Whatever Happened to Breast Implant Illness

In the wake of Covid and long Covid, the impending crisis of BII seems to have been shoved aside

I think it is fair to say that the Covid pandemic changed life as we knew over those nearly three years of insanity, probably forever. Before Covid, undeniably the biggest issues in the plastic surgery world were, as usual, related to breast implants. Since the expose by Connie Chung on her show, Face to Face With Connie Chung, in 1990, the subject of women becoming sick after undergoing breast augmentation has persisted. When this issue was first raised, it is no exaggeration to say that it resulted in a media firestorm, prompted countless lawsuits, and led thousands of healthy women to have their implants needlessly removed.

After more than a decade of studies, the controversy died down, but never really went away. The advent of the internet and social media did more than anything else to resurrect this issue as women who felt they were alone with their problems, and dismissed by their doctors, found each other on web sites. One is www.healingbreastimplantillness.com . The founder of this site now claims to have a Facebook group with over 150,000 members.  

Breast implant illness (BII) is not a recognized official diagnosis, but rather a term used to describe women who got breast implants and then became sick. It applies to both saline implants, which contain sterile salt water, and those filled with silicone gel. It has been a frustrating condition to pin down because it is so lacking in specific features beyond having implants and not feeling well. Some women claim they became ill within days or weeks of getting breast implants; others claim they became ill decades later. The list of signs and symptoms of BII in the above website includes 52 items one of which is basically every autoimmune disorder known.

Autoimmune disorders, caused by dysfunction of the immune system, comprise between 80 and 150 conditions which affect an estimated 8% of the US population. This is probably an underestimate because many people go undiagnosed or have more than one condition. 80% are women for reasons that are not understood. This conservatively amounts to around 21 million women.

There is no doubt that some women with breast implants have become ill with a variety of illnesses. The problem is that we have not been able to make a case for causation. Thirty years of study have failed to reveal a direct connection between breast implants and systemic illness in women. The largest study ever undertaken was by M.D. Anderson Cancer Center. It looked at 100,000 women from 2005 on. Results were published in the Annals of Surgery January 2019 (Vol. 269, Issue 1, pp. 30-36). Although several autoimmune conditions appeared more common than expected, the numbers were so small that no conclusions could be drawn. Further study was recommended.

The cause of BII is almost undoubtedly multi-factorial, involving genetic, metabolic, lifestyle, and psychosocial factors. Another such condition has been recently recognized: long Covid. Some people seem to have long term problems after infection with the virus that causes Covid or even just from the vaccines for this. Like BII, it has been frustratingly difficult to pin down. For example, for entirely inexplicable reasons, it has been found to be more common in individuals who profess to be non-binary in their gender identification. Go figure.

In 2018, the National Breast Implant Registry was established to study the issue of BII. As of February 2024, over 1600 physicians have enrolled more than 102,000 women in the study.

Of course, this does not help women grappling with possible BII now or those contemplating breast implant surgery, both cosmetic and reconstructive in the near term. Plastic surgeons and implant manufacturers can be fairly criticized for taking so long to properly study this problem.

Another problem with BII is that no treatment is universally effective.

Removal of breast implants is terribly inconsistent in relieving symptoms of supposed BII. Some sources, including healingbreastimplantillness.com claim that implant removal alone is not sufficient; the capsule (scar) around the implant must be removed as well. This is a much bigger operation than removing implants alone and, in some cases, surgically impossible to do. There are no studies that show this improves the result of explantation. Some surgeons have advocated removal of lymph nodes in the armpits because microscopic bits of silicone have been found in these. Again, there is no data that this is beneficial, and the operation can create serious problems with arm swelling and infections.  

Patients seeking relief of symptoms they allege were caused by their implants are easy prey for unscrupulous surgeons and other practitioners who offer radical surgery and such unproven treatments as intravenous infusions of various types, a wide range of detoxification programs, and supplements of all sorts. All of these come at a cost. I know of one woman who spent over $50,000 on worthless IV therapy with no benefit. Healingbreastimplantillness.com promotes a naturopathic practitioner (not an MD), Dr. Ben Lynch, who has an entire line of supplements and treatments based on his claimed expertise on epigenetics- how genes are expressed. One scientist with a PhD in genetics describes Lynch and other like him as a modern-day version of a snake oil salesperson.

Several years ago, I posted an article online that simply questioned the claim that implants are toxic devices, and no one should get them. Mind you, I did not question that some women with implants were ill; I have always held that there might be a few women who do not tolerate breast implants. There is nothing you can place on or in the human body that somebody might not react to. Allergies to metal, latex, and an infinite number of cosmetic and medical products exist. Why should breast implants be immune to this? The response to my article was a tidal wave of vitriol. Women who were not even patients of mine gave me one-star reviews online and tanked my overall rating. I had to shut down my Facebook page and website until the furor subsided.

For women who have been told there is an epidemic of BII out there, the numbers do not support that. If you look at the most pessimistic numbers of women who claim to be ill from breast implants, it is no more than 1-2% of those who have them. I have seen women with implants that are 30 years old on up to nearly 50 years. Many of these implants have ruptured or leaked. Some are surrounded by thick shells of calcium. Almost without exception, these women are healthy. Timmy Jean Lindsey had the very first breast implants inserted in 1962, when she was 29 years. She is now 92 years old, in good health and still has her original implants. She has been offered free surgery to remove or replace them and has always declined.

I advise all young women seeking breast implants to realize that we do not know all there is to know about them and that no one can predict what will happen to them or their implants decades into the future. It is a real black mark in plastic surgery that, after over sixty years of experience with them, we do not have better information to impart to our patients.

Richard T. Bosshardt, MD, FACS

For a unique peek into the fascinating and misunderstood world of plastic surgery, check out my book, now available on Amazon as an eBook and in paperback.