A Word About Breast Implant Illness (BII)
My daughter’s school hosted a father-daughter dance last year. After dinner, they served up a delicious dessert called spumoni. Spumoni is an Italian ice cream made commonly with pistachio. My daughter dutifully asked the server if spumoni had any nuts in it. She was told no. My daughter is quite disciplined about asking if any food item has nuts in it since she has a severe allergy.
After a couple of generous spoonfuls, she started to experience the usual symptoms: tingling of her tongue, hives on her cheeks, swelling in her throat. She and I recognized it right away and we left the dance in a hurry in search of the nearest pharmacy. Her allergy isn’t severe enough to warrant an epi-pen injection. But, an urgent dose of benadryl is required before she gets rather uncomfortable. After a quick swig of the cherry flavored elixir, she felt better. Then, we went home… exhausted but relieved.
Nuts are a ubiquitous part of the American diet. Most people enjoy the flavor of nuts on ice cream, cookies, and pies without giving it a second thought. But to my daughter, it is a toxin. Her body exhibits severe symptoms in response to this commonly consumed food item.
In a similar manner, I recently had a patient who was deathly allergic to Tylenol. Tylenol is one of the most frequently and widely consumed medications on the planet. It is a go-to medicine for headaches for most of the population. Yet, to my patient, a seemingly benign drug like Tylenol will cause her throat to swell and her blood pressure to drop and her heart rate to rise before going into shock.
How different are we as people! We are all individually unique and have bodies that react to different stimuli in different ways.
Breast implants have been around since the 1970s. They have been used both for cosmetic and reconstructive purposes on innumerable people who have benefited from them. They have been rigorously tested by the FDA for safety, longevity, and health effects both positive and negative. Thus far, there appears to be no scientific evidence that breast implants, silicone or saline, cause harm to the vast majority of the population who have them.
However, could it be that in a certain subset of people, they could cause a variety of symptoms that interfere with their health and sense of well being? My answer is ABSOLUTELY! After all, why should we expect this particular medical device to be perfectly accepted by every person’s immune system?
Breast Implant Illness (BII) is a disease which is yet to be formally defined by the medical community. There is no diagnostic procedure to determine its presence. But, its symptoms have been outlined by many women with breast implants as the following:
-lack of moisture and thinning of skin
-pain and discomfort to the chest and ribs
-lack of energy
-gastrointestinal and digestive problems
-thyroid function abnormality
Could breast implants, silicone or saline, cause these symptoms? It is certainly possible. Do they cause these symptoms in everyone? No. Should everyone who has one or more of these symptoms get their breast implants removed immediately? No.
As with most every medical condition, you need first to start with a knowledgeable physician specializing in internal medicine. They can start the process whereby a correct cause of your symptoms can be determined. Often, this is a diagnosis of exclusion. What is “diagnosis of exclusion”? It means that before the cause of the symptom is attributed to breast implants, for example, all other possible and perhaps more common diagnoses must be ruled out. As the old adage goes, “common things are common”. This means that thyroid problems are more commonly the cause of sluggishness and brain fog than breast implants. Therefore, you should rule out thyroid dysfunction before you attribute the cause of your symptoms to breast implants. After all, if you have your breast implants removed and still have one or more of your symptoms, you have undergone a body altering surgery unnecessarily.
Every physician who is board certified in internal medicine in the United States is trained to think scientifically. This means that as doctors, we must be objective and scientific about disease and its causes and treatments. Otherwise, we are no better than any quack selling snake oil. In medical school, a physician is taught that every medicine that is approved by the FDA in this country has to pass the test of being more effective than placebo. The placebo effect is a powerful phenomenon that is difficult to explain fully in the scientific sense. It means that if a patient has a symptom, let’s say, chronic stomach aches, certain people can actually be treated with a tablet that looks and tastes just like real medicine but is actually just made of sugars and binders, if they believe it is real medicine that they are taking. The effectiveness of this non-medicine-containing tablet is rather remarkable. Nearly 4 out of every 10 patients that take a placebo tablet feel that their stomach aches are better.
Now, let’s get back to Breast Implant Illness. Breast Implant Illness remains an undefined disease. It is definitely possible that in a subset of the population, these devices may cause a myriad of symptoms that alter their lives in a negative manner. And, the removal of the devices may be the most effective treatment causing complete resolution of the symptoms.
But, we must study it and test it and define it so that as physicians we can treat patients most effectively.
There are plastic surgeons who have come out and stated that the Breast Implant Illness is already a defined disease and the only way to treat it is by removing the implants. Some have even come out and stated that an “en bloc” removal is the only effective treatment. An “en-bloc” removal is defined as the following:
When breast implants are surgically inserted, the body forms a capsule around it. A capsule is a pocket made of very thin, soft layer of scar tissue that the body forms around the implants. In vast majority of patients with implants, a capsule is not able to be felt under the breast tissue. A capsule is not harmful to the body just as a scar you form after a mole removal is not harmful to the body. The surgeons who state that an en-bloc removal is the only real effective treatment for Breast Implant Illness claim that the capsule must be removed in its entirety along with the breast implants.
THIS VIEW HAS NEVER BEEN TESTED AND SHOWN TO BE EFFECTIVE IN ANY PATIENT IN ANY RANDOMIZED LARGE SCALE CLINICAL STUDY.
Remember, for a procedure to be accepted as the gold standard, a large number of patients have to undergo breast implant removal with some receiving complete capsule removal and others having partial capsule removal and still others having no capsule removal. In the setting of all patients not knowing which operation they received, the group receiving complete capsule removal must have definitive reduction of their symptoms over the partial removal group and the no-removal group. So, it is my opinion that en-bloc capsule removal with implant removal may be effective but has yet to be proven to be so in any study.
My advice to patients as a plastic surgeon who has been in practice for over 15 years and board certified by the American Board of Plastic Surgery is that if you have symptoms of Breast Implant Illness, you should consult an internist and get a full physical exam and be tested for a complete set of diagnostic blood work. If this has turned up nothing with regard to diagnosis for more common causes of your symptoms, consult a board certified plastic surgeon to discuss your questions regarding your breast implants.
-Dr. Richard Lee