Abstract
Breast implant illness (BII) is a condition characterized by elusive diagnostic criteria and self-reported diverse disabling and distressing physical and psychological symptoms. With currently significant increase in public awareness, BII is perhaps becoming the most controversial subject in aesthetic and reconstructive breast surgery, generating heated debates between those who do not believe such a condition exists and those who demand its acceptance as a recognized diagnosis. Silicone incompatibility has been associated with “autoimmune/inflammatory syndrome induced by adjuvants” (ASIA syndrome) or Shoenfeld's syndrome. It is still unclear, however, whether BII symptoms would have occurred if no implants had been placed in the first place. The purpose of this literature review is to analyze critically the current state of scientific evidence related to this condition. Though the psychosomatic theory is most likely, the mechanism of BII symptoms is probably multifactorial. At present, BII being an underlying connective tissue disorder cannot be confirmed; moreover, whether improved aesthetic outcome and patient’s overall satisfaction with the profile of their reconstructed or augmented breasts translate into decreased self-reported BII symptoms is still not well elucidated.
Level of Evidence III
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Similar content being viewed by others
References
Bouhadana G, Chocron Y, Azzi AJ, Davison PG (2020) Perception of implants among breast reconstruction patients in Montreal. Plast Reconstr Surg Glob Open 8(9):e3116
Marano AA, Cohen MH, Ascherman JA (2020) Resolution of systemic rheumatologic symptoms following breast implant removal. Plast Reconstr Surg Glob Open 8(5):e2828
Newby JM, Tang S, Faasse K, Sharrock MJ, Adams WP (2020) Understanding breast implant illness. Aesthet Surg J. https://doi.org/10.1093/asj/sjaa329 (Epub ahead of print. PMID: 33247711)
Kaplan J, Rohrich R (2021) Breast implant illness: a topic in review. Gland Surg 10(1):430–443
Nanayakkara PW, de Blok CJ (2016) Silicone gel breast implants: what we know about safety after all these years. Ann Intern Med 164:199–200
Abi-Rafeh J, Safran T, Al-Halabi B, Dionisopolous T (2019) Death by implants: critical analysis of the FDA-MAUDE database on breast implant-related Mortality. Plast Reconstr Surg Glob Open 7(12):e2554
Song WJ, Kang SG, Seo BF, Choi NK, Lee JH (2020) A systematic review of the national breast implant registry for application in Korea: can we predict “unpredictable” complications? Medicina (Kaunas) 56(8):370
Magnusson MR, Cooter RD, Rakhorst H, McGuire PA, Adams WP Jr, Deva AK (2019) Breast implant illness: a way forward. Plast Reconstr Surg 143 (3S A Review of Breast Implant-Associated Anaplastic Large Cell Lymphoma): 74S-81S
Brawer AE (2017) Destiny rides again: the reappearance of silicone gel-filled breast implant toxicity. Lupus 26(10):1060–1063
Chi D, Ha AY, Keane G, Myckatyn TM (2021) Discussion: a national survey to assess the population’s perception of breast implant-associated anaplastic large cell lymphoma and breast implant illness. Plast Reconstr Surg 147(4):804–805
Ranieri J, Fiasca F, Guerra F, Perilli E, Mattei A, Di Giacomo D (2021) Examining the post-operative well-being of women who underwent mammoplasty: a cross-sectional study. Front Psychiatry 12:645102
Coroneos CJ, Selber JC, Offodile AC 2nd, Butler CE, Clemens MW (2019) US FDA breast implant postapproval studies: long-term outcomes in 99,993 patients. Ann Surg 269(1):30–36
Lachmansingh DA (2019) Breast Implant Illness And Psychiatric Implications. Ir J Psychol Med 4:1–2
Adidharma W, Latack KR, Colohan SM, Morrison SD, Cederna PS (2020) Breast implant illness: are social media and the internet worrying patients sick? Plast Reconstr Surg 145(1):225e–227e
Lee M, Ponraja G, McLeod K, Chong S (2020) Breast implant illness: a biofilm hypothesis. Plast Reconstr Surg Glob Open 8(4):e2755
