A Practical Guide to Managing Patients With Systemic Symptoms and Breast Implants

Breast Implant Surgery: The Importance of Informed Health Care Decisions and Outcome Monitoring

Breast implant surgery is a popular, globally performed, and frequently requested cosmetic and reconstructive surgical procedure. Breast implant surgery can cause implant-associated systemic symptoms and types of implant-associated cancers, so it is vital to monitor patient outcomes. Most patients who undergo breast implant surgery do not experience health problems. However, patients who do experience health problems as a result of breast implant surgery form a unique patient population. When plastic and aesthetic surgeons, nurses, and other healthcare providers are knowledgeable and experienced in recognizing and treating patients with health problems related to breast implant surgery, the health outcomes of this patient population improve. This article aims to promote informed decision-making and increase patient safety by providing information about the health problems associated with breast implant surgery. This article also highlights recent safety announcements and updates from the United States Food and Drug Administration (FDA). Ensuring the safety of patients undergoing breast implant surgery is a responsibility shared by plastic and aesthetic surgeons, nurses, and other healthcare providers; the general medical community; breast implant manufacturers; and the FDA. These entities must collaborate and coordinate as a united group to accomplish this important goal. The nursing profession can contribute to these collaborative efforts by serving as professional liaisons to these entities and advocating for continued collaborative efforts to increase the safety of patients who have undergone breast implant surgery.

Breast Implants: Low Rate of Annual Check-Ups Results in Delayed Presentation of Ruptured Implants

Background: Breast-implant-based reconstruction is one of the most performed procedures in plastic surgery. Despite the high durability of breast implants, various complications are accompanied with prolonged inlay duration, particularly implant rupture. Many aftereffects can be associated with implant rupture, especially siliconoma and BIA-ALCL. Without regular implant check-ups, implant-related issues may remain underrecognized. Here, we analyzed the number of breast implant carriers needing revisions and if patients adhered to annual implant follow-up recommendations. Methods: We reviewed 1128 breast procedures at the department of plastic surgery at the University Clinic of St. Poelten between August 1st 2018 and December 31st 2023. Patients were analyzed to see whether regular check-ups of their breast implants were performed. Additionally, implant-related complications were investigated, as well as if they were noticed by implant carriers. Results: Only 15.46% of breasts implants were regularly checked at least once a year in our cohort. The remaining 84.54% of patients consulted our department due to pain or aesthetic discomfort without periodical follow-ups. Most implant ruptures (73.8%) were diagnosed in patients consulting acutely due to pain or capsular contraction after an average of 17.36 ± 10.57 years. Routine examination uncovered 26.2% of silent implant ruptures without patients yet complaining of clinical symptoms as early as 15.44 ± 11.17 years. Conclusions: Most implant ruptures develop clinical symptoms as an indicator that removal is warranted. However, only regular follow-ups can identify implant complications several years earlier and possibly reduce severe sequalae such as BIA-ALCL. This highlights the significance and necessity of annual breast implant controls by surgeons and radiologic imaging to prevent devastating implant-associated aftereffects.

Connective Tissue and Autoimmune Diseases Associated With Postsurgical Breast Augmentation: An Updated Review

This review provides an updated overview of the association between breast augmentation and connective tissue diseases (CTDs). A narrative review of recent literature was conducted. Various autoimmune disorders, such as Raynaud's syndrome, rheumatoid arthritis (RA), and Sjögren's syndrome, have been reported in association with breast implants, particularly silicone implants. Symptoms can be diverse and systemic, including fatigue, joint stiffness, muscle pain, skin rashes, and neurological and gastrointestinal issues. Explantation has shown promise in alleviating symptoms, but the exact pathogenesis remains unclear. Recent studies emphasize the need for informed consent, vigilant monitoring, and multidisciplinary management. The association between breast implants and CTDs remains contentious. While advancements in implant technology have improved patient outcomes, concerns about long-term health implications persist. Continuous research is necessary to elucidate the mechanisms underlying these potential risks and to develop informed patient care guidelines. In this narrative review, we discuss the history of breast implants, illness associated with breast augmentation, and treatment of CTDs and autoimmune diseases associated with breast augmentation.

Preoperative Patient Guidance and Education in Aesthetic Breast Plastic Surgery: A Novel Proposed Application of Artificial Intelligence Large Language Models

Background

At a time when Internet and social media use is omnipresent among patients in their self-directed research about their medical or surgical needs, artificial intelligence (AI) large language models (LLMs) are on track to represent hallmark resources in this context.

Objectives

The authors aim to explore and assess the performance of a novel AI LLM in answering questions posed by simulated patients interested in aesthetic breast plastic surgery procedures.

