Understanding Breast Implant Illness

For the last several decades, breast augmentation with implants has consistently been one of the top-performed aesthetic procedures in the United States. The U.S. Food and Drug Administration (FDA) has approved two types of breast implants — saline-filled and silicone gel-filled — for increasing breast size in women, for reconstruction after breast cancer or trauma, to correct developmental defects, and to improve the result of a previous surgery.

While breast augmentation surgery with a board certified plastic and reconstructive surgeon has long been considered generally safe and effective and FDA-approved implants undergo extensive testing prior to hitting the market, there are potential risks associated with breast implants once they are placed in the body. Rupture, infection, capsular contracture (scar tissue squeezing the implant), pain, and the need for replacement and revision procedures are all possibilities, as is the chance for systemic symptoms that have come to be known as breast implant illness (BII).

Over the last few years, there has been a rise in women with breast implants reporting the unexpected onset of a cocktail of symptoms ranging from fatigue and brain fog to muscle weakness and respiratory issues. Celebrities like Chrissy Tiegen, Ashley Tisdale, and Hayley Hubbard have recently opened up about the physical and psychological impacts their breast implants have had on them. Despite the growing chorus of anecdotal evidence, what makes BII so evasive is the lack of research surrounding it, the confusion over the root of the problem, and the difficulty in pinpointing a diagnosis.

To learn more about breast implant illness, what may cause it, how it can affect your health, and treatment options, The AEDITION spoke with Nima Naghshineh, MD, a board certified cosmetic surgeon and founder of Dr. Nima Plastic Surgery based in Pasadena, California.

What Is Breast Implant Illness?

“Breast implant illness or silicone implant illness, often does not refer to a specific disease or problem and has not been formally categorized or defined by the medical community,” Dr. Nima explains. Because there is no distinct set of symptoms but rather an assortment of indicators that the body is negatively impacted by the implant, it’s hard to explain what the illness is in specific terms. “BII is more like an all-encompassing category of issues/symptoms that some women with implants have described,” he continues.

What’s more? There seems to be no rhyme or reason for when it arises. According to Dr. Nima, BII symptoms may present at any time. “There are several individual theories about what causes BII, but most hinge on the idea that there is some degree of interaction between the implant, a pro-inflammatory presence (typically bacteria or fungus), and the body’s exaggerated response to all of this,” Dr. Nima shares. It should be noted that the type of implant is not considered a specific root of the condition. “Though textured breast implants — as opposed to the more common smooth — have been implicated in breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), there is no clear association between implant type, model, or manufacturer with BII,” he adds.

So, it is not necessarily the body rejecting the implant but rather issues during the surgery that leads to infection. “It has been shown that a large percentage of capsules (greater than 40 percent) removed at the time of implantation had bacterial colonization,” Dr. Nima explains. As such, improving implantation techniques could, theoretically, help prevent complications. “Employing sterile ‘no-touch’ techniques when placing the implants could reduce the risk of bacterial contamination and subsequent inflammation and BII as a result,” he says.

Diagnosing Breast Implant Illness

“If you believe that you may have symptoms related to BII, it is important to seek a board certified plastic surgeon who specializes in breast-related issues and reconstruction,” Dr. Nima emphasizes. “Your surgeon will examine you and may suggest follow-up with your PCP and other specialists such as a rheumatologist.” Patients may undergo a blood test, MRI, and/or ultrasound to test for iron levels, autoimmune disease, liver function, blood count, and more.

One of the things that makes BII so difficult to conclusively diagnose is the fact that the symptoms often point to other conditions. “Because the symptoms associated with BII can overlap with existing known diseases, such as autoimmune diseases, it is important to rule out these known diseases at the same time as exploring the possibility of BII,” Dr. Nima says.

