Elizabeth J Hall-Findlay, MD, FRCSC
January 12, 2018.
It can be very difficult to interpret all the information that we get bombarded with each day. This is even more difficult when it comes to health or science information. Even I have trouble trying to find the flaws in “junk science” articles – they can make them sound so legitimate. Just read Gwyneth Paltrow’s latest product that she is selling on her GOOP website: coffee enemas. We actually know that they can be dangerous but the claims are almost believable because the words that they use (and make up) sound like real science.
The latest is “breast implant illness”. It makes total sense that patients want to try to find a cause for their illness. That is what we, as physicians, try to do as well. How could you not blame something like breast implants if you develop an autoimmune disease after having had silicone placed in your body?
It is just that the science does not support it. You can easily find numerous articles on either side of the debate – and they all sound legitimate. But the real scientists (and I do not pretend to be one) looked at all the studies and the Institute of Medicine (the most respected of organizations) said that there was no evidence of any link between silicone and autoimmune diseases https://www.ncbi.nlm.nih.gov/books/NBK44778/ .
Although many women will develop a variety of diseases over their lifetime, the studies show that with age-matched controls, the same number of women without implants develop the same diseases as the women with implants.
Breast implants are actually the most studied medical device on the market. Sure – the earlier implants did fall apart easily and even the current implants, which are far better made, can develop a split in the envelope and the gel can “leak” out. Older implants had silicone oils and they could develop “gel bleed” which led to a higher rate of capsular contracture – but not autoimmune diseases. Current implants are not perfect, and of course, even the saline implants have a silicone elastomer envelope.
That said, you may have heard about a lymphoma associated with breast implants. This is a relatively new disease and it has not been described in any patient where only a smooth implant was used. It appears to be associated with aggressively textured implants (which are relatively new) and many of us (plastic surgeons) do not use these implants. It appears (now that they understand it) to be completely curable. It is still rare, occurring in about 1/30,000 patients with implants. Don’t forget that breast cancer occurs in 1/7-10 women – with or without implants. Although rare, I personally do not feel that advantages of texturing are worth the added risk – even if it is very slight.
So what do you do if you start developing fatigue or other symptoms such as pain in your joints or hair loss? It can be very difficult to find a cause for these symptoms even in patients without implants. Of course we all want to find a solution and it makes sense to question whether they are related to implants.
When implants are removed, some patients will get better. Of course capsular contracture (tightening of the capsule around the implant) can cause some pain – and that can be relieved with either release or removal of the capsule. But that doesn’t mean that illnesses are caused by implants. Capsules are made of your cells and they form around any foreign body – including artificial hips and pacemakers.
Some patients get better because of the “placebo” effect. It is well understood that patients can get better if they think that the treatment will be effective. We cannot ignore this effect, but patients need to be aware that it does not “prove” that whatever it was that was changed is actually the cause of the problem. There is a huge difference between “association” and “cause”.
So, what do you do if you still want the implants removed to see if you get better? Remember that the science that is available today is clear that there is no association between silicone and disease. Anyone who has ever had an injection has liquid silicone in their body. Anyone who has taken Ovol drops as a baby or other gastric preparations to reduce gas as an adult – those are made of silicone (simethicone). It is everywhere and it is very inert. You cannot remove all the silicone from your body.
If you are going to get your implants removed, do you need to have all or part of the capsule removed as well? Remember that the capsule is made up of your own cells and it has nothing to do with silicone. Sometimes there will be some silicone in the capsule if your implant has leaked or if you have one of the older (1980s) implants that did have some “gel bleed”.
The capsule is often completely removed if it has hardened. Capsules will often disappear by themselves when the implants are removed. If they remain, they do not cause a problem. As surgeons, we need to make the best decision for you – and complete capsule removal can cause problems. Removal leaves a large “raw” surface area that is like a huge “road rash”. It oozes and bleeds and can take time to heal. Removal of any capsule that extends up into your armpit is dangerous territory – there are nerves and blood vessels that can be inadvertently disturbed during capsule removal. The “risk/benefit” ratio may not be worth it – especially because we do not believe that there is any medical indication to remove a capsule due to “breast implant illness”.
There are numerous websites out there where people believe strongly that breast implant illness is a true disease. There are also people who will prey on your fears and take advantage of you. There are people out there who claim to be “experts in breast implant illness and treatment”. Be careful – they may just be interested in making money from you. You could accuse me of the same – I make money from performing breast augmentations. But anyone who knows me is aware that I always try to do ”the right thing for the patient at the right time for the right reason”.
I do not believe that a true “breast implant illness” exists. I have been in practice for over 30 years and I have seen these fads come and go. The science is clear. That, however, does not mean that I am not sympathetic. I understand that many patients are suffering – both physically and emotionally – and I wish I could do more than say “I don’t know”. Just because we do not know the answers doesn’t mean that we are incorrect in our assertion that implants do not cause disease.