1
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Kabir R, Stanton E, Sorenson TJ, Hemal K, Boyd CJ, Karp NS, Choi M. Breast Implant Illness as a Clinical Entity: A Systematic Review of the Literature. Aesthet Surg J 2024:sjae095. [PMID: 38636098 DOI: 10.1093/asj/sjae095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/30/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Breast implant illness (BII) has become a contentious subject in recent years. While some studies have reported associations between breast implants and autoimmune diseases, others have failed to establish a definitive link. OBJECTIVES The objective of this study is to provide a comprehensive, up-to-date evaluation of the literature surrounding BII, with an emphasis on identifying patient-related factors that may be associated with BII. METHODS A systematic review was performed following PRISMA guidelines using Pubmed (MEDLINE), EMBASE, and Cochrane databases to search for relevant studies published in the last twenty years. RESULTS Thirty-one studies were included with a total of 39,505 implant patients and mean age of 44.2 ± 9.30 years. Fifteen studies reported implant explantation status with 72.4% patients choosing to remove their implants. Among these, nine studies reported symptom improvement in 83.5% patients. Fifty-three percent of patients undergoing explantation had total capsulectomy. Twenty-eight studies documented total numbers of patients experiencing symptoms related to BII, with 31.3% patients reporting such symptoms. Among these, sixteen studies of 4,109 BII patients distinguished whether the reason for implantation was cosmetic augmentation or reconstruction. When specified, more patients experiencing BII-related symptoms received implants for "cosmetic" versus "reconstructive" reasons (Cosmetic: 3,864/4,109; 94.0% vs. Reconstruction: 245/4,109; 5.96%, p < 0.001). CONCLUSIONS This review provides an overview of the current state of knowledge regarding BII. Our study highlights a potential relationship between BII and indication for implants (cosmetic vs. reconstructive) among other variables, offering valuable insight on factors associated with BII and directions for future research.
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Affiliation(s)
- Raeesa Kabir
- Medical student, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Eloise Stanton
- Medical student, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Thomas J Sorenson
- Hansjorg Wyss Department of Plastic Surgery, NYU-Langone Health, New York, NY, USA
| | - Kshipra Hemal
- Hansjorg Wyss Department of Plastic Surgery, NYU-Langone Health, New York, NY, USA
| | - Carter J Boyd
- Hansjorg Wyss Department of Plastic Surgery, NYU-Langone Health, New York, NY, USA
| | - Nolan S Karp
- Hansjorg Wyss Department of Plastic Surgery, NYU-Langone Health, New York, NY, USA
| | - Mihye Choi
- Hansjorg Wyss Department of Plastic Surgery, NYU-Langone Health, New York, NY, USA
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2
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Suri K, Billick S. Breast Implant Illness Through a Psychiatric Lens. Aesthetic Plast Surg 2024; 48:559-567. [PMID: 37828367 DOI: 10.1007/s00266-023-03692-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023]
Abstract
Since their introduction in the 1960's, the safety of silicone breast implants has remained contentious due to concerns regarding carcinogenicity as well as a growing array of adverse psychiatric symptoms, which have now been termed 'Breast Implant Illness.' This article aims to explore the merits of a psychiatric approach to treating Breast Implant Illness by outlining how it is defined by psychiatric symptoms and categorized alongside other psychiatric illnesses. Furthermore, it is unclear whether the pathology of Breast Implant Illness is purely medical or psychiatric. However, the efficacy of the medical approach to treatment through a process called explantation, which involves removal of the implant and surrounding scar tissue, or capsule, is not strongly supported by existing data. A psychiatric approach to treatment, in conjunction with explanation, thus holds potential in remedying the novel and poorly understood Breast Implant Illness.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Kashviya Suri
- The University of Pennsylvania, Philadelphia, PA, USA.
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3
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McGuire PA, Glicksman C, McCarthy C, Spiegel A. Separating Myth from Reality in Breast Implants: An Overview of 30 Years of Experience. Plast Reconstr Surg 2023; 152:801e-807e. [PMID: 37010472 DOI: 10.1097/prs.0000000000010488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
SUMMARY The purpose of this article is to review the pivotal events in the history of breast implants in the United States, including the events leading to the U.S. Food and Drug Administration moratorium on the use of silicone gel implants and subsequent approval; the emergence of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL); and persistent concerns about an association between breast implants, autoimmune disease, and systemic symptoms. This article reviews the medical literature to outline our current knowledge on BIA-ALCL; offers recommendations for diagnosis and management of symptomatic and asymptomatic patients with textured implants; and reviews the science of potential associations of implants with autoimmune and systemic symptoms. The authors hope to help patients separate myths from reality and make educated decisions on having breast implants placed or removed.
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Affiliation(s)
| | | | - Colleen McCarthy
- the Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Aldona Spiegel
- The Center for Breast Restoration, Weill Cornell Medical School, Houston Methodist Academic Institute, and Division of Surgical Innovation, Houston Methodist Hospital
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4
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Spoor J, Mureau MAM, Hommes J, Rakhorst H, Dassen AE, Oldenburg HSA, Vissers YLJ, Heuts EM, Koppert LB, Zaal LH, van der Hulst RRWJ, Vrancken Peeters MJTFD, Bleiker EMA, van Leeuwen FE. The Areola study: design and rationale of a cohort study on long-term health outcomes in women with implant-based breast reconstructions. Ann Epidemiol 2023; 82:16-25. [PMID: 37028614 DOI: 10.1016/j.annepidem.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 02/27/2023] [Accepted: 04/02/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Implant-based breast reconstructions contribute considerably to the quality of life of breast cancer patients. A knowledge gap exists concerning the potential role of silicone breast implants in the development of so called 'breast implant illness' and autoimmune diseases in breast cancer survivors with implant-based reconstructions. Breast implant illness (BII) is a constellation of non-specific symptoms reported by a small group of women with silicone breast implants. METHODS/DESIGN The Areola study is a multi-centre retrospective cohort study with prospective follow-up aiming to assess the risk of BII and autoimmune diseases in female breast cancer survivors with and without silicone breast implants. In this report, we set out the rationale, study design and methodology of this cohort study. The cohort consists of breast cancer survivors who received surgical treatment with implant-based reconstruction in six major hospitals across the Netherlands in the period between 2000 and 2015. As comparison group, a frequency-matched sample of breast cancer survivors without breast implants will be selected. An additional group of women who received breast augmentation surgery in the same years will be selected to compare their characteristics and health outcomes with those of breast cancer patients with implants. All women still alive will be invited to complete a web-based questionnaire covering health-related topics. The entire cohort including deceased women will be linked to population-based databases of Statistics Netherlands. These include a registry of hospital diagnostic codes, a medicines prescription registry and a cause-of-death registry, through which diagnoses of autoimmune diseases will be identified. Outcomes of interest are the prevalence and incidence of BII and autoimmune diseases. In addition, risk factors for the development of BII and autoimmune disorders will be assessed among women with implants. DISCUSSION The Areola study will contribute to the availability of reliable information on the risks of BII and autoimmune diseases in Dutch breast cancer survivors with silicone breast implants. This will inform breast cancer survivors and aid future breast cancer patients and their treating physicians to make informed decisions about reconstructive strategies after mastectomy. REGISTRATION This study is registered at ClinicalTrials.gov on June 2nd 2022 (NCT05400954).
