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How to Understand Breast Implant Illness Symptoms

By Dr. Randy Rudderman
In Plastic Surgery Articles

Breast Implant Illness (BII) is a term used to refer to a constellation of symptoms that can develop after undergoing breast cosmetic augmentation or reconstruction or using breast implants. Women who self-identify as suffering from this condition feel their symptoms are directly connected to their saline or silicone breast implants. BII impacts each person uniquely.

SYMPTOMS OF BII INCLUDE:

  • Chronic fatigue
  • Hair loss
  • Memory and concentration problems (“brain fog”)
  • Muscle aches and joint pain
  • Anxiety
  • Rashes and skin problems
  • Headaches
  • Breathing problems
  • Cardiac Issues (palpitations, concerns for irregular heart rhythm)
  • Gastrointestinal (Food sensitivities)
  • Autoimmune issues
  • Depression
  • Neurologic issues
  • Hormonal issues
  • ENT (Ear ringing)
  • Unexplained Weight Gain

One of the most common complaints is extreme fatigue that does not resolve with adequate rest. These symptoms can appear any time after implant surgery, whether immediately or after several years.

FIRST STEP – ROUTINE BLOOD WORK

If you have some or all of the symptoms reported with Breast Implant Illness, the first most reasonable approach is to have simple routine blood work performed. Please consult with your Internist and/or Family Practice Provider for you specific needs.

The tests may include:

  • Basic metabolic screen (can rule out anemia and common metabolic disorders, etc.)
  • Hormonal Screen (evaluate Thyroid and Ovarian end Adrenal function. etc.)
  • Inflammatory Markers (ANA, Rheumatoid Factor, CRP, etc.)
  • Autoimmune Screen (for fibromyalgia, scleroderma, and auto immune disorders, etc.)

Many patients have as well undergone cardiac workup, GI evaluation, Brain scans and Neuro workup, and ENT evaluations.

HOW DO OUR PATIENTS DESCRIBE THESE SYMPTOMS, AND WHICH ONES ARE MOST LIKELY TO RESOLVE WITH IMPLANT REMOVAL?

All of the symptoms that patients relate to BII have definitions found in medical literature and easily found on the web. And yet patients describe these issues in an often characteristic way when in a consultation that differs from “classic” descriptions. The following is examples, but not an exhaustive reporting of our experience.

Chronic Fatigue

Classic Description: Chronic fatigue syndrome (CFS) is a complicated disorder characterized by extreme fatigue that lasts for at least six months and that can’t be fully explained by an underlying medical condition. The fatigue worsens with physical or mental activity but doesn’t improve with rest. Described as due to lack of exercise and/or depression. The cause is unknown.

BII Patient Description

I feel tired out of proportion to the way I should. I wake up often tired, but the tired doesn’t really capture the fatigue. I feel I have to take a nap, and this doesn’t help. I exercise or want to, and it make me feel worse. I have children and expect some fatigue. My partner sees me struggle. All my lab work is normal. I remember what it should be like to get through day and wonder if I will be able to feel that way again.

Following Implant Removal

Majority of patients with normal blood work with this symptom report improvement within 1-3 days of surgery. A smaller group will report improvement in 1-2 months. A small percentage will not report resolution.


Hair Loss

Classic Description

Causes – Family history (heredity). Hormonal changes and medical conditions due to pregnancy, childbirth, menopause, thyroid problems, immune system related medications and supplements. Many people experience a general thinning of hair several months after a physical or emotional shock or very stressful event. This type of hair loss is temporary.

BII Patient Description

Crazy amount of hair loss every time I’m in the shower. Have no family history of hair loss. Hormones are normal and eat a great diet.

Following Implant Removal

Majority start to see new growth and have cessation of loss within several weeks of surgery. A small percentage will not report resolution.


Memory and Concentration Problems (“brain fog”)

Classic Description

Stress and chronic stress can increase blood pressure, weaken the immune system, and trigger depression, lack of sleep, hormonal changes, diet, medications and medical conditions.

BII Patient Description

I have always had a good memory, I work in a demanding field and have never had issues, I find it difficult even now in the consult to remember what I know are important details, my partner can confirm that I’m not the same, my labs are normal, I’m too young to be treated like I have dementia.

Following Implant Removal

Majority of patients with normal blood work with this symptom report improvement within 1-3 days of surgery. A smaller group will report improvement in 1-2 months. A small percentage will not report resolution.


