Pittwater Life May 2023 Issue

Health & Wellbeing
with Dr John Kippen
Health & Wellbeing
A summary of Breast Implant
Illness and issues to consider
Approximately 20,000
women get breast
implants per year in Australia,
for both reconstructive
and cosmetic indications.
Breast implant illness (BII) is a
wide collection of symptoms in
a person with breast implants.
Synonyms of issues include
silicone implant disease and
autoimmune/ inflammatory
syndrome induced by adjuvants
(ASIA).
BII symptoms vary in type
and severity however there
are often multiple symptoms
involving multiple systems –
musculoskeletal, systemic, and
cognitive.
Symptom onset is variable
and can range from months to
many years.
Symptom resolution is also
variable from rapid and dra-
matic, to slowly progressive, to
little change to no change, and
actual progression.
The exact incidence of BII is
not precisely known, however
It seems to be increasing but
this may be due to increased
awareness.
In 2020, the American Governing
Body, the Food and Drug
Administration (FDA), advised
implant manufacturers to have
warning labels on the implants
suggesting patients may
develop systemic symptoms,
joint and muscle pain, chronic
fatigue, and autoimmune conditions.
It is clear more research is
needed to improve recognition,
understanding and treatment.
Diagnosis is by excluding
other conditions and a resolution
of symptoms.
There is no single diagnostic
test and tests are usually guided
by the symptom profile.
At presentation to a Plastic
Surgeon, most patients have
had several tests and seen
several doctors.
The exact cause is not known
and is considered either an
autoimmune/inflammatory response
or low-grade bacteria on
the implant surface (biofilm).
BII can occur with silicone or
saline fill, textured or smooth,
and round or shaped.
The implant envelope in all
types contain silicone.
There does seem to be an
overlap with auto-immune and
connective tissue disorders such
as lupus, rheumatoid arthritis,
and scleroderma.
Treatment involves removing
the implant (explant), removing
the capsule (capsulectomy
– either partial, subtotal, or
complete), and removal of the
implant and capsule as a single
unit (en bloc capsulectomy).
This condition is separate
from Breast Implant Associated
Anaplastic Large Cell
Lymphoma, BIA-ALCL, a cancer
in the tissue and fluid around
implants.
There is no association with
cancer.
Prevention is difficult to
advise on as the cause is not
known.
Not having implants is an
obvious suggestion, especially if
replacing implants.
It may be worth trying a
different implant in a different
pocket, but recurrence cannot
be predicted or prevented.
An increased risk may occur
with a personal or family history
of autoimmune conditions,
allergies, irritable bowel
syndrome, migraines, chronic
fatigue, and fibromyalgia.
Implant rupture is not known
to increase or decrease the risk.
Surgery is usually under general
anaesthetic with hospital
stays of one to three days.
Individual protocols vary
with surgeons and conditions.
Time in hospital, dressings,
drains, post-surgical bra or
binders, suture selection (dissolving
or removed) should be
discussed.
An important consideration
is a combined lift procedure.
Lift techniques often involved
additional and visible scars.
A full discussion of risks and
complications should be comprehensive.
Our columnist
Dr John Kippen is a qualified,
fully certified consultant
specialist in Cosmetic, Plastic
and Reconstructive surgery.
Australian trained, he
also has additional
Australian and International
Fellowships. He welcomes
enquiries; email
doctor@johnkippen.com.au
50 MAY 2023
The Local Voice Since 1991