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Affiliation(s)
- Jonathan Spoor
- Department of Epidemiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Juliëtte Hommes
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Plastic and Reconstructive Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Hinne Rakhorst
- Department of Plastic, Reconstructive and Hand Surgery, Ziekenhuis Groep Twente, Enschede, the Netherlands
| | - Anneriet E Dassen
- Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Hester S A Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Esther M Heuts
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Linetta B Koppert
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Laura H Zaal
- Department of Plastic Surgery, Velthuis kliniek, Hilversum, the Netherlands
| | - Rene R W J van der Hulst
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Plastic and Reconstructive Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | | | - Eveline M A Bleiker
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Family Cancer Clinic, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
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5
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Serena TJ, Habib P, Derosa A. Breast Implant Illness: A Cohort Study. Cureus 2023; 15:e38056. [PMID: 37228535 PMCID: PMC10208020 DOI: 10.7759/cureus.38056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 05/27/2023] Open
Abstract
Background Breast implant illness (BII) is a clinical disease defined by a constellation of symptoms that patients experience as a result of their breast implants. This retrospective, cohort study evaluated the benefit of breast implant explantation with total capsulectomy on patients' symptoms. Methodology This is a single-center, single-arm, cohort study utilizing retrospectively collected data. All participants included in this study voluntarily presented to the department of plastic and reconstructive surgery and requested breast implant removal. A total of 229 patients were enrolled in the study over a three-year period from 2018 to 2021. The primary endpoints of the study were to objectively grade the improvement of symptomatology following surgical intervention. The secondary endpoints were to identify co-factors such as age, comorbidities, implant characteristics, the timing of symptoms, and other data that were potentially influenced by or influencers of the breast implant illness. Results The study achieved a total of 549-point decrease in symptom frequencies following surgery. Furthermore, with an average preoperative symptom score of 3.5 (scored 1-5) and a postoperative average of 1.9, the study demonstrated a score reduction of 1.6 across all symptoms. Furthermore, the study was able to eliminate on average 2.8 symptoms of breast implant illness from every patient following explantation. Conclusion Breast implant illness is a true clinical entity that affects an extensive population of patients who have undergone breast augmentation. This study has not only highlighted the extensive morbidity of breast implant illness but has also demonstrated that there is an opportunity to standardize treatment for this disease. These outcomes have proven that a significant reduction in disease severity can be achieved with breast implant explantation and total capsulectomy.
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Affiliation(s)
| | - Peter Habib
- General Surgery, Beaumont Health, Farmington Hills, USA
| | - Amy Derosa
- Plastic and Reconstructive Surgery, Beaumont Health, Farmington Hills, USA
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6
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Weitkunat A, Targosinski S, Bauer B, Grünert JG, Winsauer S. [The Emerging Interest in Breast Implant Illness and its impact on Patient Behavior]. HANDCHIR MIKROCHIR P 2022; 54:489-494. [PMID: 36343629 DOI: 10.1055/a-1901-9041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Breast implant illness (BII) is a loosely defined term for a collection of non-specific systemic symptoms that are hypothesised to be associated with breast implants. BII symptoms include fatigue, hair loss, rashes, chronic pain, and others. However, conclusive evidence for a causal relationship between silicone implants and BII remains lacking. In the light of recent findings that textured implants can, in rare cases, lead to breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a potential link between breast implants and BII is conceivable and justifies further investigation. We observe a growing number of patients seeking consultation and treatment for systemic symptoms related to breast implants, which is reflected in increasing interest in literature and social media. The aim of this work was to investigate the growing interest in BII. We now describe the clinical features of a patient who suffers from symptoms that are consistent with BII and contextualise clinical presentation in a review of literature and google trend analysis.
