A Retrospective Review of 288 Patients undergoing Total Capsulectomy and Removal of Breast Implants for Breast Implant Illness
Joseph R. Spaniol, MD1, Jacob Y. Katsnelson, MD2, Joshua C. Buinewicz2, Brian R. Buinewicz, MD2.
1Temple University Hospital, Philadelphia, PA, USA, 2Abington Memorial Hospital, Philadelphia, PA, USA.
Introduction:Breast implant illness (BII) is a novel syndrome involving a constellation of symptoms, potentially driven by a reaction of the patient’s immune system to her breast implants; awareness of which is fueled by social media. BII symptoms can affect all organ systems, and recommendations regarding treatment vary. We present a retrospective chart review of 244 patients who have presented to a single surgeon with BII symptoms and underwent bilateral implant removal and total capsulectomy.
Methods:After IRB approval, we conducted a retrospective review of all women aged 18 and older who presented to the senior author with symptoms attributed to their breast implants who underwent total capsulectomy and removal of both implants. Data obtained from the chart review included demographics, reason for initial implant placement, medical history, exam findings, and symptoms. Operative findings at the time of surgery were noted. Pathology results were reviewed in addition to post-operative visit notes.
Results:The study consisted 244 patients collected over three years, from August 1, 2016 to August 30, 2019 who underwent bilateral implant removal and total capsulectomies with the senior author. The most common symptoms mentioned at time of initial evaluation included generalized pain, fatigue, cognitive “fogginess”, migraines, headaches, anxiety, arthritis, and vision changes. The number of complaints did not vary significantly between types of implants.All capsules were sent to permanent pathology, and 106 (22%) of the capsules were found to have evidence of acute or chronic inflammation. The rate of inflammation between different makes and models of implants was not significant. However, comparing all silicone implants to all saline implants, evidence of capsule inflammation was significantly more common in capsules associated with silicone implants at a rate of 29.67% compared to 16.31% in capsules associated with saline implants (p=0.0006). Post-operative visit notes addressed specific symptoms in 44 patients, and of these, 41 (93%) reported a decrease in the number of symptoms after surgery. Overall, 85% of patients were pleased with the results of the surgery.
Conclusion:Our study has several limitations. However, evidence of capsule inflammation was common, and was significantly more commonly associated with silicone implants. This, in addition to the observed high patient satisfaction suggests that there is an organic pathologic process involved in BII. We believe that total capsulectomy and implant removal in patients with suspected BII can be safely performed and with high patient satisfaction.
Back to 2020 Abstracts