Over 300,000 women in the United States have breast augmentations, most using silicone gel implants, each year. Most are ecstatic with their new breast size and shape. A small percentage of women experience complications, such as capsular contracture, rupture, breast deformity, implant malposition, seroma, or a more serious and less common issue called breast implant illness. Some of these conditions have been studied and statistically are associated with a few of the below conditions. However, despite the increased association, there has not been scientific evidence that it is causative. More research is actively being done to see if this is the case. As of late, there has been an increase in the amount of attention surrounding the topic of Breast Implant Illness (BII) including a rare malignancy called ALCL. – There are growing concerns about the correlation between breast implants and health issues. These illnesses can impair a person’s quality of life. If a woman has implants and she has a lot of unexplainable symptoms causing her to not feel well, and more common medical explanations are ruled out, it’s reasonable for her to consider removing her implants. Unfortunately, there is not a test to confirm the relation between the two, so the decision to remove the implants (explanation), will ultimately be a personal one. A discussion with a plastic surgeon experienced with treating women with BII and other implant issues is strongly encouraged.
Symptoms Reported by Women with Breast Implantsinclude but are not limited to:
- Brain Fog
- Memory Loss
- Muscle/Joint Pain
- Hair Loss
- Dry Skin
- Weight problems
- Poor Sleep/Insomnia
- Dry Eyes
- Decline in Vison
- Hypo/Hyper Thyroid Symptoms
- Hypo/Hyper-Adrenal Symptoms
- Parathyroid Problems
- Hormone Imbalances
- Diminishing Hormones
- Early Menopause
- Low Libido
- Slow Healing, Easy Bruising
- Difficulty Swallowing/Choking
- Gerd Related Reflux
- Metallic Taste
- Gastrointestinal Issues
- Sudden Food Intolerance
- Fever/Night Sweats
- Intolerance to heat/cold
- Persistent bacterial, viral, fungal/yeast infections
- Recurring sinus infections
- UTI infections
- Skin Rashes
- Ear Ringing
- Swelling of the Hands/Feet
- Enlarged or Tender Lymph Nodes
- Shortness of Breath/Pain/Burning around Implant or Underarm
- Liver or Kidney Dysfunction
- Gallbladder Issues
- Lyme Disease
- Auto-Immune Diseases
- BIA-ALCL(Anaplastic Larger Cell Lymphoma)
When a woman gets breast implants, the body may respond to the fact thatlarge foreign objects have beenimplanted in your chest.Although silicone is the most common implant material used by many specialties (e.g. pacemakers are encased in silicone),it’s possiblefor a small percentage of patientsto experienceaforeign body immune response which potentially could cause autoimmune symptoms and diseases.BIA-ALCL is a rare but highly treatable type of lymphoma that can develop around breast implants. Itonlyoccursin women witha history oftextured surfaced breast implants. BIA-ALCL is a cancer of the immune system, not a type of breast cancer. Symptoms may include breast swelling pain, asymmetry, lump/s in the breast or armpit, skin rash, hardening of the breast,often associated with a latefluid collection (seroma).Symptoms typically developonaverage8 years post-op. BIA-ALCL has been found with both silicone and saline texturedimplants. To date, there are no confirmed cases involving a smooth surfaced breast implant.Most cases occur with macro textured implants made by Allergan. Testing can determine if a womanhasBIA-ALCL. The steps that should be taken include
- Schedule a follow-up appointment with your plastic surgeon to discuss concerns.
- Following a physical examination, an ultrasound or MRI may be recommended to evaluate for fluid ormasses.
- If fluid or a mass is found, patients will require a biopsy with drainage of the fluid to test for BIA-ALCL. This fluid will be tested for CD30,flow cytometry, and cytology studies to confirm or rule out this diagnosis.
- Schedule a follow-up visit to discuss the next steps ineither case, positive or negative for BIA-ALCL.
BIA-ALCL – What Can Be Done?
When a woman is diagnosed with BIA-ALCL, her doctor will refer her for a PET/CT scan to look to see if the disease may have spread outside of the breast/s.
- For patients with BIA-ALCL only around the implant, surgery is performed to remove the breast implant and the scar capsule around the implantcalled an En Bloc Capsulectomy.See below for further implant removal treatment options.
- If the disease has spread, the patient will be referred to an oncologist forstaging evaluationof BIA-ALCLand treatment planning.
Breast Implant Illness – What Can Be Done?
When a woman hits a roadblock because medical professionals have been unable to diagnose the cause of her symptoms or effectively treat them, many women consider breast implant removal also called explanation. The good news is that between 50% to 70% of women have improvement or no longer bothered by their symptoms following this procedure. This procedure can be performed by itself or in conjunction with a lift with or without fat transfer to replace some of the volume and shape lost by implant removal. Fat harvested from a woman’s own body (popular areas: abdomen, hips, back, thighs) is used to improve irregularities following an En Bloc.
Drs. Nichter and Horowitz are experts in breast fat grafting and developed their exclusive procedure called California Breast Lift® to provide an alternative to breast implants.This technique adds volume, improves contour, and provides a subtle lift. If significant breast sag exists, fat grafting alone will not address this issue.Often patients have En Bloc Explantation first and then decide later if they wish to have further surgery.
For women who wish to remove their implants and not replace them with new implants, the En Bloc procedure is performed alone. The capsule and implant are carefully removed through an incision made in the lower breast crease. The breasts are not reconstructed. The downside to En Bloc alone is that the breast appearance after surgery may not be ideal. On the flip side, anytime after the recovery process, it is possible to have a procedure to lift the breasts and/or add fat for volume replenishment.
An En Bloc and Breast Lift combine the implant removal mentioned above with a breast lift procedure to tighten the breast skin and reshape the breast tissue for a perkier more attractive appearance.This will not increase breast volume.
Fat grafting after breast implant removal is an artistic specialty for plastic surgeons who specialize in this technique.
The gold standard to achieve the best results after implant removal is the combination of an En Bloc with a Breast Lift and Fat Grafting. It is the most extensive of the procedures mentioned, but certainly the most effective for achieving a beautiful appearance following implant removal.
Dr. Nichter and Dr. Horowitz advise their patients with silicone gel implants older than 10-12 years to consider replacing them or removing them as implant rupture rates increase significantly after this time. Should that occur, a capsulectomy is required.
The most important decision you can make is to find the most qualified and competent board certified plastic surgeon with many years of experience in the surgical management of Breast Implant complications including breast implant-associated illness or ALCL. Drs. Nichter and Horowitz for more than 25 years have specialized in the management of these issues, have protocols in place for testing, and are skilled in treating not just these problems but also breast revision, lifts, reductions, and non-silicone natural implant choices including your own fat and are FDA investigators for IDEAL® Smooth Saline implant that feels like silicone gel but without the potential for silent rupture for peace of mind. Their goal is to guide you throughout the decision-making process.