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Affiliation(s)
- Adina Weitkunat
- Klinik für Hand-, Plastische und Wiederherstellungschirurgie, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | - Stefan Targosinski
- Klinik für Hand-, Plastische und Wiederherstellungschirurgie, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | - Benedikt Bauer
- Klinik für Hand-, Plastische und Wiederherstellungschirurgie, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | - Jörg G Grünert
- Klinik für Hand-, Plastische und Wiederherstellungschirurgie, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | - Stefan Winsauer
- Klinik für Hand-, Plastische und Wiederherstellungschirurgie, Kantonsspital St Gallen, Sankt Gallen, Switzerland
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7
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Berben JA, Miseré RML, Schop SJ, van der Hulst RRWJ. The Influence of Personality on Health Complaints and Quality of Life in Women With Breast Implants. Aesthet Surg J 2022; 43:245-252. [PMID: 36073675 PMCID: PMC9896140 DOI: 10.1093/asj/sjac247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A causal relation between systemic symptoms and breast implants has not been established. Psychological factors, such as personality and psychological distress, are strongly associated with the development of medically unexplained symptoms. It can be hypothesized that psychological factors may be related to the development of breast implant illness (BII). OBJECTIVES This study was conducted to evaluate the correlation between self-reported health complaints, health- and breast-related quality of life (QoL), and personality, in women with cosmetic breast implants. METHODS Women who attended the plastic surgery outpatient clinic of Maastricht University Medical Center between October 2020 and October 2021 for reasons related to their implants and women recruited for a BII study at the Center during this period were invited to participate in this study. Only women who underwent cosmetic breast augmentation were eligible. Participants completed a physical complaints score form and the BREAST-Q, SF-36, and EPQ-RSS questionnaires via an online survey. RESULTS In total, 201 women completed the questionnaires. Extroversion and social desirability were predominant personality traits in women with breast implants, followed by neuroticism. Relatively high levels of neuroticism were found compared with normative data. Neuroticism correlated significantly with health status and breast-related QoL. Physical and mental health-related QoL had the strongest correlations with neuroticism (β = -3.94, β = -4.86, P < 0.001). CONCLUSIONS Personality can play a role in the development of complaints. High levels of neuroticism are seen in cosmetic surgery patients and are negatively correlated with subjective health and patient-reported outcomes in women with breast implants. Therefore, neuroticism may be a factor in the development of BII. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Juliënne A Berben
- Corresponding Author: Juliënne A. Berben, Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, the Netherlands. E-mail:
| | - Renée M L Miseré
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Sander J Schop
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - René R W J van der Hulst
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
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8
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Autoimmune/autoinflammatory syndrome induced by adjuvants: a focus on silicone. Clin Rheumatol 2022; 41:3275-3283. [PMID: 35798923 DOI: 10.1007/s10067-022-06274-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/30/2022] [Accepted: 06/29/2022] [Indexed: 11/03/2022]
Abstract
Autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA) was first described in 2011 to cover disorders characterized by dysregulation of the immune system after exposure to an adjuvant. In the present review, the authors focus on silicone-induced ASIA. In the last two decades, there has been worldwide increase in the use of silicone breast implant (SBI) as an aesthetic procedure, raising concerns for possible effects on the immune system, especially in people who already have previous immune dysregulation. The authors did a critical review of the most important articles referring to silicone-induced ASIA, including most recent studies regarding physiopathologic mechanism. Despite large-scale epidemiological studies conducted to assess the association between SBI and autoimmune/rheumatic disorders, the results remain inconclusive, and the debate over the safety of SBIs remains heated. The explantation of silicone breast has been indicated for silicone-induced ASIA with improvement of unspecific symptoms in the majority of patients; however, the outcome seems different in patients with definitive autoimmune rheumatic disease (AIRD). There is no prospective study evaluating the risk of flares after SBI in patients who already have an AIRD. Therefore, based on the literature, we cannot contraindicate the procedure; however, we need to advertise about the risk of ASIA to the patients with AIRD. Long-term safety and implant-related outcomes should be discussed with these patients, considering each case individually, assessing genetic and environmental factors, and determining if the autoimmune disease is in remission or not, for shared decision among patient and the physician.
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9
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Spoor J, de Jong D, de Boer M, Rakhorst H, van der Hulst RRJW, Vrancken Peeters MJTFD, Bleiker EMA, Mureau MAM, van Leeuwen FE. Bradford Hill and breast implant illness: no evidence for causal association with breast implants. Expert Rev Clin Immunol 2022; 18:773-775. [PMID: 35702986 DOI: 10.1080/1744666x.2022.2090339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jonathan Spoor
- Department of Epidemiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Daphne de Jong
- Department of Pathology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Mintsje de Boer
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hinne Rakhorst
- Department of Plastic and Reconstructive Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Rene R J W van der Hulst
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Eveline M A Bleiker
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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10
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Suh LJ, Khan I, Kelley-Patteson C, Mohan G, Hassanein AH, Sinha M. Breast Implant-Associated Immunological Disorders. J Immunol Res 2022; 2022:8536149. [PMID: 35571560 PMCID: PMC9095406 DOI: 10.1155/2022/8536149] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/05/2022] [Accepted: 04/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Breast implants are commonly placed postbreast cancer reconstruction, cosmetic augmentation, and gender-affirming surgery. Breast implant illness (BII) is a systemic complication associated with breast implants. Patients with BII may experience autoimmune symptoms including fatigue, difficulty concentrating, hair loss, weight change, and depression. BII is poorly understood, and the etiology is unknown. The purpose of this literature review is to characterize BII autoimmune disorders and determine possible causes for its etiology. Methods The PubMed, Google Scholar, Embase, Web of Science, and OVID databases were interrogated from 2010 to 2020 using a query strategy including search term combinations of "implants," "breast implant illness," "autoimmune," and "systemic illness." Results BII includes a spectrum of autoimmune symptoms such as fatigue, myalgias/arthralgias, dry eyes/mouth, and rash. A review of epidemiological studies in the past ten years exhibited evidence affirming an association between breast implants and autoimmune diseases. The most commonly recognized were Sjogren's syndrome, rheumatoid arthritis, systemic sclerosis, chronic fatigue syndrome, and Raynaud's syndrome. Explantation resulted in alleviation of symptoms in over 50% of patients, strengthening the hypothesis linking breast implants to BII. Studies have shown that silicone is a biologically inert material and unlikely to be the cause of these symptoms. This is supported by the fact that increased risk of autoimmune disease was also reported in patients with other implantable biomaterials such as orthopedic implants. Recent studies shed light on a possible role of bacterial biofilm and subsequent host-pathogen interactions as a confounding factor to this problem. Conclusion BII could be dependent on biofilm infection and the microenvironment around the implants. The true pathophysiology behind these complaints must be further investigated so that alternative treatment regimens other than explantation can be developed. Translational significance of these studies is not limited to breast implants but extends to other implants as well.
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Affiliation(s)
- Lily J. Suh
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Imran Khan
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | - Ganesh Mohan
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Aladdin H. Hassanein
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Mithun Sinha
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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11
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Habib PM, Serena T, Derosa A. Breast Implant Illness: A Case Series. Cureus 2022; 14:e23680. [PMID: 35510012 PMCID: PMC9060741 DOI: 10.7759/cureus.23680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/27/2022] [Indexed: 11/05/2022] Open
Abstract
Since the advent of breast implants, there has been unprecedented controversy and FDA bands regarding their safety. There has been a demonstrated link with certain types of lymphoma, autoimmune disorders, and systemic illness associated with breast implants. A significant population of women currently pursue bilateral breast implant removal in hopes to alleviate a constellation of symptoms anecdotally known as “breast implant illness”. This is not yet an accepted clinical entity due to the lack of sound literature on the subject. Common presenting symptoms include fatigue, anxiety, chronic pain, endocrine, autonomic, and peripheral nervous system dysfunction. Currently, there is no standard of care or guideline for treating women experiencing such symptoms. The current literature regarding breast implant illness has been widely observational and descriptive. With over four million women across the globe with augmented breasts, the potential impact of this research is great. This paper presents three patients believed to be suffering from breast implant illness, who after en-bloc resection, experienced resolution of their symptoms.
