Breast Implant Illness (BII)

What is Breast Implant Illness (BII)?

Breast Implant Illness (BII) describes a range of symptoms that some patients with breast implants experience as part of a systemic reaction. Often patients felt well before implant surgery, and at some point afterwards – which can vary from days to years – their symptoms appeared. Patients describe that, although they look OK, they are not OK. There is ongoing debate within the medical community about the cause of these symptoms, diagnosis and treatment. Symptoms of BII include fatigue, ‘brain fog’, joint and muscle pain, rashes, autoimmune disorders and other unusual symptoms. Some women can experience BII and another medical condition at the same time. Conditions include hormone imbalances such as thyroid issues or menopause, mental health changes including anxiety or depression, autoimmune conditions such as Sjogren’s syndrome, or general imbalances in the bloods. Many patients receive multiple new diagnoses since their breast implants were inserted, but still feel unwell despite trying to address these concurrent issues. The challenge is to identify which symptoms might be related to the implants, and which are other conditions.

At Breast Implant Solutions, our team of experts aim to provide the highest quality service to answer these important questions so that patients with BII are listened to, supported and have access to the all tests they might need.

How common is Breast Implant Illness?

It is unclear how many people with breast implants develop BII. A recent scientific paper from the Netherlands reported 4.7% of cosmetic breast implant revision surgery was performed because of BII, which represented 0.1% of all breast implant surgeries. However, many believe the real number of BII cases worldwide is higher. Patients with BII often seek medical input, but fail to receive a diagnosis of BII, partly because there are differences in opinion within the medical community. As social media raises awareness of BII, more people are reporting BII symptoms. Instagram, Facebook and Tiktok offer groups such as ‘The Heal is Real’ or ‘Healing breast implant illness’ that allow women to share their personal experiences, and offer mutual support in what can be a difficult period for patients.

If you feel you might have symptoms of BII, Breast Implant Solutions was set up to support you with any investigations, tests, scans, or treatments you may wish to consider.

References:
Lieffering AS, Hommes JE, Ramerman L, Rakhorst HA, Mureau MAM, Verheij RA, van der Hulst RRWJ (2022). Prevalence of local postoperative complications and breast implant illness in women with breast implants. JAMA Network Open. 5(10): e2236519.

Do I have Breast Implant Illness? How to know if you might have BII

Trying to establish the cause of symptoms is difficult. Breast Implant Solutions defines three types of patients with breast implants.

  • Type 1: Patients with breast implants that feel well
  • Type 2: Patients with breast implants and symptoms resulting in a new diagnosis of a known medical condition. This might include thyroid issues, autoimmune conditions, menopause, blood imbalances, or chronic inflammation.
  • Type 3: Patients with breast implants who experience symptoms related to their implants and seek a diagnosis of BII
  • Type 4: Patients who have had their breast implants removed, but still have symptoms related to BII

At Breast Implant Solutions, we advise women to be alert to the symptoms of BII, as well as those of other medical conditions, so that we can help you gain the diagnostic information you need for your breast, body, and wellness needs. We offer a range of specific blood tests you can pick to help find a reason for your symptoms or to address any concerns you have. We also provide high-definition breast implant ultrasound scans performed by consultant plastic surgeons to look for other implant related issues, such as rupture, and provide a same-day report which hopefully provides reassurance to you.

Do all women with breast implants get BII?

Many women with breast implants lead a normal lifestyle and are happy with their decision to have breast implant surgery. However, scientific data is emerging that shows many patients develop symptoms after breast implant placement. A recent study published in the Aesthetic Surgery Journal reported 1 in 3 women with breast implants described three of more BII symptoms. Fortunately, conversations are becoming more open about this new condition, and women are coming forward to share their experiences and support one another in what can be a difficult time of uncertainty as to what the cause is. We at Breast Implant Solutions aim to be a centre for any testing, scanning, and treatment options that patients may wish to explore, and we fully support women with implants to keep this open dialogue with one another.

Reference:
Miseré RML, Colaris MJL, Tervaert JWC, van der Hulst RRWJ (2021). The prevalence of self-reported health complaints and health-related quality of life in women with breast implants. Aesthetic Surgery Journal. 41(6):661-668.

