Fibromyalgia and breast implants

Breast Implant Illness (BII) is a difficult and controversial issue which has sparked lively debate over the past few decades. In light of the recent Woman's Hour programme on fibromyalgia and breast implants, the ABS would like to clarify it's position on Breast Implant Illness.
 
Symptoms sometimes described as BII is a complex of potentially over 100 symptoms, which have been linked to silicone breast implants.

These symptoms range from fatigue, muscle and joint pain, brain fog, headache, psychological symptoms and anxiety, to hair loss.

Many of these symptoms can be due to a range of causes, such as menopause, fibromyalgia, mental health issues, autoimmune disease, etc and a causal link between the implants has been very difficult to prove, despite the huge number of women globally with silicone implants. This reflects the heterogeneity of their symptoms and the overlap with other illnesses, many of which are very common. There are, however, a number of reports of women whose symptoms have improved after implant removal surgery. However, this is not always the case.

There is higher risk of developing these symptoms post insertion of a breast implant if an individual suffers from a chronic condition (like fibromyalgia), has multiple allergies, suffers from irritable bowel-disease or has a personal or family history of pre-existing history or autoimmune disease.
 
There are several theories about a possible biological link between implants and these symptoms. These range from the silicone acting as a trigger for an autoimmune reaction, low grade infection around the implant, capsule formation, and a psychosomatic response due to the very large volume of information on social media about this condition. In the former two causal theories, it is clear that removal of the implant may cause symptom resolution. In the latter, it is postulated that implant removal may have a psychologically (placebo) beneficial effect.

Currently, the World Health Organisation (WHO) does not recognise BII as a specific entity. This does not mean that it does not exist, but rather that the evidence in support of this is not yet clear. As new evidence accrues, it may be that the WHO will recognise this. 

The ABS would like to make clear, however, that BII is not yet recognised as a defined disease by the WHO. The vast majority of women with silicone implants have no issues with them and are very healthy and happy with them, and we would caution any implication that this is a common condition. Sadly, there are many women who have had implant removal for possible BII who derive no benefit from the surgery and indeed may suffer great harm. Explantation surgery when done for this reason is often done with a total capsulectomy which carries significant risks of pain, bleeding, fluid build-up, cosmetic deformity and a small risk of lung collapse. 

A balanced approach to BII is therefore required to prevent causing significant physical and psychological harm due to women seeking unnecessary explantation surgery, whose symptoms - in the vast majority of cases - are not linked to their implants in any way, but rather due to a range of well recognised traditional health issues. Many of these women will be breast cancer survivors whose implants were placed for reconstruction after mastectomy and removal of these implants may leave them without any breasts at all, potentially requiring major revision surgery.

The ABS has an open mind about BII and works with other specialties (through the Plastic, Reconstructive and Aesthetic Surgery, Expert Advisory Group (PRASEAG)) to continually review data concerning this. However, we still have much more research to do to prove the association, identify valid methods to confirm the diagnosis and to understand its causation and optimal treatment. 

For those undertaking an implant-based reconstruction or a breast augmentation, it is our practice to discuss BII as part of the consent process. 

Listen to Woman’s Hour episode here