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12
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Yang S, Klietz ML, Harren AK, Wei Q, Hirsch T, Aitzetmüller MM. Understanding Breast Implant Illness: Etiology is the Key. Aesthet Surg J 2022; 42:370-377. [PMID: 33871569 DOI: 10.1093/asj/sjab197] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Because breast augmentation is one of the most popular cosmetic procedures, the issue of implant-related complications has been widely debated ever since the FDA approved the use of implants in 1962. Although decades have passed, breast implant illness (BII) still represents a poorly defined and controversial complication. With ongoing nonscientific discussion in the mainstream media and on social media, revealing the etiology of BII is urgent because knowledge of this subject ultimately influences patients' decisions. Little or no scientific research is currently available on BII and no final conclusions regarding its etiology, clinical manifestations, diagnostic criteria, or treatment have been made. This review aims to give an overview of the hypotheses on the etiology of BII and seeks inspiration to improve the conditions of BII patients.
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Affiliation(s)
- Siling Yang
- Department of Plastic and Aesthetic Surgery, First Affiliated Hospital of Guangxi Medical University, GuangXi, China
| | - Marie-Luise Klietz
- Department for Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Horneide, Münster, Germany
| | - Anna Katharina Harren
- Department for Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Horneide, Münster, Germany
| | - Qiang Wei
- Department of Plastic and Aesthetic Surgery, First Affiliated Hospital of Guangxi Medical University, GuangXi, China
| | - Tobias Hirsch
- Department for Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Horneide, Münster, Germany
| | - Matthias M Aitzetmüller
- Department for Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Horneide, Münster, Germany
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13
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Magnusson MR, McGuire P. Commentary on: Understanding Breast Implant Illness: Etiology is the Key. Aesthet Surg J 2022; 42:378-380. [PMID: 33864368 DOI: 10.1093/asj/sjab191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Mark R Magnusson
- Dr Magnusson is an associate professor, School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Patricia McGuire
- Dr McGuire is a clinical instructor of surgery, Washington University, St. Louis, MO, USA
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14
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McGuire P, Clauw DJ, Hammer J, Haws M, Adams WP. A Practical Guide to Managing Patients With Systemic Symptoms and Breast Implants. Aesthet Surg J 2022; 42:397-407. [PMID: 34687293 PMCID: PMC8922689 DOI: 10.1093/asj/sjab375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Numerous studies have explored the possibility of an association between breast implants and systemic symptoms potentially linked to exposure to silicone. Some studies show no direct association whereas others provide insufficient scientific evidence to prove or disprove an association. Nonetheless, some patients with breast implants remain concerned about the possible role of their implants in systemic symptoms they may be experiencing. This paper provides a practical approach for plastic surgeons in managing patients with breast implants who present with systemic symptoms, including recommendations for patient counseling, clinical and laboratory assessment of symptoms, and/or referral. Integral components of patient counseling include listening attentively, providing unbiased information, and discussing the risks and benefits of options for evaluation and treatment. A thorough history and assessment of symptoms, including appropriate laboratory tests, may identify underlying conditions to expeditiously address patients’ health issues through a specialist referral. Diagnosing and treating disorders that are causing a patient’s symptoms, if unrelated to their implant, would avoid a potentially unnecessary surgery. Ultimately, better information is needed to reliably guide patients in an evidence-based fashion. Long-term follow-up of patients who are explanted to see what symptoms may or may not improve could be useful in educating patients. Control groups in studies prospectively following women with implants for development of systemic symptoms would also be useful because the symptoms reported are common in women without implants. Cases are presented to illustrate the recommendations for a practical approach toward management of women reporting systemic symptoms with breast implants.
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Affiliation(s)
| | - Daniel J Clauw
- Department of Anesthesiology, Medicine (Rheumatology), and Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | | | - William P Adams
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
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15
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Atiyeh B, Emsieh S. Breast Implant Illness (BII): Real Syndrome or a Social Media Phenomenon? A Narrative Review of the Literature. Aesthetic Plast Surg 2022; 46:43-57. [PMID: 34231017 DOI: 10.1007/s00266-021-02428-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/13/2021] [Indexed: 12/16/2022]
Abstract
Breast implant illness (BII) is a condition characterized by elusive diagnostic criteria and self-reported diverse disabling and distressing physical and psychological symptoms. With currently significant increase in public awareness, BII is perhaps becoming the most controversial subject in aesthetic and reconstructive breast surgery, generating heated debates between those who do not believe such a condition exists and those who demand its acceptance as a recognized diagnosis. Silicone incompatibility has been associated with "autoimmune/inflammatory syndrome induced by adjuvants" (ASIA syndrome) or Shoenfeld's syndrome. It is still unclear, however, whether BII symptoms would have occurred if no implants had been placed in the first place. The purpose of this literature review is to analyze critically the current state of scientific evidence related to this condition. Though the psychosomatic theory is most likely, the mechanism of BII symptoms is probably multifactorial. At present, BII being an underlying connective tissue disorder cannot be confirmed; moreover, whether improved aesthetic outcome and patient's overall satisfaction with the profile of their reconstructed or augmented breasts translate into decreased self-reported BII symptoms is still not well elucidated. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Bishara Atiyeh
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Saif Emsieh
- American University of Beirut Medical Center, Beirut, Lebanon.
