What Exactly is Breast Implant Illness?

Breast implant illness has gained increasing attention in the media and online recently. This entity has been discussed by plastic surgeons and patients for several years. Breast implant illness is an association between breast implants and a symptom complex characterized by a variety of symptoms such as fatigue, hair loss, myalgia (muscle pain), arthralgia (joint pain), weight loss or other nonspecific symptoms.

What should I do if I think my implants are making me sick?

Patients who have symptoms like those noted above should discuss this with their plastic surgeon or a surgeon familiar with this entity. In my opinion, all patients should also have a medical workup, which may involve a consultation with a rheumatologist, endocrinologist, neurologist, or other specialists. Blood work should include autoimmune studies that look for autoimmune or rheumatologic diseases like lupus and rheumatoid arthritis. Workup should also involve assessing for endocrinology abnormalities like hypothyroidism and general medical problems like anemia. All of these disorders may mimic breast implant illness and it is critical that they are not missed since breast implant illness remains somewhat controversial and these other disorders have been well described and have objective laboratory studies, but more importantly if they are not treated, patients’ symptoms will persist.

Is there a medical test that can help determine if I have breast implant illness?

Breast implant illness is somewhat controversial because there is no blood test that can diagnose it, and there are no other types of laboratory studies, which can be used to objectively show physiologic abnormalities in patients with symptom clusters; however, there are many patients who anecdotally feel that their nonspecific symptoms resolved after breast implant removal. In addition, less common disorders and diseases like cancer including lymphoma or infectious diseases including Lyme disease can also cause these symptoms. So it is critical that patients have a thorough objective medical workup even if the patient ops to remove her breast implants.

Do I need a special surgery to have the implants removed?

Recently, the concept of an en bloc capsulectomy has promoted for patients seeking breast implant removal. En bloc capsulectomy means removing the entire scar tissue layer that surrounds any breast implant. Any foreign body including breast implants placed in the body will naturally have a layer of scar tissue formed around it and historically, capsulectomy was performed on a routine basis for patients who had capsular contracture, which is thickening of this normally thin scar tissue envelope. Patients who have capsular contracture will have hardening, tightening, and discomfort around their breast implants that is objectively found on exam. Most patients with breast implant illness do not have capsular contracture. Most patients who have capsular contracture do not have breast implant illness, so there is no specific association between capsular contracture and breast implant illness. Nonetheless, patients who wish to have their peri-prosthetic scar tissue layer (the capsule) removed with the breast implant can have this performed; however, it does increase operative time, risk of postoperative bleeding, can increase postoperative pain, and can interfere with vascularity of the overlying tissues if a concurrent breast lift (mastopexy) is performed with en bloc capsulectomy and implant removal. This type of surgery generally takes about 4 hours to complete but will vary from patient to patient.

What is recovery like from bilateral breast implant removal with capsulectomy and breast lift?

In general, most patients will return to work in less than a week. There will be drains inserted during surgery to each breast. This is done because a pocket is left behind where the breast implant was previously. These drains are generally removed about 4-5 days after surgery. Most patients can resume exercise activity beginning about 2 weeks after surgery. We also have you avoid heavy lifting for the first two weeks post-operatively. The incisions with the surgery are located around the areola, a vertical and a horizontal incision on the breast. Dissolvable sutures are used during the surgery. No permanent sutures. Patients will use antibiotic ointment on the incisions for a few weeks until they are completely healed. Settling of the breasts can take 3-4 months to be completed. All scars take 1-2 years to fade.

What happens to the implants after they are removed?

We generally discard any implant that has been in the body because they have been exposed to bodily fluids. If you wish to have the implants sent for pathology, we can do this. There would be additional fees associated with this from the pathology company. In general, pathology and other labs results, such as bacterial and fungal swabs are not done routinely unless there is the presences of some type of abnormal fluid.

Is breast implant illness a medical diagnosed medical condition?

I think it is important for patients and physicians, both proponents and skeptics of this disorder, to keep an open mind. It is possible that the symptom complex patients describe is not related to the breast implants, but is related to other environmental factors, which may be identified in the future (for instance, pesticides, heavy metals in the environment, sleep disturbance due to phone and computer screens) have all been implicated for similar symptom complexes, but it is also important to remember that breast implants are cosmetic devices that are not medically necessary, and therefore can be removed at any point if patients desire them to be removed, but as noted above, other possible causes of the patient’s symptoms need to be evaluated, identified, and treated if necessary, and other procedures may be necessary to optimize the aesthetic result after removing implants including breast lift.

Please contact our office by phone at 216.514.8899, or email us at info@drgoldman.com, if you have any questions about breast implant illness or en bloc capsulectomy.