Muscle Aches and Joint Pain

Classic Description

Fibromyalgia – Pain, you may feel as though you’ve got pain that spreads throughout your entire body, with certain parts, such as your neck and back feeling particularly painful.
Tiredness, fatigue and generally feeling like you have no energy. Sleeping badly and waking up feeling unrested. Cause – genes. Fibromyalgia seems to run in families, other diseases. A painful disease like arthritis or an infection raises your chances of getting fibromyalgia, emotional or physical abuse, post-traumatic stress disorder (PTSD), gender, anxiety and depression, not moving enough.

Rheumatoid Arthritis – Tender, warm, swollen joints; Joint stiffness that is usually worse in the mornings and after inactivity; Fatigue, fever and loss of appetite. Cause is unknown. Researchers think it’s caused by a combination of genetics, hormones and environmental autoimmune.

Osteoarthritis – Primary osteoarthritis is caused by the breakdown of cartilage, a rubbery material that eases the friction in your joints. It can happen in any joint but usually affects your fingers, thumbs, spine, hips, knees, or big toes. Osteoarthritis is more common in older people.

BII Patient Description

My ankles hurt, the bottoms of my feet hurt when I stand up in the morning. I have random pain in joints, not always the same ones, sometimes both elbows. My fingers hurt, sometimes feel swollen. Non-steroidal like Advil really don’t help. My doctor says my labs and x-rays are totally normal. I’m too young to have osteoarthritis.

Following Implant Removal

Majority of patients with normal blood work with this symptom report improvement within 1-3 days of surgery. A smaller group will report improvement in 1-2 months. A small percentage will not report resolution. There is a group of patients particularly with ankle and foot pain, and stiff joints including hands that will present to the office the day after surgery with resolution of pain.


Anxiety

Classic Description

Causes trauma, stress due to an illness, stress buildup, personality, other mental health disorders. Having blood relatives with an anxiety disorder, drugs or alcohol.

BII Patient Description

I started having anxiety for no reason. I’ve never had this issue. My partner has seen a major change in my behavior. The medications vie been given are not working, or I don’t want to take medications for this.

Following Implant Removal

Majority of patients with normal blood work with this symptom report improvement within 1 -2 weeks of surgery. A smaller group will report improvement in 1-2 months. A small percentage will not report resolution.


Rashes and Skin Problems

Classic Description

Hives (urticaria) and swelling (angioedema) is when your body responds to a foreign substance (allergen). Hives or swelling that last for less than six weeks are considered acute, meaning they come on suddenly. Allergic reactions to certain foods or medications often cause acute hives and swelling. When hives linger for more than six weeks, the condition is chronic. In 95% of chronic conditions, cause- unknown thought to be autoimmune in nature.

BII Patient Description

I started to see skin changes, thought this was aging but I seem too young for this, eye swelling even with sleep, my pictures look different, doesn’t respond to anti-allergy pills, strange rashes on arms and legs, or torso, or underarm. Have seen several dermatologists who can’t explain it.

Following Implant Removal

Majority of patients with normal blood work with this symptom report improvement within 1-3 days of surgery. A smaller group will report improvement in 1-2 months. A small percentage will not report resolution. There is a group of patients that will present to the office the day after surgery with resolution of rashes objectively documented.


Headaches

Classic Description

Headaches require careful evaluation. If migraines, and associated with motor function and or sensory changes, a neurologic workup is advised. Etiology of headaches is vast and if not resolved with implant removal must be evaluated by a specialist.

BII Patient Description

Typically, these patients had issues before breast implants and now have higher frequency of headaches and or migraines.

Following Implant Removal

A number of patients will report total resolution, some less frequency. Outcomes are extremely variable.


Breathing Problems

Classic Description

There are wide range of descriptions for breathing problems.

BII Patient Description

I feel like I can’t take a deep breath, I have felt winded walking upstairs but have had full cardiac and pulmonary evaluation that are normal, sometimes just can’t breathe normally.

Following Implant Removal

Majority of patients with normal blood work and with this symptom report improvement within 1-3 days of surgery. A smaller group will report improvement in 1-2 months. A small percentage will not report resolution. Some will wake up in recovery room and report resolution of this concern.


Cardiac Issues (palpitations, concerns for irregular heart rhythm)

Classic Description

Variable

BII Patient Description

Between 25-30% of our patients have reports concern with their heart. Many have made a trip to the ER or had full evaluation by their internist or cardiologist and have a totally normal reported test. In spite of this, many have persistent issues, out of proportion to their age or health status.

Following Implant Removal

Majority of patients with normal blood work and with normal prior cardiac evaluation this symptom report total resolution of this issue noticeable within 1-3 week of surgery. A smaller group will report improvement in 1-2 months. A small percentage will not report resolution.