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16
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Assessing Long-Term Outcomes in Breast Implant Illness: The Missing Link? A Systematic Review. Plast Reconstr Surg 2022; 149:638e-645e. [PMID: 35103633 DOI: 10.1097/prs.0000000000009067] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY The purpose of this special topic article is to explore the current state of outcomes-based literature related to breast implant illness and summarize the key understandings that emerge from the summation of existing studies. While implanted silicone devices are some of the most ubiquitous products in modern medicine, the safety of silicone breast implants has long remained under scientific scrutiny. In the era of social media and with breast implants once again under public scrutiny with the recent connection of texture silicone implants to breast implant-associated anaplastic large-cell lymphoma, the borders between breast implant illness and other implant-related diseases are becoming clouded in the public eye. The surgical management options for breast implant illness range from simple implant explantation alone to complete en bloc capsulectomies, or even secondary exploratory operations for additional capsulectomy in persistently symptomatic patients. In this review of outcomes-based studies related to breast implant illness, the authors found that a subset of patients improves with surgical intervention but limited evidence to inform most current surgical management practices. Further, the nature of this illness renders it difficult to study. A carefully designed, large, prospective, outcomes-based study is still required if an evidence-based and sound treatment approach for this condition is to be established.
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Effects of Silicone Breast Implants on Human Cell Types In Vitro: A Closer Look on Host and Implant. Aesthetic Plast Surg 2022; 46:2208-2217. [PMID: 35075507 DOI: 10.1007/s00266-021-02762-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/29/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Silicone (gel) breast implants (SBI) are used world-wide for breast augmentation, and reconstruction or to correct breast deformities. They consist of two compounds: an elastomer silicone shell (envelope) and a silicone gel filler (core). Breast Implant Illness (BII) is a term used for women with SBI, who suffer from various of symptoms including myalgia, arthralgia, fatigue, fever, dry eyes and/or dry mouth (sicca), as well as cognitive disturbances, which are rated by these woman as response to SBI. The pathogenesis of these adverse effects as well as the histocompatibility and the SBI-cell interaction of silicone and its surrounding tissue (implant-host tissue interface) is a subject of current research. The main purpose of this review is to provide an overview of the current knowledge regarding the effects of silicone (gel and elastomer surfaces) of a SBI on different human cell types from experimental - in vitro - models. METHODS A comprehensive research was conducted by two independent reviewers in March and July of 2020 in the PubMed, MEDLINE, and Cochrane databases. RESULTS A number of 1328 articles on this topic were initially identified, of which 62 could be finally included an analysed in this review. CONCLUSION SBI may lead to a physiologic pro-inflammatory and foreign body host response with fibrous encapsulation accompanied by a disturbed Th17/Treg balance and IL-17 production. No causal relationship is known for systemic symptoms and/or autoimmune outcomes in the context of BII. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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18
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Miseré RML, van der Hulst RRWJ. Self-Reported Health Complaints in Women Undergoing Explantation of Breast Implants. Aesthet Surg J 2022; 42:171-180. [PMID: 33252630 PMCID: PMC8756082 DOI: 10.1093/asj/sjaa337] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Concerns about the safety of silicone breast implants (SBIs) have existed for years, but a causal relation between systemic complaints and SBIs has not been proven. Nevertheless, some women are worried and even request explantation. Objectives This study aimed to review the explantation procedures performed, focusing on patient-reported symptoms preoperatively, the effect of explantation, and the effect of breast reconstruction on these symptoms. Methods A retrospective chart review was performed for patients who had undergone explantation between 2010 and 2020 at Maastricht University Medical Center. Patients who had undergone tissue expander removal, tissue expander–implant exchange, or direct implant exchange were excluded. Results More than half of the patients undergoing explantation reported complaints, mostly pain. Some 15% reported systemic complaints they believed were implant related. Breast implant illness (BII) was found to be the fifth most common indication for explantation (11.2%). A history of either allergies or implant rupture resulted in higher odds ratios of having BII (odd ratios, 2.1 and 2.1, respectively). Subjective improvement of BII after explantation was reported by about 60% of patients. Conclusions A relatively low prevalence of suggested BII exists among women undergoing explantation; 1 in 9 procedures were performed for this reason. Allergy and implant rupture may increase the likelihood of having BII. About 60% of BII patients experienced an improvement in their complaints after implant removal. Autologous breast reconstruction appears a good alternative. Prospective studies into health complaints and quality of life should be performed to confirm the effectiveness of explantation as a therapy for BII. Level of Evidence: 4
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Affiliation(s)
- Renée M L Miseré
- From the Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - René R W J van der Hulst
- From the Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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19
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Mortada H, Ibrahim N, Almousa H, Aldihan R, Arab K. Perceptions and attitudes toward unusual complications following breast implant surgeries among Saudi female patients: How knowledgeable are our patients? J Family Med Prim Care 2022; 11:1327-1334. [PMID: 35516704 PMCID: PMC9067191 DOI: 10.4103/jfmpc.jfmpc_1385_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/08/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background: The number of breast implant-related procedures has rapidly increased. Given the current increase in social media coverage and its influence on the decision to undergo breast implant surgeries, it is critical to identify patients’ misinformation about unusual complications related to breast implants. Therefore, the present study aimed to assess the perceptions and attitudes toward unusual complications related to breast implants among patients who underwent breast implant surgeries. Methods: In the present cross-sectional study, a questionnaire was distributed between April 2021 and May 2021 among patients who had undergone breast implant surgeries between 2016 and 2021 at King Saud University Medical City in Riyadh, Saudi Arabia. The 26-item questionnaire was distributed online to assess the participants’ perceptions about breast implant illness (BII), capsular contracture, and breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). Data were analyzed using Statistical Package for the Social Sciences (SPSS), version 23.0. Results: In total, 106 patients who underwent breast implant surgeries were included in the present study (response rate: 73.6%). Their mean age was 43.68 ± 10.69 years. The reason for undergoing breast implant surgery was cosmetic in 41.5% of the participants and reconstructive in 58.5%. Moreover, 22.6%, 23.6%, and 24.5% of the participants had knowledge about BIA-ALCL, BII, and capsular contracture, respectively. Conclusions: The present findings indicate that it is important for plastic surgeons to discuss unusual complications related to breast implants with patients on a regular basis. Despite the obscurity of these complications, such discussions are important to provide best available information to patients.
