Breast Surgeon Dr Mary Ling puts the issue under the microscope
What is breast implant illness?
Breast implant illness (BII) refers to a wide range of symptoms that can occur after cosmetic augmentation or reconstruction with breast implants.
BII is not currently recognized as an official medical diagnosis, but it is increasingly being acknowledged. In 2020, the US Food and Drug Administration (FDA) released recommendations to breast implant manufacturers for new breast implant labelling, including warning women they may develop systemic symptoms such as joint and muscle pain, chronic fatigue and autoimmune diseases.
BII is still poorly understood, with good quality scientific evidence lagging behind anecdotal stories.
How common is it?
There have not been any studies looking at the number of women with breast implants who develop BII. In recent years, more women have been reporting BII symptoms, which may be because social media groups and media coverage have raised awareness of the condition.
What are the symptoms?
Many of the symptoms of BII are also experienced by the general public on a frequent basis. Some of the symptoms are listed on the diagram (left). The symptoms can appear at any time after implant surgery.
Who is at risk?
BII is more likely to occur in women who have a personal or family history of autoimmune conditions, allergies and conditions such as irritable bowel syndrome, migraines, chronic fatigue or fibromyalgia.
How is BII diagnosed?
There is currently no specific test to diagnose BII. Generally, tests are performed to exclude other potential causes of the symptoms (unrelated to the breast implants).
What is the treatment?
Surgery to remove the implants (explant surgery) and its surrounding tissue capsule (capsulectomy) can improve symptoms of BII. Capsulectomy can be:
- En bloc – removing the implant and capsule in one piece
- Total – removing the implant and the capsule, just not in one piece
- Partial – removing the implant and part of the capsule
- It is generally recommended that implants are not replaced if the main reason for removal is BII.
What are the outcomes after explant surgery?
There is not much research on outcomes after explant surgery for BII. Case series have reported women with partial or complete resolution of symptoms after explant surgery.
Is Breast Implant Illness the same as Breast Implant Cancer?
No. Breast Implant Illness (BII) is a completely separate condition to Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). BIA-ALCL is a rare cancer of the immune system that occurs only in women with breast implants. It is not breast cancer, but rather a type of lymphoma that grows in the tissue capsule which the body has formed around the implant.
|Unknown incidence||1 in 1000 to 1 in 10000|
women with implants
|Any type of implants||Textured implants|
|Wide range of systemic|
symptoms that can affect
the entire body
|Local symptoms: persistent|
breast swelling or pain, lump in
breast or armpit
|No specific tests||Ultrasound and MRI breasts and sampling of fluid around implants|
|Breast implant removal with capsulectomy may improve symptoms||Breast implant removal with en bloc capsulectomy is usually curative|
FAQ. – What will my breasts look like after explant surgery?
Your breasts will not look the same as before your original breast implant surgery. The weight of the implants stretches your tissue and causes changes in the rib area. After surgery, breast sagging and deflation occurs, which may improve over the course of 3 months.
The appearance of your breasts after explant surgery depends on:
- The size of your implants: larger implants will have more stretching effect on the natural breast
- The size of your breasts before implants: women with naturally smaller breasts will be less affected as there is less skin and breast tissue to sag
- Body changes while having implants (e.g. weight changes, pregnancy, menopause): hormonal and weight changes will often make your breasts saggier and without the extra volume of the implant, your breasts may look more deflated
- Your age: small breasts in young women may contract back to close to their original appearance, whereas, older women have less elastin and collagen in their skin and are less likely to revert back
Additional procedures such as a breast lift and/or fat grafting can be performed to improve aesthetic outcomes.
Dr Mary Ling. Specialist Breast Surgeon
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