Breast Implant Illness: Treatment Using Total Capsulectomy and Implant Removal

Stephen E. Metzinger, MD, FACS; Christopher Homsy, MD; Magnus J. Chun, BS; Rebecca C. Metzinger, MD

ePlasty. 2022;22(e5)

Limitations

The results of this study have several limitations. Due to the retrospective nature of our study, data collection bias may occur in which symptoms reported may not represent all symptoms associated with BII. Sampling bias may be possible because patients who had their implants removed were not representative of the overall breast reconstruction patient population. Although comorbidities are presented in this study, it does not take these into account in the data analysis. Additionally, although a questionnaire was provided to each subject, a BREAST-Q evaluation of outcomes^[33] for these women would provide a more accurate subjective assessment of their mammary, extra-mammary, and other systemic symptoms. Further prospective studies taking into account of comorbidities would be beneficial to understanding BII more in depth.

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Table 1. Common symptoms of BII
BII Common Symptoms
• joint and muscle pain	• swollen and tender lymph nodes in the breast area, axilla, supraclavicular, and cervical
• chronic fatigue	• premature aging
• memory and concentration problems	• bouts of dehydration for no reason
• breathing problems	• frequent urination
• sleep disturbance	• numbness/tingling around implant and underarm
• rashes and skin problems	• optic neuritis
• dry mouth and dry eyes	• hypo/hyperthyroidism
• dry skin and dry hair	• liver/kidney dysfunction
• anxiety	• hypo/hyper adrenal symptoms
• depression	• cramping
• headaches	• hormonal imbalance
• hair loss	• toxic shock symptoms
• gastrointestinal problems	• panic attacks
• slow muscle recovery after activity	• symptoms or diagnosis of fibromyalgia
• easy bruising	• symptoms or diagnosis of lyme disease
• fever and night sweats	• symptoms or diagnosis of autoimmune disease or connective tissue disorders (ie, lupus, Hashimoto's thyroiditis, rheumatoid arthritis, scleroderma)
• brain fog (cognitive dysfunction)	• delayed wound healing
• heart palpitations, changes in heart rate, heart pain	• GERD
• sore hip joints, aching backbone and sore feet	• vertigo
• new and persistent viral and bacterial illnesses	• dysphagia and digestive disorders
• symptoms or diagnosis of BIA- ALCL	• fungal infection
• tinnitus	• food allergies
• food intolerance

Table 2. Characteristics of patients with reported BII symptoms
Age at surgery: average (range), years		45.5 (29–73)
BMI, average (range)		26.3 (19–36.8)
Textured implant–to–smooth implant ratio		1:5
Placement of implants, %
	Subpectoral plane	59
	Subglandular plane	41
Follow-up time: average (range), months		5.0 (0.5–20)
Patient diagnosis, %
	Baker-Gordon Grade I capsular contracture	0
	Baker-Gordon Grade II capsular contracture	0
	Baker-Gordon Grade III capsular contracture	75.5
	Baker-Gordon Grade IV capsular contracture	14.5
Comorbidities/past medical history, %
	Hyperthroidism/Hypothyroidism	34.7
	Fibromyalgia	16.3
	Hyperlipemia	14.3
	Mental Disorder/Depression/Anxiety	14.3
	Hypertension	8.1
	GERD	6.1
	Diabetes Mellitus	6.1
	Asthma	4.0
	Migraine	4.0
	Lupus	2.0
	Atrial Fibrillation	2.0
	Inflammatory Arthritis	2.0
	COPD	2.0
	Osteoarthritis	2.0
	Raynaud's Disease	2.0
	Hepatitis C Virus	2.0
	Obstructive Sleep Apnea	2.0
	Osteopenia	2.0
	Achalasia	2.0
	Pulmonary Embolism	2.0
	Erythema Nodosum	2.0

Table 3. Ten most common self-reported symptoms of BII in study cohort
Symptom	Patients, % (n = 200)
Mastodynia	100
Capsular contracture	90.0
Fatigue	82.5
Loss of concentration during activities	81.5
Joint pain or arthralgia	57.5
Muscle pain	51.5
Rash or other skin disorder	37.5
Ocular compliant	23.5
Memory loss	18.0
Autoimmune diagnosis	10.5

Table 4. Pathologic examination of culture on removed specimens
Organism	Patients, % (n = 137)
Propionibacterium acnes	49.6
Staphylococcus epidermidis	26.2
Propionibacterium granulosum	16.8
Alpha-hemolytic Streptococcus species	8.7
Bacillus species*	2.5
Escherichia coli	0.7
Mycobacterium chelonae	0.7
Mycobacterium fortuitum	0.7
Mycobacterium avium-intracellulare	0.7
Candida albicans	0.7
Aspergillus fumigatus	0.7
Positive culture for more than 1 organism	10.2
Positive culture for more than 3 organisms	2.2