Breast implant illness is a controversial topic in surgical circles as there is no diagnostic test for it. It is fair to say that many surgeons are sceptical that the condition exists. The topic came to prominence because there was a group of women who had symptoms that were difficult to explain. Less commonly, patients started to pop up with lymphatic cancer several years later after having implants.
Researchers have long pointed out that any device such as an implant can develop a bio-film infection. Symptoms of such an infection include tiredness, chest pain, difficulty sleeping, depression, night sweats and brain fog. Bio-films are tricky as the bugs live within the body reaction capsule next to the implant, well hidden from body defences or any tests.
Moreover, it takes special measures to identify these bugs – such as scraping the bugs off tissues after surgical removal and growing in an enriched medium for 28 days under aerobic and anaerobic conditions. In our experience, most of the bugs that are grown are derived from bugs present on the skin and the armpit, but there is a miscellaneous group from elsewhere that seem to correlate with the unwelcome symptoms such E. coli, atypical mycobacterium and others.
The good news is that if the problem is suspected, the implants can be removed, together with the body reaction capsules around them. This removes not only the implant but also the bugs associated with it.
At the same time, large volume microfat grafting is done, whereby fat is taken from another part of the body and injected into the pre-existing breast tissue in front of the implant to compensate for the removal of the implant. It is all over in one operation and outcome measures indicate a high satisfaction rate with the naturally enlarged breast.
We don’t really know what the risk is of serious problems with implants until we have much more data, and it is not usually seen in most cases. Once we have enough data to correlate the bugs and their symptoms for those affected, we will be able to publish with our bacteriology colleagues and help get the problem better understood.
Dr David Crabb, Rodney Surgical Centre