New breast implant disease data supports removal

A three-year research program into breast implant complications continues to build on the body of knowledge about breast implant disease, with the latest data showing continued physical and psychological benefits after implants are removed, says Professor Anand Deva.

The research by Deva and colleagues is published at Journal of Cosmetic Surgery.

Baylee Saltmarsh knew something was wrong with her new breast implants as soon as the painkillers wore off. She was just 18 and had undergone surgery because she suspected her athletic build meant she would struggle to find modeling work. Feeling insecure and under pressure to conform to unrealistic industry expectations, she went to a plastic surgeon.

After the surgery, the pain was intense as her body struggled to accommodate the implants, which were significantly larger than she wanted.

Within 10 days, the infection had appeared on both sides, and a day before she turned 19, her body collapsed from the infection, she was rushed to the hospital for emergency surgery. He spent two months in the hospital and another four months on high doses of antibiotics before he finally got it all.

Then the systemic symptoms started.

“I fell asleep as soon as I put my shoes on,” says Baylee, now 26.

“I had brain fog, my irritable bowel syndrome got worse, my hair was falling out and I had unexplained rashes that were so bad that I spent two hours before a photo shoot with a make-up artist who specialized in covering up tattoos.

“Nobody mentioned that my implants could be causing it, and I was just dismissed by the doctors, so I thought it was all in my head.”

In 2019, two years after her initial surgery, her textured implants were recalled due to links to anaplastic large cell lymphoma (BIA-ALCL), a form of cancer related to non-Hodgkin’s lymphoma.

Scans showed multiple lumps on her chest wall, and while her biopsies were clear, she was at high risk of developing ALCL. However, he could not face another surgery to remove them.

The following year, she quit modeling and retrained in fitness, becoming a personal trainer specializing in Pilates. Still struggling with systemic symptoms, she began reading about breast implant illness (BII) and realized other women were going through the same thing as her.

She finally had the implants and the hardened tissue surrounding them removed in 2022 – against the advice of her surgeon, who told her BII was “just a hypothesis”.

“I woke up from surgery and my head felt clear for the first time in years,” he says.

“It was like a weight had literally been lifted. The inflammation and breakouts are gone now, and while chronic fatigue is still a problem, it’s something I’m trying.

“I’m open to other things being at play, but in my mind, the implants were causing inflammation in my body and I just wanted them out.

“If I could go back, I would hug an 18-year-old and tell her that she shouldn’t be doing this to her body to conform to society’s expectations of beauty.”

She’s now developed a following on Instagram and TikTok, where she regularly answers questions about breast implants and BII, trying to demystify the process and make sure other women considering implants have vital information she didn’t have.

The challenges of breast implant disease

Unfortunately, stories like Baylee’s are not uncommon.

About 20,000 Australian women have breast implants each year, either for cosmetic reasons or for reconstruction after breast cancer, but there is little data available on complications.

There is no data on how many women experience the more familiar problems of leakage, tearing or distortion, let alone the myriad symptoms associated with BII, such as autoimmune disease, gastritis, chronic fatigue, joint pain, hair loss, anxiety and depression.

Head of Plastic and Reconstructive Surgery at Macquarie University Hospital, Professor Anand Deva has been performing breast augmentation and reconstruction for three decades.

In 2018, she established Macquarie University Hospital’s world-first Breast Implant Clinic to provide women with a low-cost, convenient way to check their implants and seek help for complications.

Since then, Professor Deva has been filling the gap in understanding complications by collecting data from his patients.

“About 80% of women come to the clinic seeking help for physical complications, but we are seeing an increase in women with BII symptoms as more people learn about the condition,” she says.

“It’s still hard to put a number on how many women experience these systemic symptoms and we still don’t know what causes them.

“There is such a wide range of symptoms and they vary not only from patient to patient but even in the same patient from month to month.”

Some BII patients have leaking or ruptured implants, but most do not, so in trying to find the root cause, he and his colleagues investigated other aspects, including the presence of bacteria and foreign bodies, as well as psychological ties.

They found inflammation and changes in the tissue surrounding the implants that suggest changes due to contact with foreign bodies, but the answer is likely to be more complex than a single cause.

The first option Professor Deva offers all women with BII is to have their implants removed, and he and his colleagues are doing ongoing research into the physical and psychological effects.

“What we know is that when we offer these women implant surgery, with a full or partial capsectomy to remove the thick tissue that has formed around the implants, in many cases, most of their symptoms disappear and those that remain they become less severe and affect their lives less,” he says.

“But not everyone continues to feel great, which suggests that there are likely to be other factors that we don’t fully understand yet.”

Removal success data

In one follow-up six months after removal80% of patients with BII symptoms reported feeling significantly better, and he recently presented at a conference in the US new data showing that this benefit continues in about 70% of cases at 12 months.

A common symptom of BII is anxiety, and in a collaborative study with psychologists now being completed, women with BII symptoms were found to have anxiety levels three times higher than a control group of women with breast implants, but no related health problems.

When the BII group’s anxiety was assessed six months after implant surgery, it had returned to the same level as the control group.

“Removing the implants and removing the worry that they have something in their body that is making them sick is hugely beneficial for their mental health, and we know that the mind and body are intimately connected,” says Professor Deva.

“After studying it for three years, I thought it must be a combination of physical, biological and psychological factors that lead some women to feel so good, but we still don’t know who is at risk of developing BII.”

The importance of regular checks

Breast implant design may have had a few changes along the way, but Professor Deva says the implants are still essentially the same silicone-filled bag that was created in the 1960s.

If they undergo changes such as pregnancy, breastfeeding, weight loss and menopause, they will eventually fail.

“Everyone with implants should have an annual checkup, and after three to four years, consider getting some imaging in the form of an ultrasound for a mammogram to make sure there’s no pathology around them,” she says.

“There is still such a lack of understanding of BII that unless a clinician asks about systemic symptoms, they may never put two and two together.

“I also want to see surgeons taking responsibility for their work, doing these checks themselves and listening to their patients’ concerns.”

With a long history of regulatory failures and the ongoing pressures of societal ideals of beauty, advertising and now social media, she says we continue to fail women — and we need to do better.

This content was originally published on Macquarie University Lighthouse.