by Rohrich, Rod J.; Kaplan, Jordan
Plastic and
Reconstructive Surgery: February 2020
- Volume 145 - Issue 2 - p 587-589
Breast implants are among the most well-studied implantable
medical devices placed in humans. They have been used in both reconstructive
and aesthetic breast surgery for more than 60 years. The safety of the device
has been affirmed repeatedly through extensive long-term studies and further
research continues to take place in order to ensure patient safety.1 Recent
scientific studies have shown an infrequent correlation between textured breast
implants and anaplastic large cell lymphoma (ALCL), which has resulted in a
specific subset of textured breast implants to be removed from market secondary
to a higher incidence of this disease.2 Such action reaffirms the
importance of ongoing research in all aspects of plastic surgery as we always
place patient safety first and foremost.
As physicians who took a Hippocratic oath to do no harm, we
must adhere to these same scientific standards if we are to meaningfully define
the wide range of symptoms that have collectively become known on social media
as “breast implant illness.” This condition has been attributed to any and all
types of saline and silicone breast implants and their surrounding silicone
shells. It has been postulated that the implant shell itself may have toxins or
other yet-to-be-defined elements that cause a myriad of symptoms yet to be
articulated in a scientific manner.3 A 2006 study published in the Annals
of Chemistry evaluated the total platinum concentration in both patient
tissue and breast implant samples. The authors concluded that women with
silicone breast implants have platinum levels that exceed that of the general
population.4 However, a critical analysis highlighted that platinum
concentrations in blood and urine samples showed no statistically significant
difference and that both the control and implanted groups were shown to have
platinum levels comparable to those in platinum industry workers. Furthermore,
the study design was deemed nonreproducible.5,6 Pinpointing a material
explanation for breast implant illness symptoms has been impeded by poor data
collection and lack of science and dissemination of misinformation on social
media, which places patients with breast implants at risk of making improperly
informed decisions.
This is not to say that breast implant illness does not
exist—both patient advocacy groups and the U.S. Food and Drug Administration
recognize various symptoms as being risks related to breast implants7—but
rather that there is no current scientific evidence to support such claims. It
is therefore the responsibility of plastic surgeons to advise patients who may
present with symptoms associated with breast implant illness to seek full
evaluation by our medical and rheumatology colleagues to ensure we are not
missing any type of disease process; the American Society of Plastic Surgeons
is taking the lead in working with patients and with the Food and Drug
Administration to investigate these widely reported symptoms in an effort to
supplant speculation with data and science.