Even so, medical advancements are leading to broader consensus on the illness. “Simply put, doctors are also scientists. Many make their decisions based on the evidence in the medical literature,” he explains. “As we get more data on BII, we will find less disagreement and a more unified approach to this issue,”

Symptoms of Breast Implant Illness

As we’ve established, there is no one set of symptoms for breast implant illness, and the effects aren’t always just physical. Dr. Nima says women who have experienced BII often put symptoms into the following categories:

• Physical: Hair loss, dry skin, and rashes are some of the most prevalent physical indicators of BII. These are surface-level and can be seen rather than felt.
• Central Nervous: This includes brain fog, memory loss, vertigo, headaches, migraines, and tinnitus (ringing in ears).
• Cardiorespiratory: Dr. Nima says “shortness of breath, heart palpitations, arrhythmia, heart pain, cough, and throat clearing,” are potential issues that may arise.
• GI & Genitourinary: “Frequent urination, liver and kidney problems, reduced libido, UTI, reflux, gastritis, weight loss/gain, sudden dehydration, liver dysfunction, leaky gut, IBS, metallic tastes, choking, difficulty swallowing, pancreatitis, [and] gallbladder disease” may also accompany BII, Dr. Nima explains.
• Musculoskeletal: Some women report muscle or joint pain, numbness or tingling in the upper and lower limbs, fibromyalgia, neuralgia/burning pain, discoloration of hands/feet, and slow muscle recovery after activity.
• Immune: As we’ve mentioned, BII can present like an autoimmune disease. It may lead to “Raynaud's, Hashimoto’s, RA, scleroderma, SLE, Sjogren’s, MCTD, MS, recurrent infections, toxic shock, fevers night sweats, slow healing and easy bruising, chronic fatigue, persistent infections, sudden food intolerance, allergies, and tender lymph nodes,” Dr. Nima says.
• Psychological: And it’s not just physical symptoms — BII can manifest in “anxiety, depression, panic attacks, and the feeling of impending death,” he notes.

Breast implant illness is not life-threatening, but the symptoms can certainly be strong enough to affect a person's quality of life. Depending on the severity, it may lead to additional medical expenses and impact both physical and emotional wellbeing.

Treating Breast Implant Illness

Because women experience BII symptoms at different points in time, it may go undiagnosed, untreated, or be perceived as another ailment, which is why it’s so important for those with breast implants to be vigilant and work with a board certified provider. The reality is that treating individual symptoms may not be sufficient. The biggest source of improvement is often breast implant removal — but it’s not that simple. Dr. Nima explains that “whether it’s for BII, breast implant-associated lymphoma, or severe capsular contracture with pain,” removing the implant “is not enough.”

The explant will require the removal of the capsule surrounding the implant as well. “We know that, for many of these problems, the issue is the capsule,” Dr. Nima notes. “Therefore, when possible, an en bloc total capsulectomy is recommended.” The capsule can then be sent to a pathologist and examined. “Any fluid around the implant, as well as a piece of that capsule, should also be sent for microbiology testing which will look at whether there are any organisms, like bacteria, colonized in the capsule,” he adds.

For patients whose symptoms cannot be attributed to another condition (think: rheumatic or autoimmune), “[they] are likely to have an improvement in physical symptoms as well as psychological well-being” after breast implant removal, Dr. Nima says.

Patient Perspective

After years of weight fluctuation, Maddi, 27, decided to get tear-drop silicone breast implants in 2018 to help restore volume in her breasts. Shortly after, the Las Vegas resident started noticing symptoms of breast implant illness.

The Takeaway

Not every woman who has breast implants experiences breast implant illness, but, if you are concerned it may develop, Dr. Nima says “the most effective way of reducing your risk of BII is to remove and replace [the implants] with your own fat and to have a complete removal of the capsule or scar tissue surrounding the implants.” Breast augmentation via fat transfer offers a natural way to address any excess skin, volume loss, or dissatisfaction with shape that accompany the implant removal. “When using one’s fat, you can restore a significant amount of volume in just one procedure at the time of explant,” Dr. Nima says.

If you have breast implants and are experiencing any of the symptoms outlined above, it is important to consult with your plastic surgeon to determine the best course of treatment.