Breast implant illness symptoms and signs

BII affects each patient slightly differently, though often patients find many symptoms in common with one another. This can be a relief to find other women with similar symptoms and a similar story, so that they can find an explanation for why their symptoms have occurred. Symptoms and signs of breast implant illness can include:

  • Chronic fatigue / tiredness
  • ‘Brain Fog’
  • Feeling numb
  • Dry mouth and dry eyes
  • Joint and muscle pain
  • Memory and concentration problems
  • Sleep disturbance
  • Skin issues, such as rashes or dry skin
  • Hair loss or thinning
  • Mood changes
  • Anxiety or depression
  • Breathing problems
  • Fever
  • Headaches or migraine
  • Gastrointestinal problems
  • Numbness and tingling in fingers

BII symptoms can appear any time after breast implant surgery. Some patients feel fine initially, and go on to develop symptoms years later. Others experience almost immediate symptoms of BII after breast implant surgery. Confusingly, many symptoms of BII are also associated with autoimmune and connective tissue disorders, such as scleroderma, rheumatoid arthritis, and SLE (lupus). This is why some patients with BII are sometimes mis-diagnosed with other medical conditions such as autoimmune or connective tissue disorders.

Many of the symptoms above are non-specific and can indicate other medical conditions or lifestyle factors. Currently, there is limited scientific evidence supporting a direct link between breast implants and the specific set of symptoms above. Nevertheless, some women with breast implants describe a clear improvement or complete resolution in symptoms after implant removal (explant). This is why there is ongoing research in the association between breast implants and wellness.

If you have breast implants and are experiencing any of the symptoms above that worry you, we offer a range of tailored blood tests at Breast Implant solutions designed to exclude other conditions and look for toxins or imbalances in the blood that might give useful information to you. We also offer a complete breast implant scan to check for rupture, and other implant issues, to help you decide how best to manage your breast implants.

What are the other names for Breast Implant Illness?

BII is an evolving area, as more data is published and more patients come forward to describe their journey. There are several terms used to describe this collection of symptoms experienced by patients with breast implants. Terms include:

  • Breast implant illness
  • Breast implant disease
  • Breast implant syndrome
  • Systemic reaction
  • Autoimmune/inflammatory syndrome induced by adjuvants (ASIA).
  • Silicone implant illness

What is ASIA?

ASIA stands for Autoimmune/inflammatory syndrome induced by adjuvants.
It was the diagnostic terms originally used to describe the symptoms some patients had with breast implants. This term is used less commonly now. ASIA as a diagnosis came about when patients reported feeling unwell after breast implants, and the thought was the implants triggered an autoimmune disease or a connective tissue disorder in some patients. Researchers think that some women might have a reaction in their body to the materials used in the implants, such as the silicone. One popular idea is that certain women might have genes that make their immune system react to the breast implants. This ‘autoimmune’ condition means that the body’s immune system is reacting to something in the implants. The diagnostic puzzle is still not fully solved, and there is much ongoing research in this area, in the hope that women – with or after implants – can lead healthy, active, and full lives.

Who gets breast implant illness? How do you get BII?

Any person with breast implants can go on to develop symptoms of BII. Indeed, 1 in 3 women with breast implants describe three of more symptoms that fit with BII. It may well be that certain patients are more predisposed to BII than others, which would explain why some patients go on to develop BII, and others do not.

Researchers do not know the exact cause of breast implant illness. Theories as to what causes BII include:
Autoimmune or inflammatory reaction to parts of the breast implant, such as silicone within the breast implant
Bacteria may grow on an implant surface and cause infection locally and in the bloodstream (biofilm infection)
Reaction to the surgery used to insert breast implants.

Many patients describe to us that many inflammatory issues feel better after explant surgery, and as a result Breast Implant Solutions offers an inflammatory and autoimmune testing service for patients if they wish to have testing before and/or after surgery.

Autoimmune testing

References:
Miseré RML, Colaris MJL, Tervaert JWC, van der Hulst RRWJ (2021). The prevalence of self-reported health complaints and health-related quality of life in women with breast implants. Aesthetic Surgery Journal. 41(6):661-668.

How common is breast implant illness?

It is unclear how common BII is, but given breast implants are the number one cosmetic procedure for women in the UK, and more than 400,000 people in the USA have breast implants each year, it is likely there is a growing number of women out there who have BII, and many more that have breast implants and symptoms, but are yet to put the two together to explain why. The data suggests 4.7% of cosmetic breast implant revision surgery was performed because of BII, but this is likely to be an underestimate given the lack of formal reporting of BII symptoms.

References:
Lieffering AS, Hommes JE, Ramerman L, Rakhorst HA, Mureau MAM, Verheij RA, van der Hulst RRWJ (2022). Prevalence of local postoperative complications and breast implant illness in women with breast implants. JAMA Network Open. 5(10): e2236519.

Is there a test for BII?

