This is from the Aesthetic Surgery Journal April 2022. In looking into Breast Implant Illness, there is a lot of murkiness. A lot of the symptoms are vague, or they overlap with other possible causes like allergies, autoimmune disease, perimenopause and menopause among other issues. So where do you start?
Most doctors don’t think you should jump immediately to breast explant surgery where the breast implant and capsule are removed surgically. Part of this is because they may not be the cause; there is a cost of time and money to do the surgery; there is risk with any surgery; and there is an aesthetic price to pay- most women who do breast augmentation did it for a reason, so removing the implant may leave them not feeling great about how things look.
So what is that work up?
According to the article, “A Practical Guide to Managing Patients with Systemic Symptoms and Breast Implants,” they broke it down by symptoms and possible other causes.
FATIGUE.
- Possible other causes: aging, motherhood, medications, sleep issues, anemia, infection, diabetes, inflammatory, depression, lifestyle.
- Physical exam: look for enlarged lymph nodes, particularly if the implant was used for breast cancer reconstruction.
- Review medications
- Lab tests: EKG or cardiac work up, CBC, ESR, Vitamin D, Calcium, chemistry panel, thyroid tests.
BRAIN FOG
- Possible other causes: Frequently seen in perimenopause time. Focus should be done on sleep and psychiatric issues – depression/anxiety/etc.
- If cancer patients, need to image for TIA or cancer metastasis.
- If depression, see a therapist.
ANXIETY
JOINT PAIN
- Possible other causes: aging, trauma, infection, gout, degenerative joints, arthritis, malignancy, autoimmune (lupus, Sjogren, scleroderma, fibromyalgia)
- Evaluate onset, location, progression, other systemic symptoms
- See if family history
- Exam should look at range of motion, swelling, inability to bear weight, older age.
- Lab tests: Xrays or other studies can be helpful. Blood work like ESR and CRP can help rule out autoimmune issues.
HAIR LOSS
- See if due to shedding or breakage. Look at family history, medical conditions, diet, meds, and thyroid function.
GI SYMPTOMS
- What are the symptoms? Constipation, diarrhea, or both?
- Look at allergies, lactose and fructose intolerance, celiac disease, inflammatory bowel issues. See a GI doctor for a full workup.
They conclude that explant surgery is always an option.
But they give the reminder that 50% of patients report improvement of systemic symptoms after removal, but the improvement may be partial and temporary. “Women with no laboratory confirmed disease were the most likely to achieve symptom improvement following removal of their breast implants.”
Who else benefitted usually?
- Women with BMI > 30
- Those with clinically detectable capsular contracture
My thoughts?
Complex issue. I think BII is real. Many studies coming out are linking it with biofilm, a chronic low grade infection causing inflammation. But I have patients who removed their implants and felt better and those who did not. I have many patients with implants who have no issues. So I don’t think this is a black and white thing. Looking at the timing of onset is important. And many of these issues are also issues of aging, menopause, stress, etc. So again, complex issue.