Breast Implant Removal
What is breast implant illness?
That’s a great question. Unfortunately, we really don’t know. There is a notion that there are symptoms in patients who have had breast implants. This can be something as simple as nausea or vomiting or it can be as something much more like rheumatoid arthritis or arthritic conditions or reactions. Along with this, patients have also noted pains and aches and in some there is descriptions of “brain fog.” I will include a list of some of the more common things that have been seem. Unfortunately, there is no direct relationship between breast implants or breast implantation and breast implant illnesses or BII.
How do I know if I have breast implant illness?
That’s another great question. Unfortunately, we don’t really know what defines breast implant illnesses or BII. What we do know is that in some patients several years after breast implantation, there is a presentation of diffuse, non-specific symptoms that make the patients feel ill. In many, they simply comment that “they just don’t feel right.” This presentation can be due to a whole host of underlying diseases or maladies. There is no exact relationship between these very generic symptoms and breast implants or implantation. Unfortunately, that’s not really a great answer. Also, to make it even more confusing, there is not even a lab test or value or anything that can substantiate the phenomenon of breast implant illness. For that reason, breast implant illness, continues to be a very ill-defined phenomenon in patients who have had breast implantation.
Are there any specific tests for breast implant illness?
This actually is the reason that breast implant illnesses/BII becomes even more confusing. As of this writing, there is no specific lab test or any type of diagnostic test that can actually be performed to diagnose breast implant illness. As of now, it is a symptom-based diagnosis only.
I will try to elaborate. If we think you are sick, we usually got a blood test to show if in fact, your white cells are elevated. This is a very routine test. With that in mind, we can tell that you’re going through some sort of body reaction or inflammation. With breast implant illness, no such test exists. There are some tests that have been suggested. However, these same tests that have been elevated in some patients, are normal in others. So, no specific lab test can be run to help us diagnose this problem. In similar fashion, there are no diagnostic test to be run. For example, there’s no x-ray or CAT scan we can get to show changes or define breast implant illness.
For that reason, the diagnosis of breast implant illness is still a very difficult thing to make. More often than not, a team of physicians, including a rheumatologist and a surgeon can work together to rule out other processes and then finally end up with the diagnosis of breast implant illness.
What are the symptoms I should look for if I think I might have breast implant illness?
Again, there’s a whole host of possible symptoms. Each person reacts differently. Even in some patients, the only thing they present with is “I’m not feeling well,” OR “I’m not feeling the way I used to.” That’s really not something that is definitive. This leaves the physician/surgeon guessing and that is not a good place to be. Also, in some cases, age is an issue. The implantation could have taken place many years ago. And the patient now is going through regular aging. This can only complicate the presentation since normal aging and arthritic changes can complicate the well-being of the patient and impact the diagnosis.
If you look at one of the earlier questions, there is a whole host of possible symptoms. It could be that you suffered from some of these symptoms even prior to the implantation process. It could be that you are suffering from some sort of other malady, or these new symptoms could be possible signs of breast implant illness. As you can imagine, for these reasons, the diagnosis of breast implant illness/BII sits in a bit of a gray zone. For that reason, the surgery teams are always very apprehensive to simply diagnose somebody as having breast implant illness without being absolutely sure that all other diagnosis have been ruled out.
I thought I had breast implant illness and then I had my breast implants removed. Nothing changed? Why?
Unfortunately, this can happen. Personally, I had several cases where we were absolutely sure that somebody had breast implant illness. They had a host of clinical symptoms that were similar to what we would define as possible symptoms of breast implant illness/BII. In those cases, after conferring with the patients, we decided to take the implants out. These patients though did not really improve. Their symptoms did get slightly better. However, the overall “fix” that we had hoped to deliver, did not materialize. The patients themselves noted that they were somewhat frustrated since they did not get a resolution of all the symptoms as they had hoped. For that reason, again, breast implant illness tends to be very ill defined. As I noted above, in some cases when we remove the breast implants, the fix that we hope to get is simply not there. Please note that in other scenarios, when implants have been removed, they have improved dramatically. Did I do something different? No. Was the operation dramatically different? No. Were the patients very different when compared in regard to body or presentation? No. So all variables considered, I cannot really say if implant removal does or does not help the symptomology. It is very individualized to the person and to the symptoms. Our job/my job as the surgeon is to simply help get you over the hump with the understanding that all attempts have been made to make you better.
If I have implants, does that mean I will definitely get breast implant illness?
No, it does not. A tremendous number of patients around the country and around the world get breast implants every year. Less than one percent of patients presents back with symptomology or problems. Of these, even a smaller number note symptoms or concerns that would fall under an umbrella of breast implant illness or BII. For that reason, we do not necessarily consider breast implant illness/BII as something that happens routinely.
Think of this in the big picture. We put in hundreds of thousands of implants a year, between cosmetic and reconstructive cases (breast cancer reconstruction). Less than one percent of these patients presents back with issues. This is specifically in the arena of cosmetic surgery. Reconstructive surgery is different because those patients have chemotherapy and radiation and are much complicated. In the cosmetic arena, we do not routinely see breast implant illness/BII. If we do see this more routinely, we would probably not do breast implantation at all.
Had a family member who has breast illness. Does that mean I also get it?