Currently there is no specific test to make a diagnosis of Breast Implant Illness. In many situations patients have had a whole range of blood tests, all of which have been negative, and they reach the conclusion that it must be that they have Breast Implant Illness as the cause for their concerns and frequently therefore decide to remove their breast implants. A significant number of patients who describe symptoms of BII and remove their implants get some relief of symptoms, if not all their symptoms. At Breast Implant Solutions we continue to monitor blood results of our patients from our carefully selected panel of blood tests in the hopes that eventually we can contribute to the wider research efforts to find a diagnostic test. 

Could I have something else apart from breast implant illness?

Yes. It is entirely possible you have breast implants and a new diagnosis of an established medical condition has arisen by chance since your implant surgery. One study compared the diagnoses of medical conditions of 25,000 women with breast implants with almost 100,000 women without breast implants. They found that the breast implant patients were significantly more likely to be diagnosed with autoimmune conditions, rheumatic disorders, Sjögrens’s syndrome, systemic sclerosis, SLE (lupus), scleroderma and sarcoidosis, compared the non breast implant patients.

These other diagnoses may or may not have been triggered by the implants being present. Regardless of causality, it is important that a diagnosis is made, so that treatment discussions can take place. It is also useful to have a diagnosis so that you can use this information to help inform your decision making incase you need to decide to have your breast implants removed or not. If the symptoms are from a separate condition, and you have your implants removed, but no treatment for the other medical diagnosis, it is possible your symptoms remain. This is why we encourage appropriate testing prior to any surgery.

References:
Maijers MC, de Blok CJM, Niessen FB et al (2013). Women with silicone breast implants and unexplained systemic symptoms: a descriptive cohort study. The Netherlands Journal of Medicine. 71(10):534-540.

Watad A, Rosenberg V, Tiosano S, et al. (2018). Silicone breast implants and the risk of autoimmune/rheumatic disorders: a real-world analysis. International Journal of Epidemiology. 47(6):1846-1854.

What conditions are associated with breast implants?

Breast implants have been associated with many diseases and conditions. Examples include autoimmune conditions, thyroid issues, connective tissue disorders, scleroderma, rheumatoid arthritis, and SLE. The evidence suggests these conditions are more prevalent in women after breast implant surgery. For example, 37.4% of women report rheumatic symptoms and other BII-like symptoms after breast implant surgery. The ‘cause and effect’ debate is such that one may argue whether the medical condition was always going to happen, or if the implant placement sped-up the diagnosis. Some patients believe they would never have had a diagnosis of one of these conditions had they not had breast implant surgery. Our role at Breast Implant Solutions is to support women in their breast implant journey, and help provide support through data-driven answers to what is happening in their body through our testing and imaging service.

Reference:
Giltay EJ, Bernelot Moens HJ, Riley AH, Tan RG (1994). Silicone breast prostheses and rheumatic symptoms: a retrospective follow up study. Annals of Rheumatic Diseases. 53(3):194-196.

What do plastic surgeons think about BII?

Surgical opinion differs dramatically about BII depending on who you speak to. At Breast Implant Solutions, we are advocates of the condition and fully support our patients in their quest for more information and to find a solution as to why they feel unwell. Other colleagues around the world share our philosophy. For example, Dr Robert Whitfield, President of the Aesthetic Surgery Education and Research Foundation, states: “Usually, my clients with BII find me after exhausting all other medical avenues and going through exhaustive medical testing.” We too have parallels with this, and find patients have often consulted many other avenues before finding us.

How do you treat BII?

Many patients with BII no longer want to keep their breast implants, as they attribute a link between the implants and their symptoms, and therefore they seek breast implant removal. This is performed with or without a total capsulectomy (removal of all the scar tissue around the implant). Most patients requesting a total capsulectomy do so in order to return to their ‘pre-implant’ self, with the hope this has the greatest chance of improving health symptoms and overall wellness. Scientific data is emerging in support of implant removal and total capsulectomy as a combined single procedure. However, many sceptics exist in the plastic surgery community. At Breast Implant Solutions, we fully support patients and their wishes, and aim to help them find the best solution for their health goals.

What is en bloc capsulectomy?

Many surgeons offer to remove the scar tissue (capsule) around the breast implants at the same time as implant removal. This is a ‘capsulectomy’. A capsulectomy can be total, when it is all removed, or partial, when only some of it is removed. When the breast implant and capsule are removed together as a unit, the name is an ‘en bloc capsulotomy’, from the French meaning ‘in one piece’. Though the scientific merits of en bloc capsulectomy are only just emerging, many of our patients specify they want a total capsulectomy, with a preference for a total en bloc capsculectomy, so that the entirety of the implant and surrounding tissue is removed.