Wee CE, Younis J, Isbester K, Smith A, Wangler B, Sarode AL, Patil N, Grunzweig K, Boas S, Harvey DJ, Kumar AR, Feng LJ (2020) Understanding breast implant illness, before and after explantation: a patient-reported outcomes study. Ann Plast Surg 85(S1 Suppl 1):S82–S86
Colaris MJL, Cohen Tervaert JW, Ponds RWHM, Wilmink J, van der Hulst RRWJ (2021) Subjective cognitive functioning in silicone breast implant patients: a cohort study. Plast Reconstr Surg Glob Open 9(2):e3394
Siling Y, Klietz ML, Harren AK, Wei Q, Hirsch T, Aitzetmüller MM (2021) Understanding breast implant illness: etiology is the key. Aesthet Surg J. https://doi.org/10.1093/asj/sjab197 (Epub ahead of print. PMID: 33871569)
Miseré RML, Colaris MJL, van der Hulst RRWJ (2020) The prevalence of self-reported health complaints and health-related quality of life in women with breast implants. Aesthet Surg J. https://doi.org/10.1093/asj/sjaa207
Balk EM, Earley A, Avendano EA, Raman G (2016) Long-term health outcomes in women with silicone gel breast implants. A Syst Rev Ann Intern Med 164:164–175
Colaris MJL, de Boer M, van der Hulst RR, Cohen Tervaert JW (2017) Two hundreds cases of ASIA syndrome following silicone implants: a comparative study of 30 years and a review of current literature. Immunol Res 65(1):120–128
Khoo T, Proudman S, Limaye V (2019) Silicone breast implants and depression, fibromyalgia and chronic fatigue syndrome in a rheumatology clinic population. Clin Rheumatol 38(5):1271–1276
Shoaib BO, Patten BM (1994) An MS-like syndrome in women with silicone breast implants or silicone uid injections in breast. Neurology 44:37–44
Mcguire PA, Haws MJ, Nahai F (2019) Breast implant illness: how can we help? Aesthet Surg J 39(11):1260–1263
Rohrich RJ, Kaplan J, Dayan E (2019) Silicone implant illness: science versus myth? Plast Reconstr Surg 144(1):98–109
Duvic M, Moore D, Menter A et al (1995) Cutaneous T-cell lymphoma in association with silicone breast implants. J Am Acad Dermatol 32:939–942
FDA (2011) Update on the Safety of Silicone Gel-Filled Breast Implants Center for Devices and Radiological Health. Center for Devices and Radiological Health U.S. Food and Drug Administration, June 2011
Bragazzi NL, Hejly A, Watad A, Adawi M, Amital H, Shoenfeld Y (2020) ASIA syndrome and endocrine autoimmune disorders. Best Pract Res Clin Endocrinol Metab 34(1):101412
Caravantes-Cortes MI, Roldan-Valadez E, Zwojewski-Martinez RD, Salazar-Ruiz SY, Carballo-Zarate AA (2020) Breast prosthesis syndrome: pathophysiology and management algorithm. Aesthetic Plast Surg 44(5):1423–1437
Cohen Tervaert JW, Kappel RM (2013) Silicone implant incompatibility syndrome (SIIS): a frequent cause of ASIA (Shoenfeld’s Syndrome). Immunol Res 56(2–3):293–298
Shoenfeld Y, Agmon-Levin N (2011) “ASIA”—autoimmune/inflammatory syndrome induced by adjuvants. J Autoimmun 36:4–8
Fuzzard SK, Teixeira R, Zinn R (2019) A review of the literature on the management of silicone implant incompatibility syndrome. Aesthetic Plast Surg 43(5):1145–1149
Calobrace MB, Mays C (2021) An algorithm for the management of explantation surgery. Clin Plast Surg 48(1):1–16
Tang SY, Israel JS, Afifi AM (2017) Breast implant illness: symptoms, patient concerns, and the power of social media. Plast Reconstr Surg 140:765e–766e
Jewell ML, Jewell HL (2019) Breast implant-associated illness: medicine by belief, so says Dr. Google. Aesthet Surg J 39(4):NP87–NP89
Lund H (2021) Commentary on: understanding breast implant illness. Aesthet Surg J. https://doi.org/10.1093/asj/sjaa363
Azzi AJ, Almadani Y, Davison P (2021) A national survey to assess the population’s perception of breast implant-associated anaplastic large cell lymphoma and breast implant illness. Plast Reconstr Surg 147(4):795–803
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine 6 (7): e1000097
ASPS Evidence Rating Scales (2011). www.plasticsurgery.org/documents/medical-professionals/health-policy/evidence-practice/ASPS-Rating-Scale-March-2011.pdf.
