THIS.
THIS. THIS. THIS.
I saw this journal article “Breast Implant Illness: A Biofilm Hypothesis,” in the Plastic and Reconstructive Surgery Journal 2021 Best Paper Award Journal, and I nearly cried for joy. I believe Breast Implant Illness, also called BII, is real. But I also think there are women who have implants who have no issues. So why?
I learned about biofilm almost a decade ago. It was an “Aha!” moment for me, where all of the sudden many mysteries of breast implant issues made sense. Capsular contracture and breast implant issues may be due to biofilm, a low grade chronic infection. We didn’t know it was an infection, as our techniques for putting in implants and analyzing tissue for infection in capsules and implants was not accurate enough. But now with new microbiology culture techniques, we can see bacteria where before “nothing grew in culture.”
Please read my many blogs on biofilm HERE. If you are considering breast augmentation with implants, DO NOT CUT CORNERS. Find someone who believes in biofilm, uses the right incisions, soaks in antibiotics, uses Keller funnels, et al.
Study:
They prospectively followed 50 consecutive patients who self-referred for explantation (breast implant removal) for BII.
- Preoperative symptoms were analyzed: fatigue, brain fog, muscle pain, hair loss, dry skin, premature aging, insomnia, vertigo, GI issues, skin rashes, headaches, et al
- They looked at implant insertion date, shape, texture, fill, brand
- History of illness was evaluated: onset of symptoms, preimplant disease (diabetes, thyroid, breast cancer), prior diagnosis of acne
- Implants and capsules were removed en bloc when possible
- Implants were photographed.
- Implant shell and capsule were sent for histology and microbiological culture
Findings:
- BII did not correlate to implant type, surface or fill
- No significant finding as to duration of implant or location of original surgery
- Chronic infection was seen in 36% of cases with Propionibacterium acnes
- Histology showed synoviocyte metaplasia found in greater incidence than matched cohort who had no BII symptoms
- 84% of patients had partial or complete resolution of BII symptoms
- No patients wanted implants again
Their conclusion?
BII is a genuine entity worthy of further study. A large portion of these patients showed chronic infection, and further investigation of immune phenotypes and toxicology may be warranted.
My thoughts?
Biofilm is bad. A chronic low grade infection leads to chronic inflammation. This can cause capsular contracture and a whole host of Breast Implant Illness symptoms. Knowing all that I do, I still put implants in, but I do so very carefully. There are ways to mitigate chronic biofilm risk.
- incision under the breast
- implant placement under the muscle
- skin prep with antibacterial for days ahead of surgery
- no touch technique in the operating room with Keller funnel
- soaking the implant in antibiotic solution
- IV and oral antibiotics
There are other steps, but these are a few main ones. As I mentioned above, this is NOT a place to cut corners. Do your surgery by an accredited Board Certified Plastic Surgeon, in an accredited operating room. If your doctor does not talk about capsular contracture and biofilm risk and what they do to mitigate that risk, go to someone else. You need to prevent biofilm from forming around the time of surgery, and be protective for the first 6-8 weeks until your capsule forms. Even with doing all of this, there is still risk.
Bravo to this study. Breast implant illness is real. But I see many women who have issues of breast implant illness where it is not the implant causing the issue. In these patients when we remove the implants their symptoms do not change. It could be allergies, menopause, aging, or other issues.
How do you know if explant surgery will help you? You are likely a higher biofilm/BII candidate if your implants were not placed with the techniques listed above, your symptoms started temporally when you got your implants, and your implants are hard.
Regardless, if you feel bad and you think your implants are the cause, implant removal is a good choice. Explantation will let you know for sure. Some of these studies muddy the issues as they do a breast lift with the explant. IF you remove weight and lift the breast, you are essentially doing a breast reduction, and breast reductions are awesome to improve issues like neck, shoulder, and back pain, headaches, and other issues.