In a recent viral TikTok, New York plastic surgeon Dr. Anthony Youn, MD described a mysterious illness some patients say is caused by their breast implants. Hair loss, joint pain, fatigue, rashes and muscle pain are just a few of the symptoms described by patients who say they have Breast Implant Illness. With his TikTok video, Dr. Youn officially went on record to say BII is real, a take that some plastic surgeons have found to be controversial.
“Breast implants can cause a constellation of symptoms in some women, called BII,” Dr. Youn says in the video. “Yes, I believe it’s REAL. But I also believe that most women do just fine with implants. But definitely not all.”
Similarly, Beverly Hills, CA plastic surgeon Cat Begovic, MD has also spoken publicly about BII: “A lot of you have asked me if Breast Implant Illness is a real thing,” Dr. Begovic shared on her social media channels. “Yes, it is very real and is devastating to the women who develop it. I personally have had three close friends who had it and I know how much they went through. Luckily none of my patients have developed it, but my friends’ experiences as well as the recent Allergan breast implant recall truly shook me.”
While these surgeons have gone on record publicly, not all plastic surgeons share the same takeaway and are quick to point out that the jury is still out on what is causing these symptoms and whether or not explant surgery is helping to resolve these patients’ concerns.
What Is BII?
First, it’s important to note that BII and the textured implant recall are two different things although they are often referred to in the same breath. It was just two years ago that an FDA investigation about textured implants causing breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) in some patients, a rare form of non-Hodgkin’s lymphoma. Two years after the recall and a subsequent American Society for Aesthetic Plastic Surgery (ASAPS) BII task force, the BIOCELL textured implants in question have been taken off the market and patients are being educated on associated risks and have been given the option to swap them out if needed.
“With regard to textured implants and breast implant illness, just to clarify, those are two completely separate topics,” notes University Park, TX plastic surgeon William P. Adams, MD, a member of Breast Device Collaborative Community (BDCC), an organization that provided the FDA with a recommended breast implant patient checklist. “Textured implants as you know have had this association with a ALCL, but we also know that textured implants are rather a passenger in the development of ALCL as they are carrier for bacteria that causes chronic inflammation that then can progress to the disease.”
“Breast Implant Illness is not related to textured implants,” explains St. Louis, MO plastic surgeon Patricia McGuire, MD. “BII is not related to any specific type of implant, it occurs with saline, gel, smooth or textured. In an ongoing study where I am principal investigator, the majority of our BII patients have smooth saline implants.”
Learning More About BII
Dr. McGuire is one of the principal investigators in an Aesthetic Surgery Education and Research Foundation sponsored a study looking further into BII. “This is a prospective, blinded study where we are looking at capsules and peripheral blood on women with self-described BII as well as two control groups—women with implants who do not have systemic symptoms they attribute to their implants, and women who have never had an implanted medical device. We would like to see if there are any objective differences in the analysis of these specimens between the BII patients and control groups.”
In the study, surgeons are examining all the theorized possibilities that can be triggering symptoms. “We are looking at next generation DNA sequencing for bacterial and fungal DNA on the capsules, as well as testing capsules for the presence of heavy metals,” says Dr. McGuire. “We are looking at cytokines, antibodies to bacterial toxins, inflammatory markers, thyroid function, and Vitamin D levels in all three cohorts.”
Eugene, OR plastic surgeon Mark Jewell, MD says recent research has shown a correlation between BII symptoms and COVID-19 “long haulers.” “More is to be learned here with regards to the future research on the overlap of Covid-19 ‘long haulers’ and BII,” explains Dr. Jewell. “The National Institute of Health (NIH) has committed to something like $1.15 billion to Covid-19 research. As we move forward, we must discover what is true regarding medically unexplained symptoms of BII and similar disorders through evidence and reason towards conclusions that lead to a more accurate map of reality. Advocacy groups for these disorders appear entrenched in beliefs, resisting surrender to an opposing position regarding causation and treatment.”
Does Explant Surgery Help?
Many BII patients seek explant surgery to alleviate their symptoms, which at times does help, but not always says Los Angeles plastic surgeon Steven Teitelbaum, MD. “There is no data that shows long-term relief from explant surgery,” he says. “The problem is that people who blame their implants for almost every symptom they encounter make it difficult to study. If you believe that everything that ails you is caused by your implants, there’s no way to do a study and control all the variables. However, there are people who clearly get better with explant surgery. But we have to ask, why do they get better? Are there other things they’re doing in their lives that also contribute them to improve. We have to study these things as well, we can’t just tell people to take their implants out and they will magically improve without knowing for sure what is making them sick and what is making them better.”
“According to the Aesthetic Society’s procedural data from 2020, the number of explants surgeries being performed are on the rise,” says Dr. McGuire. “Personally, in 2019 I removed more implants than I placed. However, in 2020 I have seen a significant increase in the number of primary augmentations I’ve performed as well, so the trending numbers can be misleading. It’s important to note that not all explants surgeries are due to BII. We also have a lot of older patients taking their implants out due to body changes due to weight fluctuations as well.”
Whether or not explant surgery will relieve BII symptoms is still not known, but plastic surgeons who are studying BII symptoms say to be cautious of the surgeons who are promoting it as a cure-all fix. “This is a really important topic because there are some surgeons and patients that are very adamant that there needs to be a special type of capsulectomy performed, an en bloc capsulectomy,” adds Dr. Adams. “Patients are often times told by this a small number of surgeons promoting this procedure, but there is no science to say that this type of capsulectomy that is either needed or better.”
While no official diagnosis of breast implant illness can be given by a doctor at this time, patients who have ruled out all other possibilities should consult with a board-certified plastic surgeon to get as much information about BII, it’s causes and possible solutions.