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20
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McKernan CD, Vorstenbosch J, Chu JJ, Nelson JA. Breast Implant Safety: an Overview of Current Regulations and Screening Guidelines. J Gen Intern Med 2022; 37:212-216. [PMID: 34027608 PMCID: PMC8738800 DOI: 10.1007/s11606-021-06899-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/03/2021] [Indexed: 01/03/2023]
Abstract
Breast implant surgery for cosmetic or reconstructive purposes is becoming increasingly common. While the devices used are regulated and approved by the US Food and Drug Administration, all patients with breast implants require continued follow-up. Many patients will seek this care from their primary care providers, especially when follow-up with their plastic surgeon is difficult. It is vital that treating clinicians are knowledgeable about the history of breast implants, routine screening guidelines, and the recent breast implant "hot topics"-breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), connective tissue disease, and breast implant illness. This paper will provide the necessary information for primary care providers to appropriately counsel patients with breast implants to maintain not only their trust, but also their health.
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Affiliation(s)
- Cayla D McKernan
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joshua Vorstenbosch
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jacqueline J Chu
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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21
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Newby JM, Tang S, Faasse K, Sharrock MJ, Adams WP. Commentary on: Understanding Breast Implant Illness. Aesthet Surg J 2021; 41:1367-1379. [PMID: 33247711 DOI: 10.1093/asj/sjaa329] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Breast implant surgery is the most common plastic surgery procedure performed globally. A subset of women with breast implants report experiencing a myriad of disabling and distressing physical and psychological symptoms attributed to their implants. Social media groups have coined the condition "breast implant illness" (BII). Little to no scientific research currently exists for BII. OBJECTIVES The aim of this study was to investigate the experiences of women with BII (both those with implants still in place and those who have explanted) and compare them with those of a control group of women with implants who do not report BII. METHODS Women with self-reported BII and implants still in place (n = 51), self-reported BII who had explanted (n = 60), and women with implants in place without BII (n = 58) completed online self-report questionnaires about their symptoms, physical and mental health, health service use patterns, and lifestyle factors (eg, exercise, smoking, alcohol consumption). RESULTS Women with BII, regardless of whether they had undergone explant surgery, reported experiencing more severe somatic symptoms, higher depression, anxiety and health anxiety, and poorer physical health than women without BII. CONCLUSIONS These findings highlight the need for further investigation into the causes, risk factors, long-term effects, and potential interventions for women who experience BII.
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Affiliation(s)
- Jill M Newby
- MRFF Career Development Fellow, Black Dog Institute, UNSW Sydney, Sydney, Australia
| | - Samantha Tang
- School of Psychology, Faculty of Science, UNSW Sydney, Sydney, Australia
| | - Kate Faasse
- ARC Discovery Early Career Research Fellow, School of Psychology, Faculty of Science, UNSW Sydney, Sydney, Australia
| | - Maria J Sharrock
- Clinical Research Unit for Anxiety & Depression, St Vincent’s Hospital, Sydney, Australia
| | - William P Adams
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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22
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Roy PG, Yan Z, Nigam S, Maheshwari K. Aesthetic breast surgery: putting in context-a narrative review. Gland Surg 2021; 10:2832-2846. [PMID: 34733731 DOI: 10.21037/gs-20-892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 07/12/2021] [Indexed: 01/13/2023]
Abstract
Objective This review article summarises the latest evidence for commonly undertaken procedures in aesthetic breast surgery with a focus on key principles of breast augmentation, reduction, and mastopexy. The paper also outlines various approaches and controversies as well as complications such as breast implant associated anaplastic large cell lymphoma (BIA-ALCL) and breast implant illness (BII) which are increasingly being recognised and becoming a challenge to manage. Background Changing trends of aesthetic breast surgery over the decades has warranted a continuous evolution of this field. The ability to deliver safe and appropriate care is dependent upon sound reconstructive principles and proper training. The lack of uniformity in either is a cause of concern. The impact of social media and changing perception of body image can also no longer be overlooked in the field of aesthetics and reconstruction. Methods Review of literature including recent journals, textbook chapters, online databases like PubMed, and current government and surgical society guidelines. Conclusions Breast reconstruction is based on sound surgical principles and it is imperative to follow these for the practice of this speciality. There are two important issues that revolve around this aspect of surgery. First relates to the urgent need to invest time and effort in improving regulations and outcomes in the cosmetic surgery industry. Second, it is crucial to promote and prioritize the development and training in this field as the principles of aesthetic breast surgery underpins oncoplastic breast surgery for management of cancer.
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Affiliation(s)
- Pankaj G Roy
- Department of Breast Surgery, Oxford University Hospital NHSFT, Oxford, UK
| | - Zhiyan Yan
- Department of Breast Surgery, Oxford University Hospital NHSFT, Oxford, UK
| | - Shashank Nigam
- Department of Breast Surgery, Oxford University Hospital NHSFT, Oxford, UK
| | - Kavish Maheshwari
- Department of Plastic Surgery, Bedfordshire Hospitals NHS Trust, Bedfordshire, UK
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23
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Outcomes of Implant Removal and Capsulectomy for Breast Implant Illness in 248 Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3813. [PMID: 34513545 PMCID: PMC8423394 DOI: 10.1097/gox.0000000000003813] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
Background: Breast implant illness (BII) is a term popularized by social media to describe systemic symptoms that patients ascribe to their breast implants. Though the concept of implants as an underlying cause for a systemic illness remains controversial, few studies have delineated the implant characteristics, capsular histology, and outcomes of patients who undergo explantation for BII. Methods: We retrospectively reviewed the demographics, presenting symptoms, outcomes, capsular histology, and culture results of all women who presented to the senior author with symptoms attributed to BII and underwent breast implant removal with capsulectomy from August 2016 to February 2020. Chi-square and logistic regression analyses were performed to evaluate association between implant type, composition, and findings of inflammation on capsule pathology. Results: Among 248 patients, 111 (23%) capsules demonstrated inflammatory changes on permanent pathology. Capsular inflammation was independently associated with silicone versus saline (right odds ratio [OR] = 2.18 [1.16–4.11], P = 0.016, left OR = 2.35 [1.08–5.12], P = 0.03) and textured versus smooth implants (right OR = 2.18 [1.16–4.11], P = 0.016, left OR = 2.25 [1.17–4.31], P = 0.01). Silicone material was present in the capsules of 12 patients (4.8%). Fourteen patients had positive cultures. There was one pneumothorax (0.4%), three hematomas requiring evacuation (1%), and two DVTs (0.8%). Of 228 patients, 206 (90.4%) reported high satisfaction with the outcome of the procedure. Conclusions: In a large cohort of BII patients, we found that capsular inflammation is significantly associated with silicone and textured implants. Implant removal with capsulectomy can be safely performed in patients with BII with a low complication rate and high patient satisfaction.