That’s a great question. We do not have an absolute answer to that. As I mentioned above, breast implant illness is very rare. With that in mind, to actually see it in families or related individuals, is even more rare. As I have mentioned, we are not really sure what causes or is at the root of breast implant illnesses/BII. We suspect that it may be a body’s reaction to some of the markers around the breast implant. However, no studies that I know have shown such a direct relationship. Because we do not know the causality relationship, by the same token, we cannot say it is caused by genetics or family relationships or susceptibilities.
Are there any tests that I can get for breast implant illness like a CAT scan or an MRI?
No unfortunately. As we talked about earlier, there is not a specific test/MRI/CT scan, or ultrasound or anything else that can definitively by itself be used to diagnose breast implant illness. Breast implant illness continues to be ill defined between some anatomical presentations, some lab values, and the body physiology. So far, the most direct and absolute way to diagnose breast implant illness/BII is clinically and based on symptoms. As you can imagine, that then can range widely between patients. As for any exact or specific test, no diagnostic test as of yet exists. We all hope that there might be a test in the future. If there is, I will definitely update this set of answers.
I have to have my breast implants removed. Does Insurance pay for that? Does the breast implant company play for that?
These days, insurance companies do their best not to pay for anything. With that in mind, the specific reason for the breast implant removal has to be clearly identified. Breast implant illness/BII is still not well accepted. For that reason, insurance companies, at least in my experience, do their best to deflect the cost and not cover the implant removal. That may change in the future as breast implant illness/BII is better defined and categorized. As of now, the insurance companies tend to block the charges and consider them cosmetic only.
I had breast implants put in years ago. Are there any specific type of implants that can cause or are specifically related to breast implant illness?
That’s an interesting question. There are no specific implants that can cause or are thought to cause breast implant illness/BII. Breast implant illnesses tend to occur in all types of breast implants/implantation. It occurs in saline AND silicone implanted patients. It occurs in smooth AND textured patients. Textured implants themselves have a whole host of other issues. However, in regard to breast implant illnesses, there does not appear to be a direct relationship.
Can breast implants increase my chances of getting breast cancer?
Yes. Actually, new data shows that that can happen. Textured implants can cause a foreign body reaction and cause a specific type of breast cancer. That is Breast Implant Associated, Anaplastic Large Cell Lymphoma (BIA-ALCL). This disease presentation is specifically due to textured implants. As far as we can tell, the coverage of an implant or the shell causes a significant reaction in some patients. These patients present with non-specific swelling around the breast implant. This can take several months to several years to actually present. Usually there is no associated pain. There is discomfort. When the patient presents, we tend to also see a fluid collection around the implant. This fluid is then aspirated and can be used to diagnose the disease process.
What is the association between breast implant illness and cancer?
Breast implant illness/BII has no association with cancer. As opposed to BIA-ALCL as discussed in the previous question, breast implant illness has NO association or increased risk of breast cancer. Breast implant illnesses/BII continue to be identified or diagnosed as years go on. However, as of now, there is no increased risk of breast cancer in these patients. So again, to be sure, there is no correlation between breast implant illness/BII and any type of breast cancer.
I have decided to take out my breast implants. What type of surgery should I get?
Good question. This can sometimes be very confusing. What type of surgery should you undergo?? This all depends on the purpose of the surgery. If in fact, you are just trying to remove the implants, then a simpler surgery will suffice. However, if this is in regard to a cancer presentation like BIA-ALCL, then a more formalized operation needs to be planned and executed.
Should there be a cancer diagnosis, this would be done as a team effort. First and foremost, the diagnosis has to be confirmed. We would get the oncologist involved. We would then remove the implant as well as the shell/capsule around it. This is called an “En-Block” resection. This procedure or operation will remove all tissue that appears to be affected. Then the patient would have to go through a mild course of chemotherapy. As a side note, this is covered by insurance. The patient would then be put on a surveillance program to make sure that there is no further sequelae or recurrence of the disease process.
If cancer is not the concern, breast implant removal can be done simply by removing the implants. In some cases, if we see a thickened shell, we also remove it. If we leave it behind, we have noticed that in time patients develop a fluid collection and this gives them persistent problems. For this reason, among others, we would suggest the more aggressive approach. We would then reanimate the muscle back down onto the chest wall and reconstruct the anatomy as if in fact, there were no breast implants.
What’s the difference between the En Block breast implant removal and a standard breast implant removal?
As I noted above, an En Block resection is something that we use mostly for cancer cases like with BIA-ALCL. In those cases, we not only remove the implants but also the shell. But to be clear, WE DO THIS ALL-IN-ONE SHOT. For that reason, incisions are bigger. Our focus here is to make sure that everything comes out in one piece. We do not want it to come out in piecemeal. In a cosmetic case, this is not as much of a concern. We simply want to remove the implant and the shell/capsule. But we can do this in pieces or piecemeal. We are not as concerned about the fluid, the shell/capsule and all other associated reactions. Since the tissue is not harmful, we simply have to remove the shell and the implants. We can usually do this through a smaller incision. Our focus then is to get the anatomy back to normal.
Is there a guarantee that by removing my breast implants, that my symptoms will resolve?
No unfortunately. In my experience, we have taken breast implants out and there has been resolution of some symptoms. Let me be clear— breast implant illness/BII, and breast implant associated cancers (BIA-ALCL) are very different problems and have very different presentations. When discussing the removal of your implants, we need to be clear on what we are addressing. In patients with BIA-ALCL, breast implant removal does in fact resolve your symptoms. Our job as you can imagine is to make sure that we address your concerns correctly and get you past your surgery safely.
The right surgeon and the right team can make a big difference in your care and your well-being.