Breast implant illness (BII) refers to a wide range of systemic symptoms that can develop after undergoing breast augmentation or reconstruction with breast implants. While the exact cause is unknown, BII is believed to be related to an immune or inflammatory reaction to the implant material. With increasing awareness and recognition of this condition, many women who undergo breast implant procedures are interested in understanding their personal risk of developing complications down the road.
What is breast implant illness?
The term “breast implant illness” is used to describe a collection of systemic symptoms that arise after undergoing breast augmentation or reconstruction with implants. Symptoms are generally nonspecific and can include fatigue, cognitive dysfunction (“brain fog”), headaches, joint and muscle pain, hair loss, dry eyes and mouth, rashes, chronic infections, and hormonal issues. Importantly, these symptoms go beyond normal postoperative healing and persist long-term, often for years after the implant procedure.
While BII is not currently recognized as a definitive medical diagnosis, many plastic surgeons and health practitioners believe it represents a real entity. Estimates vary widely, but some studies have found that 50-80% of women with breast implants will experience adverse symptoms relating to their implants over a 10-year period.
Who is at risk for developing breast implant illness?
Given how common BII appears to be, experts recommend that all women considering breast implants understand they may be at risk of developing chronic symptoms after augmentation. However, some subgroups of women seem to be at higher risk than others.
Women with a history of autoimmune or inflammatory conditions
Having a personal medical history positive for autoimmune diseases (like lupus, rheumatoid arthritis, Hashimoto’s thyroiditis), allergies, asthma, eczema, or other inflammatory conditions appears to increase the risk of developing BII. This is likely due to an increased tendency to mount inflammatory reactions to foreign materials like breast implants in susceptible individuals.
Women who have had their implants for many years
Symptoms of BII frequently arise years after the initial implant procedure – often 5, 10 or even 20 years later. The longer implants have been in place, the more likely women are to develop complications. Experts hypothesize that immune system reactivity tends to increase over time with constant exposure to the foreign material.
Women with saline and silicone gel implants
Both silicone and saline breast implants have been associated with BII symptoms. Silicone gel implants were previously thought to pose greater risks, but newer research indicates that saline implants also provoke systemic reactions in many women.
Women with textured implant surfaces
Textured breast implants, which have a rougher surface designed to prevent rotation, have been linked to higher complication rates than smooth-surfaced implants. The textured shell may aggravate the immune system and make infections like capsular contracture more common.
Women with implants placed under the muscle
Subpectoral (under the muscle) implant placement seems to correlate with increased risk of BII compared to subglandular (over the muscle) placement. This may be due to greater friction and inflammation resulting from movement of the implant under the muscle tissue.
Women with silicone leakage or ruptures
Leakage of silicone gel outside the breast implant capsule and intracapsular ruptures of silicone gel implants are known to provoke localized inflammatory reactions. Women with implant ruptures are therefore at increased risk of systemic complications.
Women with capsular contracture
Capsular contracture, or tight scar tissue contracting around the implant, represents a chronic inflammatory response to the implant. It is linked to higher rates of BII symptoms, likely due to increased inflammation.
Women who have had multiple revision surgeries
Undergoing multiple implant removal and replacement surgeries appears to magnify the risks of BII. Repeated trauma to the breast tissue tends to worsen inflammation and scarring.
Other possible risk factors
A few other factors have been proposed to potentially increase vulnerability to BII, although more research is needed:
- Genetic predisposition – Variations in genes involved in immune function, detoxification, and connective tissue synthesis may play a role.
- Gut dysbiosis and leaky gut – Imbalances in gut microbiome and intestinal permeability could promote inflammation.
- Toxic load – High cumulative levels of toxins like heavy metals, pesticides, and mold could make the body more reactive.
- Trauma during surgery – Surgical trauma itself provokes local and systemic inflammatory cascades in the body.
Evaluating personal risk factors
The reason that breast implants seem to cause systemic illness in some women but not others is likely multifactorial. Leading theories point to genetic and immune variations between individuals that make some more prone to reacting to foreign materials.
When evaluating personal risk, it is helpful to consider:
- Health history – Past issues with allergies, autoimmunity, or chronic inflammation?
- Reason for implants – Is it for cosmetic breast augmentation versus reconstruction after cancer?
- Implant specifics – Saline or silicone, smooth or textured surface, placement above or below the muscle?
- Time since surgery – How many years have implants been in place?
- Problems to date – Any capsular contracture, rupture, or revision surgeries so far?
- Lifestyle factors – Diet quality, stress levels, and toxic exposures?
Keeping these factors in mind, women can have an informed discussion with their plastic surgeon about BII risks before deciding whether to proceed with implantation.
Can breast implant illness be prevented?
There is currently no way to definitively prevent the development of BII, since the underlying causes are not fully understood. However, some strategies may theoretically help reduce risks:
- Choosing saline over silicone gel implants
- Opting for smooth implant surfaces instead of textured
- Placing implants in a subglandular position above the muscle
- Avoiding multiple revision surgeries if possible
- Working proactively to reduce inflammation and autoimmunity through lifestyle approaches
More research is needed to confirm if any of these measures make a significant difference in reducing BII occurrence. But for women set on pursuing breast implants, they are reasonable precautions that may be worthwhile from a preventive standpoint.
Should women with high risk opt for breast implants?
For women with autoimmune conditions, chronic inflammation, or known reactivity to foreign materials, the relatively high chance of developing systemic issues down the road may make breast implants an unsuitable choice. Thoroughly evaluating personal risk factors for BII will help guide appropriate decision-making.
Women at high risk may want to consider alternative options for breast enhancement like fat transfer grafting, which poses less risk of immune complications. For those undergoing reconstruction after cancer, techniques using a woman’s own tissues for rebuilding breasts may be preferable.
Conclusion
Breast implant illness is increasingly recognized as a possible long-term complication of breast augmentation and reconstruction procedures. All women considering implants should understand they may be vulnerable to some degree, although some subgroups appear to be at elevated risk compared to others.
Carefully weighing risk factors like autoimmunity, length of implant duration, surgical variables, and lifestyle habits can help women make informed choices about implantation. For those at high risk, alternative approaches may be the safer option to avoid the development of systemic health problems.
With further research elucidating the contributors to BII, it is hoped that strategies can be developed to make breast implantation a lower risk procedure. In the meantime, women should approach implantation with full knowledge of the potential for short-term and long-term complications so they can make the most educated decision for their health and well-being.