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Miseré RML, Colaris MJL, Tervaert JWC, van der Hulst RRWJ. The Prevalence of Self-Reported Health Complaints and Health-Related Quality of Life in Women With Breast Implants. Aesthet Surg J 2021; 41:661-668. [PMID: 32674141 PMCID: PMC8129459 DOI: 10.1093/asj/sjaa207] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Some of the millions of women with silicone breast implants (SBIs) report a pattern of systemic complaints, known as ASIA syndrome. However, the association between these complaints and breast implants remains uncertain. Objectives This study aimed to evaluate the prevalence of complaints in women with breast implants and healthy controls, and to compare their health-related quality of life. Methods Four groups of subjects were requested to fill in a general and a diagnostic questionnaire, and the Short Form 36. Group 1 was recruited from the Dutch foundation for breast implant illness (BII). Two groups were recruited from Dutch hospitals, where they had been augmented or reconstructed with SBIs (group 2) or saline-filled and hydrogel implants (group 3). A control group without breast implants was recruited from friends of subjects from group 2. Results In total, 238 women completed the questionnaires. ASIA manifestations appeared in the majority of the respondents (72.3%-98.8%), with a latency period of 0 to 35 years. Adjusted for age, smoking, and comorbidities, typical symptoms only occurred significantly more frequently in group 1. The presence of a chronic disease was an independent predictor for ASIA syndrome. The health-related quality of life was lower in women with SBIs than in women without breast implants. Conclusions The adjusted prevalence of BII manifestations is not significantly higher in women with SBIs than in women without implants. The findings of this study suggest that results on BII are subject to selection bias. Further studies are needed to prove an association between self-reported complaints and SBIs. Level of Evidence: 2
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Affiliation(s)
- Renée M L Miseré
- NUTRIM School for Nutrition and Translational Research in Metabolism and Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Maartje J L Colaris
- Department of Plastic Surgery, Hand and Burn Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | | | - René R W J van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
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25
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Association of Breast Implants with Nonspecific Symptoms, Connective Tissue Diseases, and Allergic Reactions: A Retrospective Cohort Analysis. Plast Reconstr Surg 2021; 147:42e-49e. [PMID: 33002981 DOI: 10.1097/prs.0000000000007428] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Given the rising media attention regarding various adverse conditions attributed to breast implants, the authors examined the association between breast implantation and the risk of being diagnosed with connective tissue diseases, allergic reactions, and nonspecific constitutional complaints in a cohort study with longitudinal follow-up. METHODS Women enrolled in a regional military health care system between 2003 and 2012 were evaluated in this retrospective cohort study. A propensity score was generated to match women who underwent breast implantation with women who did not undergo breast implantation. The propensity score included age, social history, health care use, comorbidities, and medication use. Outcomes assessed included International Classification of Diseases, Ninth Revision, diagnoses codes for (1) nonspecific constitutional symptoms, (2) nonspecific cardiac conditions, (3) rheumatoid arthritis and systemic lupus erythematosus, (4) other connective tissue diseases, and (5) allergic reactions. RESULTS Of 22,063 women included in the study (513 breast implants and 21,550 controls), we propensity score-matched 452 breast implant recipients with 452 nonrecipients. Odds ratios and 95 percent confidence intervals in breast implant recipients compared to nonrecipients were similar, including nonspecific constitutional symptoms (OR, 0.77; 95 percent CI, 0.53 to 1.13), nonspecific cardiac conditions (OR, 0.97; 95 percent CI, 0.69 to 1.37), rheumatoid arthritis and systemic lupus erythematosus (OR, 0.66; 95 percent CI, 0.33 to 1.31), other connective tissue diseases (OR, 1.02; 95 percent CI, 0.78 to 1.32), and allergic reactions (OR, 1.18; 95 percent CI, 0.84 to 1.66). CONCLUSIONS Women with breast implants did not have an increased likelihood of being diagnosed with nonspecific constitutional symptoms, connective tissue disorders, and/or allergic reaction conditions. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Keane G, Chi D, Ha AY, Myckatyn TM. En Bloc Capsulectomy for Breast Implant Illness: A Social Media Phenomenon? Aesthet Surg J 2021; 41:448-459. [PMID: 32940709 DOI: 10.1093/asj/sjaa203] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND En bloc capsulectomy has recently increased in prominence as a potential surgical therapy for patients with breast implant illness (BII). However, this procedure has chiefly been recommended for treating breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). OBJECTIVES This study aimed to review the current literature and evaluate the public understanding of treatment options for BII via social media to characterize any potential communication disconnect between clinicians and patients. METHODS An electronic literature review was performed to identify all available publications mentioning evidence-based support for en bloc capsulectomy as treatment for BII and BIA-ALCL. Twitter social media posts referencing BII or BIA-ALCL were analyzed from 2010 to 2019. Author identity and any mention of surgical treatment were assessed. RESULTS A total of 115 publications on the subject of BII and 315 articles on BIA-ALCL were identified. En bloc resection was recommended only for patients with a diagnosis of BIA-ALCL. A total of 6419 tweets referencing BII and 6431 tweets referencing BIA-ALCL were identified. Tweets referencing BIA-ALCL were significantly more likely to be authored by physicians (25.9% vs 5.3%, P < 0.001), and tweets referencing BII were significantly more likely to mention any surgical treatment (7.8% vs 1.9%, P < 0.001) and en bloc capsulectomy (1.4% vs 0.3%, P < 0.001). CONCLUSIONS This study demonstrates that a communication disconnect exists between the scientific literature and social media regarding treatment options for BII and BIA-ALCL. Physicians should be aware of these potential misconceptions to empathetically address patient concerns in a patient-centered manner.
