the capsules should be removed to try and remove as much gel as possible. None of this is "enbloc" surgery which is for cancer patients only.