A Functional Medicine Approach to Breast Implant Illness: BII

More than 35 million women have breast implants worldwide, with more and more anecdotal stories of chronic health issues linked to implants. While there haven't been any controlled studies looking at the number of women who develop breast implant illness, or BII, it is becoming more and more acknowledged throughout the medical community as a possible cause of chronic health issues in women with implants, or at least as a topic that is worthy of more research.

With symptoms ranging from fatigue and brain fog to joint pain and skin rashes, BII symptoms can overlap with other chronic health conditions and is often a diagnosis of exclusion. The exact cause isn't clear, though it may be related to autoimmune or inflammatory responses to implants.

It should be noted that there is currently no recognized diagnosis code for BII in the medical community, and it's a contested topic throughout the healthcare community in general.  

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What is Breast Implant Illness (BII)?

BII is a group of symptoms that may be related to breast implants, possibly through an autoimmune or inflammatory response to the implant. It's also been referred to as ASIA (Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants). However, it's still unclear whether BII occurs as a direct result of implant materials such as saline or silicone or if the implant as a whole may stimulate autoimmune responses (as there's a higher rate of autoimmune disease in other surgical implants such as orthopedic devices).

Immune markers in women with breast implants have included the presence of antinuclear auto-antibodies (ANA), elevated rheumatoid factor and immune complexes, alterations in the T-helper/T- suppressor ratio, decreased natural killer cell activity, and antibodies to a wide range of tissue proteins. In addition, women with breast implants and dermato- myositis appear to have a significantly higher prevalence of human leukocyte antigen (HLA) compared to control subjects.

Implant life varies from person to person, and the longer an individual has them, the more likely that person is to develop symptoms. The lifetime is unpredictable, and research is still underway to find better ways of tracking potential health effects and when removal or repair is needed.

What is Silicone Hypersensitivity?

Silicone breast implants are the leading cause of silicone-related complaints. Silicone was initially believed to be inert for many years, despite brief case reports in the literature suggesting otherwise. The literature now shows that silicone appears to induce both local and systemic reactions. A significant number of women with gel-filled implants have presented with a multitude of medical symptoms, including "breast implant illness ."

One theory on how silicone-filled breast implants may invoke an inflammatory response:

1) Macrophages gather over the surface of the implant

2) Activated T-lymphocytes stimulate macrophages to fuse and form foreign body giant cells that engulf beads of silicone gel

3) Angiogenesis and fibroplasia occur around the implant in response to macrophage release factors.

Breast Implant Illness (BII) Signs & Symptoms

The symptoms associated with BII vary widely and are often symptoms that can be attributed to other body systems and common health issues, so one might not suspect BII as an initial diagnosis. From 2002 to 2020, the most frequently reported BII symptoms by patients (noted by the FDA) include fatigue, hair loss, joint pain, and a rash or skin hypersensitivity.

Some other symptoms associated with BII include:

• Dry Eyes
• Puffy eyes
• Anxiety
• Depression
• Brain fog or trouble concentrating
• Headaches
• Gut issues
• Ringing ears
• Thyroid dysfunction
• Autoimmune disease

Additionally, in September 2022, the FDA issued a safety bulletin to inform the public about reports of cancer, including lymphoma and squamous cell carcinoma, in the scar tissue (capsule) that forms around breast implants as an emerging health issue and asking providers to submit any relevant data for further examination. So, while BII it's not yet recognized as a medical diagnosis, the association between implants and chronic health issues is on the radar in both functional and conventional medicine.  

How is Breast Implant Illness Diagnosed?

BII is often a diagnosis of exclusion, meaning it's typically considered in many cases once other diagnoses are ruled out. Since many symptoms of BII overlap with other chronic illnesses like chronic fatigue syndrome (CFS), lyme disease, and fibromyalgia (FM), it can be challenging for many to get a proper diagnosis.

From a functional medicine perspective, testing for the root causes of symptoms like fatigue and joint pain by evaluating autoimmune activity, nutrient status, mold, or pathogen presence can help rule out various conditions that can cause the same symptoms as BII.

Once other possible causes of symptoms are ruled out, a diagnosis of BII may be considered, and a discussion around explant surgery may ensue. Current studies that have evaluated BII improvement post-explant show beneficial results.

