The 411 when you’re feeling a 911 regarding your breast implants

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Many women are dealing with symptoms that may be caused by their breast implants according to Dr. Michael Sundine. The information provided should be a starting place for women dealing with these issues.

“We are definitely seeing a marked increase in the number of requests for evaluation of patients with concerns about their breast implants as awareness of breast implant illness has increased.”

There are many women who have breast implants that present with a broad array systemic complaints such as: joint pain, hair loss, fatigue, cognitive dysfunction (brain fog, memory loss), aching muscles, dryness throughout the body, skin rashes, recurring infections, gastrointestinal and digestive issues, problems with the thyroid and adrenals.

Tip #1:
This constellation of symptoms and the presence of breast implants have been described as breast implant illness (BII). To date there is no specific test that can be performed to diagnose breast implant illness. An excellent review on this topic can be found on the American Society for Aesthetic Plastic Surgery website (https://www.surgery.org/sites/default/files/downloads/BII-Talking-Points-FINAL-1.15.19.pdf).

Tip #2:
For many patients with the combination of these symptoms and breast implants warrants removal of the implants and the complete capsule around the implants: a so-called en-bloc capsulectomy. The en-bloc capsulectomy essentially involves the removal of the capsule and breast implant intact in an effort to remove all of the silicone material without any further exposure to the body.

Tip #3:
An en-bloc capsulectomy cannot always be performed. Patients need to understand sometimes there are some technical limitations in the ability to perform an en-bloc capsulectomy. In order to completely remove the implant without opening the capsule a wide exposure is required. This means that likely a larger incision will be required to remove the implant and capsule than was necessary to place the implant. If the initial implant was placed through an incision around the areola or in the axilla (armpit) an en-bloc capsulectomy will likely not be able to be performed using the initial incision. There are other technical considerations where the capsule is adherent to nerves or where the capsule is adherent to the chest wall with possible collapse of the lung and in such cases a segment of the capsule may have to be left behind. Dr. Sundine performs the en-bloc capsulectomy as shown below. The implant on the right shows the capsule opened with an intact textured implant removed from the capsule. Dr. Sundine has been performing breast implant removal with total capsulectomy since 1992.

Tip #4:
It should be noted that Breast Implant Illness should not be confused with Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL). BIA-ALCL is a rare lymphoma that has developed in association with textured breast implants. This rare cancer occurs in approximately 1:3,000-1:80,000 patients. The actual incidence is not known at this time. Patients who typically develop BIA-ALCL have symptoms of breast enlargement, hardening, a breast mass, a skin rash, or fluid collection developing around the breast. Patients who are having these symptoms in association with a breast implant should follow up with their surgeon. They will likely require an imaging study such as an ultrasound or an MRI. If fluid or a mass is found a biopsy or fluid aspiration will be necessary and the tissue will be sent for specific laboratory studies.

Tip #5:
Removal of the breast implants with en-bloc capsulectomy and associated procedures are performed on an outpatient basis at an outpatient surgery center or outpatient hospital. The procedure is performed under a general anesthetic to maximize patient comfort utilizing board certified anesthesiologists.    

Tip #6:
It is important for patients to remember that following removal of the implant and capsulectomy your breasts will be deflated and the skin may be loose. There may be a concavity (sunken area) in the center of the breast. Many patients will require a mastopexy (breast lift) to lift the nipple-areola complex and also to tighten the skin. Some patients may want to improve the projection and we perform this using a circum-mammary ligament repair along with the addition of fat grafting to the breast in an attempt to restore the volume of the breast.

Tip #7:
In some cases where there is a documented breast implant rupture (by MR scan, ultrasound, or mammogram) associated with a capsular contracture the procedure has been covered by the patient’s insurance. This coverage varies widely and patients should check with their insurance company as to whether the procedure will be covered.

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Michael Sundine
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