Breast implant illness (BII) is an overall phrase that has been used by some women who have breast implants to describe a broad spectrum of systemic (affecting their whole body rather than a single body part) symptoms experienced by them. These symptoms may include tiredness, joint ache, brain fog, memory loss and headaches but other symptoms have also been described.
The WHO (World Health Organisation) does not recognise “BII” as a medical diagnosis as it has not fulfilled the criteria to be classified as a disease. No scientific link between breast implants and these symptoms has yet been identified, however, many women who identify as having these symptoms experience varying degrees of relief after their implants are removed.
So, what is new?
In light of 3 recently published high quality scientific studies investigating the possibility of systemic symptoms associated with breast implants (often referred to as breast implant illness) I have written this update to summarise their findings to help with a deeper understanding of this possible entity.
One hundred and fifty patients were enrolled in the studies*, 50 of whom identified as having symptoms they attributed to their implants, 50 women with breast implants requesting removal or exchange with no symptoms they attributed to their implants and 50 who were undergoing mastopexy (breast lift) surgery with no implants.
Detailed information was collected from the patients prior to surgery as well as 3-6 weeks after surgery, 6-months and a year after surgery. Blood was also collected and breast implant capsule (the scar tissue around the implant) was collected from the first two groups at the time of their surgery.
Were there any differences in lifestyle between the 3 groups?
In short, yes: the first group (who identified as having symptoms they attributed to their implants) reported more marijuana use, more tattoos and more allergies than those in the other groups. The first group also had a significantly higher use of certain pain medications and other herbal medicines. Finally, they used social media significantly more than those in the other groups as their primary source of medical information.
Study Part 1:
What was this about?
This investigated whether there were any differences in relief of symptoms of patients that related to the way in which the capsule was treated at the time of surgery. The 3 approaches were an “en bloc” capsulectomy (which means the implant is removed within the capsule as one unit, requiring a large scar); a total capsuectomy (in which the whole capsule is removed via a normal sized incision) or a partial capsulectomy (in which around half of the capsule is removed).
Why was this studied?
The belief of many women who attribute systemic symptoms to their breast implants is that only an “en bloc” capsulectomy will succeed in alleviating their symptoms.
So, what did they find?
The findings were that there was no difference in symptom reduction based on the type of capsulectomy. However most (but not all) of these patients did demonstrate that they had at least a partial improvement in their symptoms after surgery, and this improvement lasted for at least 6-months.
Conclusions
In conclusion the way in which the capsule was surgically managed did not make a difference to symptoms.
Study Part 2:
What was this about?
This part of the study was to determine whether heavy metals are present in the implant capsules and whether there are statistical differences in the presence of heavy metals in those in women who attribute systemic symptoms to their breast implants compared with the other groups. A wide range of substances were studied.
Why was this studied?
Many women who attribute systemic symptoms to their breast implants believe that they might be being poisoned by heavy metals leaking from their breast implants into the capsules and then into their blood stream.
So, what did they find?
Heavy metals were found in all three groups, including the last group, which was composed of women who had never had a breast implant (and indeed the levels recorded in this group were higher than in the other two groups). The only statistically significant differences found in the first group were higher levels of arsenic and zinc (both of which were actually found in amounts lower than the acceptable daily intakes), lower levels of cobalt and manganese, silver and tin.
However, there were “confounding factors” in the group of women who attributed systemic symptoms to their breast implants – women in this group had higher rates of smoking, gluten free diets (which often include higher amounts of rice or rice flour, which are a high source of arsenic and other heavy metals), dietary supplements and the presence of tattoos, all of which are significant sources of arsenic and zinc.
Conclusion:
In conclusion there was not a significant risk of heavy metal exposure from breast implants.
Study Part 3:
What was this about?
This part of the study aimed to investigate whether there was a difference in inflammation or infection in the capsules between the three groups. Also studied were differences in thyroid hormones, vitamin D levels and blood counts between the groups.
Why was this studied?
Some women who attribute systemic symptoms to their breast implants believe that their symptoms might be caused by an underlying infection or exposure to silicone particles.
So, what did they find?
No statistically significant differences were found between the first two groups’ capsules in relation to infection or inflammation, apart from those women in group 2, who had higher rates of capsular contracture, which would be expected to have higher rates of inflammation.
The presence of silicone particles on the capsules was actually lower in the first group (women who identified as having systemic symptoms) compared with the second group.
Interestingly, specific markers of inflammation from blood tests (e.g. CRP) were higher in the first group. The confounding factors are that this group had higher rates of thyroid disease, allergies and smoking, all of which can result in the elevation of these markers. In addition, anxiety, which was reported with a higher prevalence in this first group, has been associated with raised levels of other markers of inflammation that were also detected at higher levels in this group.
Conclusion:
The DNA, microbiology and antibody data from this study failed to demonstrate an infectious theory as a primary cause for the systemic symptoms reported in BII. In addition, there was no evidence of small silicone particles being a likely cause of symptoms.
Study Limitations:
All scientific studies have limitations. Whilst this series of studies is probably the most accurate study on this topic to date, and uses the very latest state of the art technology, there were relatively limited numbers – 50 in each group. These groups were large enough to produce meaningful data, but even larger groups would be beneficial for further study.
Systemic symptoms are by definition subjective, and cannot be accurately measured or verified, so this also introduces a variable that is hard to control.
*
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9208825/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9400612/
https://academic.oup.com/asj/advance-article/doi/10.1093/asj/sjac225/6671500?login=false