Methods

A publicly available AI LLM was queried using simulated interactions from the perspective of patients interested in breast augmentation, mastopexy, and breast reduction. Questions posed were standardized and categorized under aesthetic needs inquiries and awareness of appropriate procedures; patient candidacy and indications; procedure safety and risks; procedure information, steps, and techniques; patient assessment; preparation for surgery; postprocedure instructions and recovery; and procedure cost and surgeon recommendations. Using standardized Likert scales ranging from 1 to 10, 4 expert breast plastic surgeons evaluated responses provided by AI. A postparticipation survey assessed expert evaluators' experience with LLM technology, perceived utility, and limitations.

Results

The overall performance across all question categories, assessment criteria, and procedures examined was 7.3/10 ± 0.5. Overall accuracy of information shared was scored at 7.1/10 ± 0.5; comprehensiveness at 7.0/10 ± 0.6; objectivity at 7.5/10 ± 0.4; safety at 7.5/10 ± 0.4; communication clarity at 7.3/10 ± 0.2; and acknowledgment of limitations at 7.7/10 ± 0.2. With regards to performance on procedures examined, the model's overall score was 7.0/10 ± 0.8 for breast augmentation; 7.6/10 ± 0.5 for mastopexy; and 7.4/10 ± 0.5 for breast reduction. The score on breast implant-specific knowledge was 6.7/10 ± 0.6.

Conclusions

Albeit not without limitations, AI LLMs represent promising resources for patient guidance and patient education. The technology's machine learning capabilities may explain its improved performance efficiency.

Level of Evidence 4

A Prospective Observational Clinical Cohort of Women with Suspected Breast Implant Illness

Background: This study aims to describe a prospective clinical cohort of patients with silicone breast implants and suspected Breast Implant Illness (BII). Methods: Women were included in a specialized silicone outpatient clinic at Amsterdam UMC, the Netherlands. Baseline characteristics were collected including medical history, implant details, and symptoms. Experienced physicians categorized BII suspicion as high, moderate, or low, based on symptoms and after exclusion of other probable causes. Additionally, participants completed questionnaires assessing symptoms and daily life impact at baseline, 6 months, 1, 2, and 5 years. For this initial analysis, the results from the first three years of inclusions were collected. Results: Data from 353 women were collected from December 2020-December 2023. At baseline, the most reported symptoms were fatigue, arthralgia, myalgia, and morning stiffness, accompanied by local symptoms in 83.3% of patients. At the clinic, 112 women were categorized as having high suspicion of BII, 147 women as moderate, and 94 women as low. At follow-up, 182 women (51.6%) opted for explantation. Following explantation, women with a high or moderate suspicion of BII experienced more significant symptom improvement, accompanied by a decrease in anxiety and a greater sense of control over their illness, compared to women with a low suspicion of BII. Conclusions: Our study highlights a distinct interplay of systemic and local symptoms among women with suspicion of BII. Women with a high or moderate BII suspicion benefit significantly more from explantation than women with low suspicion. Experienced physicians are pivotal in effectively assessing and guiding this patient group, highlighting the need for tailored clinical approaches.

Self-reported systemic symptoms among women with breast implants

Around 2,500 women receive a breast augmentation with silicone-based implants yearly in Denmark. A number of these women report various uncharacteristic systemic symptoms, which they attribute to the breast implants, including impaired cognition, joint pain, etc. This condition has been termed "breast implant illness" and is currently not a recognised diagnosis. The correlation between the patient's self-reported symptoms and breast implants has not been established and there is limited evidence that surgery has any effect. In this review, the current literature on the topic has been reviewed.

Silicone Particles in Capsules Around Breast Implants: An Investigation Into Currently Available Implants in North America

BACKGROUND

Breast implants have always been composed of a silicone elastomer envelope filled with either silicone gel or saline. Breast implant illness (BII) is a set of symptoms that has previously been linked to the leakage of silicone particles from the implants into the body.

OBJECTIVES

Our research aimed to quantify the number of silicone particles present in the capsules of breast implants available in North America.

METHODS

Thirty-five periprosthetic capsules were sampled and analyzed, and silicone particles were counted and measured. The capsule surface area was then measured and utilized to calculate particle density and total number of silicone particles.

RESULTS

Eighty-five percent of capsules analyzed from silicone gel implants contained silicone, with an average of 62 particles per mm3 of capsular tissue. These implants had approximately 1 million silicone particles per capsule. In contrast, none of the saline implant capsules contained silicone. Capsules from macrotextured tissue expanders contained fewer and larger silicone particles.

CONCLUSIONS

Silicone gel implants presented silicone particle bleeding into the periprosthetic capsule, totaling on average 1 million silicone particles per capsule. On the other hand, no silicone particle bleeding was observed from saline breast implants. These data suggest that particle bleeding comes from the inner silicone gel, and not from the smooth outer silicone shell. Previous studies have reported the presence of breast implant illness in patients with both silicone- and saline-filled implants. Therefore, our data suggest that silicone migration is not the sole cause of BII.

LEVEL OF EVIDENCE: 4