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Affiliation(s)
- Grace Keane
- From the Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO
| | - David Chi
- From the Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Austin Y Ha
- From the Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Terence M Myckatyn
- From the Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO
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27
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Perception of Implants among Breast Reconstruction Patients in Montreal. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3116. [PMID: 33133965 PMCID: PMC7544175 DOI: 10.1097/gox.0000000000003116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/20/2020] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Background: In light of the recent surge of media coverage and social media influence regarding breast implants, it is essential to understand patients’ concerns and misconceptions so that we can better serve them. Methods: The authors designed a survey study for assessing the awareness and perception of patients toward breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) and breast implant illness (BII). In total, 130 patients presenting to the senior author’s breast reconstruction clinic completed the survey. The survey assessed patients’ knowledge on and their perception of BIA-ALCL and BII. Results: “News article” and “Television” were most often selected as sources of information for BIA-ALCL (21% and 20%, respectively) and BII (20% and 25%, respectively). A total of 100 patients (77%) had previous knowledge of BIA-ALCL. Forty-seven percent (n = 47/100) responded that they were unsure of the fate of a person diagnosed with BIA-ALCL, and 25% (n = 25/100) were unaware of the association between BIA-ALCL and specific implant type. Patients who were unaware of BIA-ALCL prognosis reported being less likely to receive breast implants in the future (P = 0.012, χ2 = 19.48). Eighty-nine patients (68%) had previous knowledge of BII. A total of 60 symptoms were mentioned by patients, with “Fatigue” (12%, n = 26) being cited the most often. Conclusions: The present survey highlights the importance for plastic surgeons to frequently discuss these entities with their patients. This should be done despite the obscurity of BII, in an effort to offer the best available evidence to our patients.
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Patel A, Blackmore K, Carruthers R. The Integrated Treatment for Chronic Pain and Anxiety in a Patient with Breast Implant Illness Symptoms: A Case Report. Integr Med (Encinitas) 2020; 19:28-33. [PMID: 33132782 PMCID: PMC7572138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Women with breast implants may experience breast implant illness (BII). BII is comprised of a collection of systemic symptoms, such as fatigue and pain, that are postulated to be related to having breast implants. CASE PRESENTATION This case report documents the naturopathic treatment of a 35-year-old female patient diagnosed with fibromyalgia, tension headaches, and chronic anxiety, perceived to be linked to and exacerbated by her textured cohesive gel implants. The patient sought naturopathic treatment for support during the explant process of her breast implants.Naturopathic treatment was provided over a 3-month period in conjunction with prescribed medication for her anxiety and tension headaches. CONCLUSION At 3 months post-naturopathic treatment, the patient experienced a reduction in anxiety, fatigue, and self-reported pain. The integration of alternative therapies with prescribed pharmaceutical treatment appeared to positively impact the health of this patient.
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Affiliation(s)
- Asmita Patel
- South Pacific College of Natural Medicine, Auckland New Zealand; School of Clinical Sciences, Faculty Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Breast Implant Illness: A Biofilm Hypothesis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2755. [PMID: 32440423 PMCID: PMC7209857 DOI: 10.1097/gox.0000000000002755] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/11/2020] [Indexed: 12/28/2022]
Abstract
Background "Breast implant illness" (BII) is a poorly defined cluster of nonspecific symptoms, attributed by patients as being caused by their breast implants. These symptoms can include joint pain, skin and hair changes, concentration, and fatigue. Many patients complaining of BII symptoms are dismissed as psychosomatic. There are currently over 10,000 peer-reviewed articles on breast implants, but at the time of commencing this study, only 2 articles discussed this entity. At the same time, mainstream media and social media are exploding with nonscientific discussion about BII. Methods We have prospectively followed 50 consecutive patients, self-referring for explantation due to BII. We analyzed their preoperative symptoms and followed up each patient with a Patient-Reported Outcome Questionnaire. All implants and capsules were, if possible, removed en bloc. Explanted implants were photographed. Implant shell and capsule sent for histology and microbiological culture. Results BII symptoms were not shown to correlate with any particular implant type, surface, or fill. There was no significant finding as to duration of implant or location of original surgery. Chronic infection was found in 36% of cases with Propionibacterium acnes the most common finding. Histologically, synoviocyte metaplasia was found in a significantly greater incidence than a matched cohort that had no BII symptoms (P = 0.0164). Eighty-four percent of patients reported partial or complete resolution of BII symptoms on Patient-Reported Outcome Questionnaire. None of the 50 patients would consider having breast implants again. Conclusion The authors believe BII to be a genuine entity worthy of further study. We have identified microbiological and histological abnormalities in a significant number of patients identifying as having BII. A large proportion of these patients have reported resolution or improvement of their symptoms in patient-reported outcomes. Improved microbiology culture techniques may identify a larger proportion of chronic infection, and further investigation of immune phenotypes and toxicology may also be warranted in this group.
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Bar-Meir E, Eherenfeld M, Shoenfeld Y. ReviewSilicone Gel Breast Implants and Connective Tissue Disease—A Comprehensive Review. Autoimmunity 2009; 36:193-7. [PMID: 14563011 DOI: 10.1080/08916931000148818] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Silicone breast implants have been in use for breast reconstruction and breast augmentation for a long time. In the late 80's anecdotal reports describing a possible association between silicone-gel filled breast implants, and autoimmune diseases was accumulating. Due to the growing concern about the safety of silicone-gel implants, the Food and Drug administration (FDA) restricted their use to participants in controlled clinical trials, including women having reconstructive surgery. However, in recent years, large meta-analyses were unable to establish an association between silicone-gel breast implants and autoimmune disease. We review the current literature, emphasizing the most important epidemiologic studies.
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Affiliation(s)
- Eran Bar-Meir
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel-Hashomer, Israel
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Williams DF. On the mechanisms of biocompatibility. Biomaterials 2008; 29:2941-53. [DOI: 10.1016/j.biomaterials.2008.04.023] [Citation(s) in RCA: 1750] [Impact Index Per Article: 109.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 04/11/2008] [Indexed: 01/02/2023]
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Abstract
Perceived poisoning may manifest in numerous ways; however, all cases share certain characteristics. All are fostered by the wide availability of unreliable information about chemical safety, poor understanding of scientific principles, and ineffective risk communication. Although this problem is still incompletely understood, some approaches have been demonstrated to be useful, such as education about risk, appropriate reassurance, and empathy on the part of the practitioner. Successful management may curtail the spread or exacerbation of symptoms, whereas unsuccessful treatment may cause the problems to escalate, with detrimental effects on both society and patient.
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Affiliation(s)
- Kristine A Nañagas
- Division of Medical Toxicology, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46206-1367, USA.
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