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What is breast implant illness or BII?

Breast Implant illness or BII is a collective term used by women who have breast implants and report a variety of different symptoms that they feel are directly related to their silicone breast implants.  Many of these symptoms are also experienced by the general public on a regular basis with or without breast implants, therefore it is difficult to scientifically study. Unlike Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), a scientifically-proven condition linked to textured breast implants, Breast Implant Illness (BII) falls into a gray area, as there is no science behind it yet to either confirm or deny its existence. Currently science has not established a direct cause or link between breast implants and the symptoms described as breast implant illness.  These reported symptoms include (but are not limited to):

• chronic fatigue
• chest pain
• hair loss
• headaches
• chills
• light sensitivity
• chronic pain
• skin rashes
• anxiety
• brain fog
• memory loss
• body odour
• sleep disturbance
• depression
• neurologic issues
• hormonal issues

More recently there has been a significant increase in the number of women who identify as having breast implant illness or BII particularly via social media support groups.

Is there any science that links BII symptoms to breast implants?

There is currently no scientific evidence that has established a direct causal link between medical grade silicone breast implants and systemic illness  despite many studies of different sizes and design that have looked at the safety of breast implants.

A lack of scientific evidence does not mean that the symptoms experienced by these women are not real.  Further studies and research in this area and long term follow up studies are needed for this group of patients.

Is there a test that can diagnose breast implant illness?

Currently there is no specific test for breast implant illness (BII), however, further research is underway in this area.  There are specific tests for auto-immune conditions that may explain some symptoms, however, there is no science that definitively links these group of symptoms to silicone breast implants.  So far studies tell us that even for patients who report breast implant illness symptoms, their blood samples may show normal results.  Studies also tell us that women in general who have never had breast implants can also report these conditions.

What are the risks of developing breast implant illness (BII)

As there is no proven link between breast implants and the list of symptoms that have been labelled as breast implant illness  there is no means for definitively testing and therefore no 'known risk'.

Does breast implant removal improve a patient's symptoms or cure a patient's symptoms?

Some studies reveal different levels of improvement in patient symptoms after removal of their breast implants some of which are short term improvements only and some symptoms that improve long term.  We are hopeful that future studies will follow patients over the long term from their explant surgery and beyond to gather more data in this area.

I believe I have breast implant illness, what should I do?

Initially you may wish to discuss your concerns with your general practitioner to check your general health and rule out any other underlying causes of your symptoms.  Your GP may also arrange breast imaging to check the integrity of your breast implants prior to referring you to your breast implant surgeon or Specialist Plastic Surgeon to discuss your concerns.

As a Plastic Surgeon I always like to discuss my patient's medical concerns and often I may request further medical investigations including pathology (blood samples) which specifically look at inflammatory markers.  I may also send you for review with immunology experts if your symptoms indicate the need.    Depending on the results of your breast imaging and your blood samples, I usually like to discuss the option of monitoring your condition over time versus proceeding to explant your breast implants.  Any surgery carries risk which will need to be thoroughly considered, however, some of the options for explant may include:

• implant removal surgery without capsulectomy - the capsule remains insitu and the breast implants are removed.
• exchange of breast implants with or without capsulectomy
• removal of breast implants with total capsulectomy or
• removal of breast implants with enbloc capsulectomy - the scar capsule and breast implant are removed in 1 piece.

If explanting is your preferred option, I routinely have any tissue I remove including the breast implant capsule and/or fluid carefully examined by a pathologist.

Following explant it is important that you attend follow up appointments with myself and my practice Nurse to monitor any changes over time.  Post-operative blood tests may also be performed.  With more information collected over longer periods of time, hopefully science can definitively answer more questions about breast implant illness.

How often should I have my breast implants checked?

Breast Implants don't last forever, I now recommend having your breast implants checked every 3 years after your initial surgery and then every 2 years after that.

Dr Eddie Cheng's Take home message

• Further long term studies are needed for this group of women who identify with symptoms referred to as BII. We need scientific studies to determine the cause of their symptoms and long term follow up results following explant surgery.
• Removal of breast implants does not always guarantee an improvement in symptoms in the long term.
• There is currently no scientific evidence that breast implants cause the group of symptoms referred to collectively as breast implant illness.
• If you you have any concerns about your general health and think it might be caused by your breast implants, speak to your GP and Specialist Plastic Surgeon for further information to help you consider your options moving forward.
• Stay in touch with your Plastic Surgeon and keep of copy of your own breast implant records as you will need to remove and replace these devices at some point in the future.
• Be familiar with The Australian Breast Implant Device Registry and keep your contact details current so that the device registry can stay in touch and keep you informed of any new developments or research.
• Regular breast cancer screening is still the most important priority for women over 40.

Or visit our Breast Augmentation and Implant page for more information

Dr Eddie Cheng is a board certified Specialist Plastic Surgeon in Brisbane, Australia.  Socialise with us @arplasticsurgery to learn more about Dr Eddie Cheng and our team. 

References

Magnussan. M, Cooter, Rakhorst, McGuire Adams, Deva. A (2019). Breast Implant Illness:  A Way Forward.  Plastic.Reconstr.Surg. 143: 74S-81S.

The American Society of Aesthetic Plastic Surgeons (Jan 2019). Breast Implant Illness - Frequently Asked Questions/Talking Points.