NIH Study Quality Assessment Tool—Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies (2014). https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools.
Sterne JAC, Hernán MA, Reeves BC, Savović J, Berkman ND et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomized studies of interventions. BMJ 355:i4919
Watad A, Rosenberg V, Tiosano S, Cohen Tervaert JW, Yavne Y, Shoenfeld Y, Shalev V, Chodick G, Amital H (2018) Silicone breast implants and the risk of autoimmune/rheumatic disorders: a real-world analysis. Int J Epidemiol 47(6):1846–1854
Sánchez-Guerrero J, Colditz GA, Karlson EW, Hunter DJ, Speizer FE, Liang MH (1995) Silicone breast implants and the risk of connective-tissue diseases and symptoms. N Engl J Med 332(25):1666–1670
Fryzek JP, Signorello LB, Hakelius L, Feltelius N, Ringberg A, Blot WJ, McLaughlin JK, Nyren O (2001) Self-reported symptoms among women after cosmetic breast implant and breast reduction surgery. Plast Reconstr Surg 107(1):206–213
McGuinness LA, Higgins JPT (2020) Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Syn Meth. https://doi.org/10.1002/jrsm.1411
Tenenbaum SA, Rice JC, Espinoza LR, Cuéllar ML, Plymale DR, Sander DM, Williamson LL, Haislip AM, Gluck OS, Tesser JR (1997) Use of antipolymer antibody assay in recipients of silicone breast implants. Lancet 349 (9050): 449–54. Erratum in: Lancet 349 (9064): 1558
Steve AK, Temple-Oberle C, Yeung JK, Lafreniere AS, Harrop AR (2021) “You helped create this, help me now”: a qualitative analysis of patients’ concerns about breast implants and a proposed strategy for moving forward. Plast Reconstr Surg 147(1):16e–24e
Keane G, Chi D, Ha AY, Myckatyn TM (2021) En bloc capsulectomy for breast implant illness: a social media phenomenon? Aesthet Surg J 41(4):448–459. https://doi.org/10.1093/asj/sjaa203
Breast Implant Illness (2021) Breast implant illness—Symptoms, explant, surgeons and detoxification. https://healingbreastimplantillness.com. Accessed 14 April 2021
Colaris MJL, van der Hulst RR, Tervaert JWC (2017) Vitamin D deficiency as a risk factor for the development of autoantibodies in patients with ASIA and silicone breast implants: a cohort study and review of the literature. Clin Rheumatol 36(5):981–993
Razavi M, Primavera R, Vykunta A, Thakor AS (2021) Silicone-based bioscaffolds for cellular therapies. Mater Sci Eng C Mater Biol Appl 119:111615
Cohen Tervaert JW, Colaris MJ, van der Hulst RR (2017) Silicone breast implants and autoimmune rheumatic diseases: myth or reality. Curr Opin Rheumatol 29(4):348–354
Clemens MW, Nava MB, Rocco N, Miranda RN (2017) Understanding rare adverse sequelae of breast implants: anaplastic large-cell lymphoma, late seromas, and double capsules. Gland Surg 6(2):169–184
Hallab NJ, Samelko L, Hammond D (2021) Particulate debris released from breast implant surfaces are highly dependent on implant type. Aesthet Surg J. https://doi.org/10.1093/asj/sjab051 (Epub ahead of print. PMID: 33564817)
Hallab NJ, Cunningham BW, Jacobs JJ (2003) Spinal implant debris-induced osteolysis. Spine (Phila Pa 1976) 28(20):S125–S138
