The Mysterious Illness Plaguing Women With Breast Implants
Last February, Renee Vidor went for a run. During her workout, she had an asthma attack. Breathing troubles were totally unexpected for the now-37-year-old mom of two, who had never experienced asthma before. It was concerning, but it wasn’t until a few months later, when she could no longer work out at all due to shortness of breath and heart palpitations, that she started to really worry.
Around the same time, Vidor also started to experience intense brain fog. That presented a big problem, since her job required public speaking at conferences and events. “I would get on stage and have complete mind blanks,” Vidor remembers. “I'd even have notes to remind me of simple things, but I was incapable of reading them.” She began avoiding social outings too, because it was too difficult to hold a conversation. “It was like my brain would shut down,” she adds. Eventually, it got to the point where she was taking several 20-minute “power naps” just to make it through the day.
When Vidor visited her doctor, she says she was told she was perfectly healthy and her concerns about her strange symptoms were brushed aside. It wasn’t the first time this happened, either. “But my practitioners always told me, ‘You're just getting older; it's normal,’” Vidor says.
Around the same time, Vidor’s mom told her a friend’s daughter had been experiencing similar health issues, and she had found relief after having her breast implants removed. Vidor’s mom urged her to look into whether her own breast implants, which she’d gotten nearly 10 years earlier, might be part of the problem.
After doing some research, Vidor learned about a Facebook group called Healing Breast Implant Illness. In it, over 100,000 members share their stories and concerns about what they refer to as Breast Implant Illness, or BII. It was in this group that Vidor learned there were thousands of other women with breast implants going through similar experiences.
Vidor went on to have her breast implants removed in September 2019, just seven months after her symptoms initially cropped up. “In joining the group, I learned that I wasn't alone and I quickly knew what I needed to do,” Vidor remembers. “I had hope that I could be 'normal' and healthy once again.”
Like many of the women she’d exchanged stories with, Vidor’s symptoms were greatly reduced after having her implants removed. “I can literally say that my life improved from the day following surgery,” she says.
Despite the fact that tens of thousands of women say they have had similar results after getting their implants removed — including quite a few fitness and fashion influencers — the mainstream medical community is divided on whether BII exists. There seems to be one big reason why.
There’s no test for BII.
Breast Implant Illness is a constellation of more than 150 possible symptoms, the vast majority of which are subjective, explains Melinda Haws, M.D., a board-certified plastic surgeon. By subjective, she means they can’t be measured by a specific test. “Brain fog, fatigue, and joint pain, while real complaints, are not things you can measure with a blood draw, see on an X-ray, or see when you perform a physical examination,” Dr. Haws points out. Other common symptoms of BII, according to women and doctors interviewed for this story, include breast pain, hair loss, rashes, and muscle pain.
Some plastic surgeons take a strong stance against BII, stating that there’s absolutely no evidence it’s real. But most acknowledge that there’s likely something going on if a woman with breast implants is experiencing these symptoms. “Breast implant illness is real in that women have real symptoms that often go away when their breast implants are removed,” says Constance M. Chen, M.D., a board-certified plastic surgeon and breast reconstruction specialist. Plus, people have been having problems with breast implants since they were invented, Chen points out.
We’ve always known that breast implants can cause issues.
Plastic surgeons will be the first to tell you that there’s always risk associated with any surgery. “Breast implants in general are a foreign body, so as with any foreign body, they can have problems,” says T.Y. Steven Ip, M.D., a board-certified plastic surgeon. The FDA actually lists 26 possible complications from breast implants, including breast pain, capsular contracture (where the tissue around the implant gets super hard and tight), rupture, and leakage. For what it’s worth, docs are on the same page about these: “ALL plastic surgeons agree on most potential side effects of ALL implants,” Dr. Haws says.
According to the FDA, these complications happen in at least 1% of breast implant patients at any time. Other research has found certain complications may be more common, though. For example, capsular contracture is thought to happen in 2 to 15% of breast augmentation procedures, with some research showing the percentage may be higher, depending on the type of implant.
That’s because different types of implants carry different risks. All implants have a silicone shell, but some are filled with saline rather than silicone. Most implants are smooth on the outside, but one type of silicone implant has a textured exterior that helps it stay in place. Last summer, Allergan, one of the companies that manufactures breast implants, complied with the FDA’s request to recall specific models of their textured implants after they were linked to a type of cancer. Again, everyone agrees this is a risk.
But what seems to be most controversial is the link between breast implants and autoimmune and connective tissue disorders, such as rheumatoid arthritis and lupus. Many of the common symptoms of BII are also present in autoimmune diseases, for example, brain fog, joint pain, fevers, and chronic fatigue. This concern has been around for a long time. Stevie Nicks even got her implants removed back in 1994 after being diagnosed with Epstein-Barr virus, an illness that often causes fatigue. And some studies do report higher rates of certain autoimmune diseases and other diseases like scleroderma and melanoma in women with certain types of breast implants.
It’s thought that some of these effects may be linked to the silicone. BII advocates point to the fact that silicone has been associated with a theoretical condition known as Autoimmune Syndrome Induced by Adjuvants (ASIA), where a foreign material in the body induces autoimmune symptoms. The theory goes that some people are more at risk for ASIA after getting breast implants, particularly those with a genetic predisposition to autoimmune disease. Some BII advocates believe those are the people who are most likely to experience BII.
