At this time, breast implant illness remains a controversial topic, without consensus among plastic surgeons. In other words, there is no consensus among plastic surgeons whether or not there is a link between breast implants and the medical conditions of concern.
Having said the above, there seems to be a growing number of patients who have undergone breast augmentation surgery who present with a group of symptoms, without an underlying diagnosis. In other words, the patient's symptoms cannot be explained by specific medical diagnosis; the concern becomes whether the breast implants are causing "breast implant illness."
Commonly reported systemic symptoms involve the central nervous system, musculoskeletal system, immune and inflammatory systems, GI and GU systems, psychological system, and the cardiorespiratory systems.
Although there is no scientific "causation" shown thus far linking breast implants to specific illnesses, having personally worked with many patients who have presented with concerns regarding breast implant illness, I think it is very important to keep an open mind and remember that we may very well not have a full understanding of breast implants and the potential interactions that may occur with each patient's unique biology. (For example, exactly how a specific patient's immune system will respond to breast implants as a foreign body). It is clear, based on the literature and my own anecdotal experience, that a significant percentage of patients who undergo breast implant removal surgery (and capsulectomy) do experience improvement in symptomatology. On the other hand, some percentage of patients continue to experience symptoms despite breast implant removal/capsulectomy surgery.
The main theory currently involves a complex interaction of breast implant material with the patient's immune system, Involvement of bacteria/fungal/virus/other adjuvants, as well as the patient's specific genetic makeup. It is theorized that the "wrong combination" of these parameters may lead to autoimmune disease and/or other associated systemic symptoms.
I encourage patients in my practice who have breast implants and have concerns about breast implant illness to undergo complete medical workups, and seek second/third opinions (internists, neurologists, rheumatologists...) as needed. I have several patients in my practice who were correctly diagnosed with somewhat rare medical conditions (and appropriately treated based on the correct diagnosis) only after seeking second and third opinions. Generally speaking, it is best not to assume that the breast implants are the cause of your sickness.
In my practice, breast implant removal surgeryfor patients who have these types of medical concerns does (at the very least) provide the patient with peace of mind - I have many patients who report significant improvement of symptoms after breast implant removal and capsulectomy surgery. After removing many breast implants for patients who have concerns regarding breast implant illness, I have been surprised at the percentage of patients who report an improvement or elimination of their symptomatology.
For patients who have thickened/ symptomatic breast implant capsules, or ruptured silicone gel breast implants, or if they have concerns about medical conditions related to the breast implants En Bloc removal of breast implantsor complete capsulectomy is the recommended procedure.
Patients should be aware that capsulectomy can expose them to additional risks, such as bleeding, size loss, contour irregularities and other serious complications. In other words, any maneuver performed during surgery exposes patients to additional risk (morbidity). For example, attempting to remove a very thin capsule that is densely adherent to the patient's rib cage may expose the patient to significant bleeding and/or entrance into the thoracic cavity.
I have also found case reports demonstrating clinical improvement after removal of capsules which histologically displayed fragments of silicone, fibrous tissue, and inflammatory cells. These reports conclude that when breast implants are thought to be the cause of a clinical inflammatory syndrome, consideration should be given to removing the capsules entirely so the chance of a perpetuating reaction will be reduced. Again, this is usually safely possible but patients and surgeons should keep the principle of "safety first" in mind; there are a small subset of patients who are not able to undergo complete capsulectomy surgery without potentially damaging the patient's rib cage, entering the thoracic cavity, and causing potentially life-threatening problems such as pneumothorax.
My best recommendation to any patient who is considering breast augmentation surgery but has concerns regarding breast implant illness: avoid breast implants. In my opinion, nothing (including enhancing breast size) outweighs peace of mind.
Patients and surgeons should have open discussions of all options as well as potential risks/complications of all options. Also, patients should understand that we certainly do not have a complete understanding of "breast implant illness" and more information will likely come to light rapidly.
Dr. Pousti performing EnBloc Breast Implant Removal
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