Breast Implant Illness: A Biofilm Hypothesis

Abstract

Background: "Breast implant illness" (BII) is a poorly defined cluster of nonspecific symptoms, attributed by patients as being caused by their breast implants. These symptoms can include joint pain, skin and hair changes, concentration, and fatigue. Many patients complaining of BII symptoms are dismissed as psychosomatic. There are currently over 10,000 peer-reviewed articles on breast implants, but at the time of commencing this study, only 2 articles discussed this entity. At the same time, mainstream media and social media are exploding with nonscientific discussion about BII.

Methods: We have prospectively followed 50 consecutive patients, self-referring for explantation due to BII. We analyzed their preoperative symptoms and followed up each patient with a Patient-Reported Outcome Questionnaire. All implants and capsules were, if possible, removed en bloc. Explanted implants were photographed. Implant shell and capsule sent for histology and microbiological culture.

Results: BII symptoms were not shown to correlate with any particular implant type, surface, or fill. There was no significant finding as to duration of implant or location of original surgery. Chronic infection was found in 36% of cases with Propionibacterium acnes the most common finding. Histologically, synoviocyte metaplasia was found in a significantly greater incidence than a matched cohort that had no BII symptoms (P = 0.0164). Eighty-four percent of patients reported partial or complete resolution of BII symptoms on Patient-Reported Outcome Questionnaire. None of the 50 patients would consider having breast implants again.

Conclusion: The authors believe BII to be a genuine entity worthy of further study. We have identified microbiological and histological abnormalities in a significant number of patients identifying as having BII. A large proportion of these patients have reported resolution or improvement of their symptoms in patient-reported outcomes. Improved microbiology culture techniques may identify a larger proportion of chronic infection, and further investigation of immune phenotypes and toxicology may also be warranted in this group.

Fig. 1.

Flowchart of BII cohort. AFB indicates Acid-Fast Bacilli; H&E, hematoxylin and eosin.

Fig. 2.

En bloc explant capsulectomy.

Fig. 3.

Nine most commonly reported symptoms.

Fig. 4.

Propionibacterium cultured from symptomatic patient.

Fig. 5.

P. acnes under microscopy, grown in thioglycollate medium. Source: Bob Strong, Centre for Disease Control. https://phil.cdc.gov/Details.aspx?pid=3083. This image is in the public domain and thus free of any copyright restrictions.

Fig. 6.

Synovial metaplasia surrounding foreign body granuloma. Source: Emauel, P. Synovial metaplasia pathology. Dermnet NZ. Available at: https://www.dermnetnz.org/topics/synovial-metaplasia-pathology/. Creative Commons Licensing, no changes made. https://creativecommons.org/licenses/by-nc-nd/3.0/nz/legalcode.