Removing the entire implant capsule in one piece in an en bloc capsulectomy is not always possible since the capsule can be delicate and might tear during the removal process. However, in most cases, surgeons can make sure the entire capsule is taken out by the end of the operation, even if it is not always in complete continuity with the breast implant. When the implants are under the muscle, the back wall of the capsule sticks to the ribs, making removal more challenging. It requires a combination of surgical techniques to safely detach it from the ribs. On the other hand, if the implants are above the muscle, removing the capsule from the surface of the pectoralis muscle is usually easier. Some patients who have had multiple implant procedures may have remaining capsule both above and below the muscle and often ask for its removal during the explantation as well.

What are the risks of capsulectomy?

Capsulectomy involves removing the entire implant capsule at the same time as removing the implant. This usually means dissecting it off the under surface of the breast and from the underlying pectoralis muscle, or from under the pectoralis muscle and from the ribs depending on the position of the implant.

Complications include bleeding (haematoma), that may require a return to the operating theatre, pain from surgical dissection of the muscle and breast implant pocket, weakness, and smaller breast size. It is possible to make a small hole between the ribs and the lung, in a sheet of tissue called the pleaura. This is a complication that is usually simply dealt with during the operation where the hole is closed with stitches, and the lung is unaffected. There would not usually be any long-term consequences of this. Very rarely, there may be lung collapse or the need for a chest drain. Finally, removing the implant capsule can lead to internal scarring which can cause distortion of the breast and an unsatisfactory appearance.

Do I need to remove the implant capsule?

There is currently no scientific evidence supporting the need to remove an implant capsule for patients health to improve after explant surgery. However, many patients request that the capsule is removed at the time of explant surgery and current studies have shown a significant health improvement in up to 70% of patients following explant surgery and many of these patients have had their capsules removed.

How soon after treatment will I see results?

After explant surgery, some patients experience immediate relief from their symptoms. Many tell us they feel more natural after explant, and feel more like their old selves. Some look back and realise how ill they felt. However, not everyone will see such a fast improvement, as for some patients the residual effects of the implants presence can linger for much longer as the body readjusts to being without breast implants.

What is the controversy with BII?

Despite patients being very clear, specific, and honest with their symptoms and experiences after breast implants, there is a debate withing the scientific and surgical community regarding evidence-based research linking breast implants to the reported symptoms. Multiple large-scale reports by regulatory bodies and scientific organisations, such as the U.S. Food and Drug Administration (FDA) and the World Health Organization (WHO), have not found a consistent link between breast implants and systemic illness. However, data is continuing to emerge, and patients clearly describe a link between their implants and the synptoms they are experiencing. Breast Implant Solutions aim to provide useful tests and scans to help support these patients in their quest for more information and understanding of their total body health.

Do doctors and medical societies such as the FDA believe BII exists?

As yet, BII is not an official diagnosis. However, the National Center for Health Research in the USA responsible for studying breast implant safety stated: ‘BII is a cluster of symptoms that doesn’t fit into any other classic disease diagnosis’, and ‘eventually will be recognized as a medical condition’. Furthermore, in September 2020, the FDA insisted breast implant manufacturers include information about the risk of symptoms that affect the ‘whole body’ to be present on the breast implant packaging, patient information booklets and checklists. These ‘whole body’ symptoms that occur in BII is progress towards a formal diagnosis of BII.

References:
Breast Implants – Certain Labeling Recommendations to Improve Patient Communication: Guidance for Industry and Food and Drug Administration Staff (2020). FDA. Available at: https://www.fda.gov/media/131885/download

Prevention: How can I reduce my risk of breast implant illness?

The only way of eliminating the risks of BII is not to have breast implants. However, many patients lead full and healthy lives with their breast implants in place. Our advice at Breast Implant Solutions is the listen to your body, and be alert to any symptoms listed above that you may experience. Symptoms might represent a BII, or a new diagnosis of an important medical condition. Please use our testing service so that all your health and wellness needs can be addressed in one service.

New research on breast implant illness

The scientific literature is only just starting to publish papers demonstrating an association between breast implants and autoimmune or connective tissue diseases. A recent study performed by the MD Anderson Cancer Center in Texas, USA, looked at the safety records of 100,000 women with or without breast implants. They demonstrated that women with silicone breast implants were more likely to be diagnosed with Sjogren syndrome (8 times increased risk), scleroderma (7 times increased risk), rheumatoid arthritis (6 times increased risk), melanoma (4 times increased risk) and go on to have a stillbirth (4 times increased risk).

References:
Coroneos CJ, Selber JC, Offodile AC, Butler CE, Clemens MW (2019). US FDA Breast Implant Postapproval Studies: Long-term Outcomes in 99,993 Patients. Annals of Surgery 269(1):30-36.