But similar to its position on BII, the medical community doesn’t agree on whether ASIA exists. Still, BII advocates are campaigning for more mandated pre-op education on the risk of possible autoimmune-related complications—which, depending on how you view the research, do seem to be present. That way, patients can understand all the potential risks before making the decision to get breast implants.
For what it’s worth, concerns over silicone are not new: The FDA even asked implant manufacturers to stop selling silicone implants in the ‘90s because of potential complications after women reported getting sick because of them. The restrictions were lifted again in 2006 after implant design was improved, but it was a controversial decision at the time. Some experts in the field were still concerned about safety, and didn’t believe the new silicone implants had been studied thoroughly enough.
Yet there’s other research, including a large-scale review published in 2000 in the New England Journal of Medicine, that says there’s no link between breast implants and autoimmune and connective tissue diseases. Doctors who dismiss BII often point to this review and an Institute of Medicine report from 1999. But BII advocates point out that both of these reviews lean heavily on research funded by Dow Corning, a breast implant manufacturer that ended up filing for bankruptcy after concerns emerged about its silicone implants. The company no longer makes breast implants. These studies also mostly looked at women who had breast implants for a few months to a few years, so they don’t account for long-term outcomes for those with breast implants.
More long-term research is underway, but for now, the FDA agrees that breast implants are overall safe.
And yet the number of women experiencing BII symptoms and seeking out explants is rising. While the FDA does not believe BII is necessarily a threat, they announced in October that they recommend plastic surgeons discuss the risk of serious complications — including BII hallmarks fatigue and joint pain — with patients.
A few plastic surgeons have even opted to stop doing breast implant surgeries altogether, instead specializing in explants only. Most plastic surgeons still do breast implant surgeries, though, for one main reason: “Compared to the number of women in the world with breast implants, the number of women experiencing BII is relatively small,” says Michelle Lee, M.D., a board-certified plastic surgeon. And for most women who get breast implants, the benefits seem to outweigh the risks. “Implants are a powerful tool in replacing volume, especially for after mastectomies, since not all women will have enough excess tissue to have a natural breast reconstruction.”
In fact, according to data from RealSelf (similar to Yelp, but for plastic surgery), 95% of people who get breast implants say they’re “worth it.” On the other hand, 98% who have them removed say the procedure is “worth it,” too.
Breast implant removal usually improves symptoms… but not always.
Alli Rodriguez, 32, was experiencing severe breast pain, rashes, headaches, joint pain, and more when she decided to pursue an explant. “I’m currently 10 weeks post-op, and I started to feel better immediately,” she says. “The pain in my breast was gone immediately. The rash also disappeared the day after. My eyes were brighter. I felt like I had more energy. I am losing weight, which was something I struggled with for years. The inflammation has also disappeared in my body. I feel like in the long-term I am going to just keep getting better.”
Rodriguez’ experience is a common one. “Most women with these symptoms feel better after the breast implant and the surrounding scar tissue, also known as the capsule, are removed,” Dr. Lee says. “However, it is important to note that not all women do.” For those patients, it’s likely their symptoms had another cause.
For those with breast implants who believe they may have BII (or are worried about getting it in the future), a full medical checkup is a good idea, Dr. Haws says. “I have personally had patients whose first concern was BII and after complete medical evaluation, their final cause of symptoms was cancer or menopause or anxiety.”
Many women with BII do experience anxiety as one of their symptoms, or potentially because of their symptoms. That was the case for Amanda DuLong, whose friends nicknamed her Sunshine for her normally sunny personality. “I suddenly had anxiety, when I’ve never had it before in my life,” she remembers. “I felt foggy-headed and depressed.” It’s not uncommon for BII symptoms to be written off as anxiety, stress, or simply getting older, as was Vidor’s experience.
But once other causes are ruled out, the only way to find out if it’s BII is to remove the implants. Many women immediately feel better, but it can take longer to see a difference. “I tell all patients it takes a full six to 12 months to determine which symptoms will resolve and stay gone,” Dr. Haws notes.
There are alternatives to breast implants.
Despite the growing awareness around BII thanks to Facebook groups and influencers speaking out about their experiences, getting breast implants remains an incredibly popular procedure, both among those seeking breast augmentation and breast reconstruction. In 2018, more than 300,000 women in the U.S. had breast augmentation surgery, and another 100,000 had breast reconstructions, according to the American Society of Plastic Surgeons.
But there are several alternatives to breast implants to consider, whether you’ve never had breast implants before or you’re looking to have implants removed and are concerned about the aesthetic results.
- Breast lift: This mainly helps with breast shape, Dr. Haws says. “Unfortunately, I see women all the time who originally saw a surgeon for a breast lift and were talked into an implant — both BII and non-BII patients.”
- Fat grafting: This procedure involves taking fat from one part of the body and putting it in the breasts. Usually, you can only go up one cup size with this method, Dr. Haws says.
- Natural tissue reconstruction: “Breast cancer survivors usually do better with natural tissue breast reconstruction, both in terms of appearance and health risks,” Dr. Chen says. This option can be done with fat grafting, or by taking a tissue flap from another area of the body.
Of course, there’s also the option to just remove the implants. “The majority of the women I see who want their implants removed are really happy with just getting rid of the implants,” Dr. Haws says. “Given a couple of months, it is amazing how much a breast will tighten up and even ‘fluff up’ and increase in size over the immediate postoperative appearance.”
Plus, the women we spoke to who removed their implants said they felt happier and more secure post-surgery. “In regards to my appearance and confidence, I've never felt better,” Vidor says. “I feel so confident about being who I was created to be. I love my body, scars and all.”