Campbell A, Brautbar N, Vojdani A (1994) Suppressed natural killer cell activity in patients with silicone breast implants: reversal upon explantation. Toxicol Ind Health 10:149–154
Bartok B, Firestein GS (2010) Fibroblast-like synoviocytes: key effector cells in rheumatoid arthritis. Immunol Rev 233:233–255
Swanson E (2020) Breast implant illness, biofilm, and the role of capsulectomy. Plast Reconstr Surg Glob Open 8(7):e2999
Ahern M, Smith M, Chua H et al (2002) Breast implants and illness: a model of psychological illness. Ann Rheum Dis 61:659
Dush DM (2001) Breast implants and illness: a model of psychological factors. Ann Rheum Dis 60(7):653–657
Jacobsen PH, Hölmich LR, McLaughlin JK, Johansen C, Olsen JH, Kjøller K, Friis S (2004) Mortality and suicide among Danish women with cosmetic breast implants. Arch Intern Med 164(22):2450–2455
Balk EM, Raman G (2016) Long-term health outcomes in women with silicone gel breast implants. Ann Intern Med 165:527–528
Zaborski D, Rzepa T, Pastucha M, Modrzejewski A, Grzesiak W (2019) Neuroticism level and life satisfaction in women undergoing breast augmentation surgery (a preliminary report). Aesthetic Plast Surg 43(2):521–530
de Boer M, Colaris M, van der Hulst RRWJ, Cohen Tervaert JW (2017) Is explantation of silicone breast implants useful in patients with complaints? Immunol Res 65(1):25–36
Valente DS, Zanella RK, Mulazzani CM, Valente SS (2021) Risk factors for explantation of breast implants: a cross-sectional study. Aesthet Surg J. https://doi.org/10.1093/asj/sjaa352 (Epub ahead of print. PMID: 33649754)
McGuire PA (2021) Commentary on: en bloc capsulectomy for breast implant illness: a social media phenomenon? Aesthet Surg J 41(4):460–462
Peters W, Smith D, Fornasier V et al (1997) An outcome analysis of 100 women after explantation of silicone gel breast implants. Ann Plast Surg 39(1):9–19
Melmed EP (1998) A review of explantation in 240 symptomatic women: a description of explantation and capsulectomy with reconstruction using a periareolar technique. Plast Reconstr Surg 101(5):1364–1373
Rohrich RJ, Kenkel JM, Adams WP et al (2000) A prospective analysis of patients undergoing silicone breast implant explantation. Plast Reconstr Surg 105(7):2529–2537
Patel A, Blackmore K, Carruthers R (2020) The integrated treatment for chronic pain and anxiety in a patient with breast implant illness symptoms: a case report. Integr Med (Encinitas) 19(4):28–33
Maijers MC, de Blok CJ, Niessen FB, van der Veldt AA, Ritt MJ, Winters HA, Kramer MH, Nanayakkara PW (2013) Women with silicone breast implants and unexplained systemic symptoms: a descriptive cohort study. Neth J Med 71(10):534–540
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest to disclose.
Human or Animal Rights
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed Consent
For this type of study informed consent is not required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Atiyeh, B., Emsieh, S. Breast Implant Illness (BII): Real Syndrome or a Social Media Phenomenon? A Narrative Review of the Literature. Aesth Plast Surg 46, 43–57 (2022). https://doi.org/10.1007/s00266-021-02428-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-021-02428-8