Throughout the last few years there have been more and more reports of ladies who do not tolerate their breast implants. While this phenomenon is certainly very rare, and the overwhelming percentage of women tolerate their breast implants without any problems, an entity called Breast Implant Illness or BII has been described. As a plastic surgeon who places implants every week and focuses his practice on Breast Augmentation this produces many questions. How come most ladies tolerate the procedure and love their results while some simply cannot tolerate the implants? Is it safe to continue to place implants? To this the answers are clear. The vast majority of implants are very well tolerated. Still, it is clear that there are some ladies who do not tolerate implants. Even if it is only 1% of patients, more research is needed as we learn about Breast Implant Illness.
In March of 2019, the FDA met to discuss Breast Implant Illness and to bring more knowledge to plastic surgeons, the overall physician community, and the public in general. Patients can experience negative effects of having an implanted device such as a breast implant with a broad range of symptoms such as allergies, chronic inflammation, and autoimmune diseases. It is important to note that while this is very rare, there are many case reports of significant disease that has come to be known as BII.
It is important to realize that while this is rare and most ladies do well with their breast implants, some women do not tolerate the implants. This is an important part of the informed decision process, and Dr. Sorokin believes in open discussions with patients both before and after their surgeries. Prospective patients must understand that implants were never designed to be lifelong devices and may need to be replaced or removed. The FDA is recommending thorough education of patients and Dr. Sorokin agrees completely. Open honest information is key, and Dr. Sorokin provides patients with his direct email address so that access to his knowledge and opinions can be quick and direct. The truth is that this is a growing field of research and while Dr. Sorokin believes breast implants are safe and effective devices for the vast majority of patients, he acknowledges that not everyone will tolerate them. Everything in life has pros and cons, risks and benefits, and patients need to understand these issues in order to make good decisions.
There are some ladies who will excitedly undergo breast augmentation to decide years later that the implants are simply not “right” for her. Not “liking” the implants or feeling they are not “her” is very different than becoming ill from the implants. There are other patients that conclude that the implants are causing Breast Implant Illness. Chronic allergies, autoimmune diseases, inflammatory syndromes, brain fog, rashes, body odor, insomnia, photosensitivity, chills, headaches, fatigue, and other symptoms that have no other known cause lead to this diagnosis. Many of these ladies have extensive testing done and have no other explanation for their illness and decide their implants must come out. There is no official medical diagnosis known as BII however this constellation of symptoms are being described by more and more ladies. There is one Facebook group with over 70,000 members! Thus, while there is little scientific data that explains these phenomena it simply cannot be ignored. Perhaps there is a reaction to simply having a foreign body present. Perhaps low levels of platinum or silicone particulates trigger disease.
Dr. Sorokin will be very honest with a patient seeking consultation for BII and explain that the implants may or may not be the cause of their symptoms and that there will be no way to know for certain without implant and capsule removal. Dr. Sorokin offers explantation of implants along with the capsule surrounding the implant. Sometimes the implant can be removed with the entire implant capsule, often described as an “En Bloc” removal. There are websites on the internet that state this is the only way implants should be removed and if a surgeon does not use this technique they are not doing a proper removal. This is inappropriate advice to be published as sometimes a capsule is thin or non-existent, and sometimes it is adherent to structures that should not be damaged. The plastic surgeon should do an appropriate procedure based on what will be the best, safe treatment for each patient. In addition, revision may be offered with a breast lift or mastopexy. This is usually done in staged procedures in order to optimize the appearance of the explanted breast. It is important for patients faced with the uncertain diagnosis of BII to understand that sometimes implant removal is not curative and some patients will continue with the same symptoms. Thus, the pros and cons of implant removal need to be discussed thoroughly.
There is much to be learned about Breast Implant Illness and as BII is studied over the next few years new treatments and recommendations will likely be discovered. As of spring 2019, when this is being written, Dr. Sorokin suggests that the best option for patients concerned about BII is to come in for consultation and learn about your options.