Breast Implant Illness

BII represents the rapidly growing concern among some women with breast implants, that the silicone shell, or the gel within, is causing their entire body to be sick. This is separate from known procedural complications of undergoing any implant-based breast surgery, and also separate from a different, distinct phenomenon that textured breast implants are associated with Anaplastic Large Cell Lymphoma. Although the reported BII symptoms can be very numerous and often vague, the prevalent notion is that the patients experiencing them truly believe that their implants are responsible, and they simply want them removed.

I have made Breast Implant Illness a particularly strong focus of my practice

Science is still catching up with this phenomenon, even after nearly six decades of debate within the patient and surgeon community, ever since the first publication about a possible link between augmentation mammaplasty and autoimmune connective tissue disorder in Japanese literature in 1964. Crystalline silica in its pure form is a known immunostimulant, as observed in stonemasons who were exposed to silica dust and developed progressive systemic sclerosis. Medical grade silicone was chemically altered to be physiologically inert, though the manufacturing process does inevitably produce impurities, the significance of which to the human body is yet unknown. Nevertheless silicone implants were deemed to be safe at that time, in part because of lack of solid evidence to the contrary, and therefore released on the market by the FDA.

silicone implants were deemed to be safe at that time, in part because of lack of solid evidence to the contrary

Since then, concerns about the safety of silicone in the human body were raised periodically, most notably by a series of case reports in the 1980’s, and a moratorium on implants in the 1990’s, each time followed by a multitude of studies which failed to definitively prove association between implanted silicone and systemic disease. The discussion gained strong momentum once again in recent years, with the advent of Social Media as its new and powerful platform. Suddenly, thousands of patients were simultaneously given a voice, and the discussion grew quickly and exponentially. This patient-led movement shared personal anecdotes and mutual support among its members, and became influential enough to catch the attention of the FDA once again. Consequently more research was funded, and additional “black box warnings” are proposed to implant packaging, warning patients about, among other things, possible unknown systemic effects of implants on the human body - a significant step in acknowledgment of this as a potential health concern by the FDA.

Breast Implant Illness Support Groups:

During my plastic surgery training, the official teaching about silicone implants was that they are safe. That was in fact the correct board answer, when I took my written board exam in 2017. Subsequently, I have treated many patients who had breast implants, often for decades, for reconstructive and cosmetic purposes. Many had no adverse issues whatsoever, and were generally grateful for the confidence their implants had bestowed them. And since implants are still the only option to significantly and reliably increase breast volume, I believe that they were the reasonable choice for those particular patients.

my immediate focus remains on my individual patients

However, I have also treated numerous patients with breast implants who had subsequently developed a constellation of significant whole body symptoms, which extensive medical workups could not decisively explain. Many of these patients had seemed to improve dramatically after explantation - for reasons which remain unclear. It was the strikingly numerous and powerful experiences with these patients which reinforced to me the reality of Breast Implant Illness - a phenomenon which I believe we are only beginning to understand. Since then I have made Breast Implant Illness a particularly strong focus of my practice, and BII patients currently represent the majority of my patient population.

Science has not yet been able to definitively demonstrate this link, though I believe we are getting closer. Part of the problem is that many studies looking at the issue were poorly designed or significantly underpowered (not enough patients enrolled) to statistically prove a link to a disorder that is relatively uncommon, very difficult to define, and mimics countless other well known and more common disorders. My hope is that in the near future, science will delineate a specific test or a questionnaire which can pre-emptively identify patients who should never have silicone placed in their body in the first place. Until then, the best we have is thoroughly informing the patients about what we already know, what we do not yet know, and making sure they understand all the risks prior to undergoing any surgery.

Personally, I stay current with medical literature on the subject, and I engage my BII patients to contribute to collecting symptom data, as I guide them through their individual healing. My screening protocols are also updated as new data emerges. In addition, I collaborate with other specialists to optimize my patients’ recovery, and I lecture on the topic of BII to other physicians and health care professionals, as means of increasing awareness. And while all of that is long-term work in progress, my immediate focus remains on my individual patients, for whom I put forth my most honest effort to deliver the precise technical procedure they deserve, to optimize their surgical outcome and leave them with the best cosmetic result I can.

- Luke Swistun, MD

General approach to explantation (individualized for every patient):

• En Bloc removal of capsule and the implant within, whenever possible

• Removal of all implant and capsule material piece by piece, if En Bloc not possible (ie. if En Bloc would risk undue harm to the patient)

• Photography and/or videography as requested

• Fungal/mold/bacterial tissue analysis if appropriate or requested

• Microscopic (histologic) tissue analysis if appropriate or requested

• Optimization of immediate cosmetic result with a breast lift, and possibly fat grafting, as indicated

• Close post-operative follow-up in person, or via teleconference if necessary (I’m always available to my patients)

• Further optimization of breast contour with additional delayed fat grafting if needed, as indicated

• Patient may keep implants and / or tissue if desired

What is it like…?