Gastrointestinal (Food sensitivities)

Classic Description

IBS, gluten sensitivity, celiac

BII Patient Description

I have difficulty swallowing, feel that something is stuck in my throat, seem to have developed this random sensitivity to a variety of foods that doesn’t fit a category, I eat healthy, and nothing changes, I can’t eliminate anything else and still eat! Many of the patients have had an evaluation by a Gastroenterologist including upper endoscopy.

Following Implant Removal

Majority of patients with normal blood work and with normal prior GI evaluation this symptom report total resolution of this issue noticeable within 1-3 week of surgery. A smaller group will report improvement in 1-2 months. A small percentage will not report resolution.


Depression

Classic Description

Highly variable

BII Patient Description

Highly Variable. Many patients feel fully frustrated that they “know” something is wrong, that their partner and friends do as well, and their physician cannot find any reason for concern. Depression is a natural result of this condition.

Following Implant Removal

When symptoms resolve, depression is likely to be positively impacted.


Neurologic issues

Classic Description

Variable

BII Patient Description

Issues range from brain fog, cognitive disfunction, sensory changes to the extremities, upper and lower, and other variable issues.

Following Implant Removal

Brain fog and cognitive disfunction often is reported to resolve within days. Upper extremity sensory changes can resolve by reports as quickly. Lower extremity issues are more variable in reporting. Issues that have h=not resolved within a month should be further evaluated to rule out treatable diseases.


Hormonal Issues

Classic Description

Thyroid, Adrenal, Ovarian

BII Patient Description

Many symptoms can be attributed to hormonal irregularity. Most patients have at least had a thyroid screen. Evaluation of estrogen progesterone testosterone is significantly more complex.

Following Implant Removal

While not common, surprisingly, there are a number of patients who had previously been placed on thyroid replacement therapy that had returned several months after implant surgery and reports normalized test results and have been taken off of replacement therapy. There are many factors and variables at play here. None the less, a return to a more “normal” life has been reported by patients. Not predictable.


ENT (including Ear ringing)

Classic Description

Tinnitus, vertigo, swallowing issues, chronic recurrent sinus infections, berating issues.

BII Patient Description

I have developed chronic issues that my ENT states is not allergy of polops or anatomy. There is a feeling of swallowing difficulty enough to have needed a scope procedure, but nothing was found. My ears ring, and have vertigo but they can’t find a reason.

Following Implant Removal

Majority of patients with normal blood work and with normal prior ENT evaluation this symptom report total resolution of this issue noticeable within 1-3 week of surgery. A smaller group will report improvement in 1-2 months. A small percentage will not report resolution.


Weight Gain

Extremely variable. However it is also quite common to hear patients say that they found a weight loss in the first 2-3 weeks of 8-10 pounds, that is theorized to be related to decrease in general body inflammation.

CONSULT WITH A BOARD CERTIFIED PLASTIC SURGEON

Breast Implant Removal is not magic. It will not cure an existing genetic, inherited, or acquired disease. And diseases, particularly those that impact quality and duration of life, like all in medicine, can and should not be overlooked by blame on implants.

There is plenty of objective evidence that there are patients who adversely react to breast implants, either due to inflammatory issues, toxicity, biofilms, or unknown causes at present. If diagnostic workup is normal, many patients report improvement, resolution, and often very dramatic change in quality of life after implant removal.

Even though many patients live out their lives with implants of many varieties with no issue, some know quickly after augmentation that the operation was not right for them, and some find after years, aging and hormonal and genetics, that what once worked no longer does.

The most important plan is to not overlook what is treatable and seek out a practice with experience to educate you with your options. Surgery is not an emergency, and you should always be given time to digest and understand your options, risks, and expectations before surgery.

As a Board-certified plastic surgeon with over 25 years as a leading plastic & reconstructive surgeon in the Atlanta area I will listen to your concerns and goals and conduct a thorough evaluation of you health, activities, general lifestyle and family history. From the consultation evolves…trust, respect, mutual understanding, and a personalized treatment plan. Contact us at 678.566.7200 to schedule a consultation in our Alpharetta or Midtown Atlanta offices.


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Dr. Randy Rudderman

Since 1989, Dr. Randy Rudderman has been in private Plastic Surgery practice in Atlanta, focusing on the full range of aesthetic procedures – eyelid surgery, breast augmentation and breast lifts, liposuction, abdominoplasty, facelifts and facial reconstruction, among others. He also has a distinguished career in the reconstructive surgery arena, including facial and breast reconstruction. He has worked as a key member of teams from several prestigious organizations – including the AO-ASIF (Association for the Study of Internal Fixation) Foundation in Davos, Switzerland, and has conducted research at Case Western Reserve University Medical Centers, CWRU Engineering School, and NASA – producing breakthroughs in joining the science of facial biomechanics and reconstructive Plastic Surgery with rapidly evolving technological innovations.

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