Functional Medicine Labs to Test for BII Patients

Functional medicine evaluation for BII patients may include testing to assess nutrient status, inflammation, autoimmune reactions, the presence of mold or other infections, and hormone testing, amongst others, depending on each particular case.

Autoimmune Panel

A 2019 study following almost 100,000 women found silicone breast implants are associated with an increased risk of autoimmune conditions such as Sjogren's, sclerosis, lupus, and polymyositis. Evaluating autoimmune activity can help determine if implants are potentially stimulating an immune response. It can also help guide pre- and post- explant treatment to support the inflammatory response and immune modulation through nutrition, lifestyle, and targeted supplementation. Studies show that explant surgery may benefit women who develop autoimmune conditions post-implant.  

Silicone Hypersensitivity Testing

The ELISA/ACT® LRA is an immunological test used to indicate toxic burden and hypersensitivities. This test measures delayed hypersensitivities to silicone and 18 other items commonly associated with implants. It is one of the only clinical procedures that can be used to test for reactivity to silicone.

Mold and Pathogen Testing

While most evidence relating to breast implant illness and mold is anecdotal, some recent case studies and prospective studies examine incidences of fungal infection and the presence of bacterial biofilms on breast implants. The most common fungi found in implants are Aspergillus spp., Candida spp., and Trichosporon, although others have been described.

Many symptoms of mold illness and BII overlap, and if mold or fungal antibodies are present, it's essential to support the immune system pre- and post-explant to support optimal health.

Heavy Metal Testing

Symptoms of heavy metal toxicity overlap with BII, and it can be helpful to rule out while determining if BII is present.

Comprehensive Metabolic Panel

Evaluating glucose, electrolytes, kidney, and liver function can help understand each patient's metabolic baseline and ability to handle explant surgery adequately and detoxify post-explant.

Hormone Testing

BII and inflammation, in general, can impact hormone function, including thyroid and sex hormones. If hormone profiles are not optimal, it may be more challenging to recover from explant surgery and BII. Testing can help indicate the need for further support pre-and post-surgery and provide a baseline for comparison.

Ultrasound Testing

Ultrasound testing may be used if an implant rupture is suspected. Ruptures of silicone implants are often asymptomatic yet are worrisome because the silicone and mold (if applicable) are free to migrate throughout the body.  

Functional Medicine Treatment for BII Before Explant

It's important to note that there's not much scientific evidence about treatment for BII; therefore, functional medicine treatment is focused on helping patients reduce inflammation.  A functional medicine approach can help prepare your body for the surgery through anti-inflammatory nutrition, gut support, and addressing any hormone imbalances, food sensitivities, or other factors contributing to autoimmunity or other symptoms that came up in a case history.  

Before anything it's essential for any patient considering explant surgery to get a medical consultation to be approved for the procedure and figure out your treatment path.

Nutrition

Therapeutic nutrition to support optimal gut health and address any food sensitivities (if present) may be necessary to reduce inflammation and support optimal immune function and detoxification. A functional medicine doctor may recommend consuming a nutrient-dense, anti-inflammatory diet before explant removal to help speed recovery. This type of eating includes an organic, whole foods approach with adequate protein, healthy fats, and fiber are ideal while at the same time reducing the intake of sugar and processed foods.

Lifestyle

Lifestyle recommendations to support detoxification may be helpful, including:

• Dry brushing, rebounding, infrared sauna, and other lymphatic support methods
• Exercise
• Stress management
• Conversations with one's care team (plastic surgeon, therapist, etc.) to feel confident in the decision to explant physically and emotionally.
  

Herbs and Supplements

It's important to discuss any supplements with your surgeon before implant removal. Some herbs and supplements can increase the risk of bleeding, so it's essential to have a medical team evaluate your protocol and adjust it for a specific time frame before and post-surgery.

Liver support, such as N-acetyl cysteine (NAC) or milk thistle, can be helpful, particularly if labs show signs of liver dysfunction or strain on the liver. Other detoxification support, such as Glutathione and vitamin C, may also be beneficial.

Essentially, pre-explant supplementation will depend on functional medicine lab analysis, patient history, and lifestyle. Herbs and supplements to support affected systems (hormones, immune modulation, lymphatic system) may be indicated on a case-by-case basis.

Functional Medicine Treatment for BII Post Explant

It's important to note that there's not much scientific evidence about treatment for post explant; therefore, functional medicine treatment is focused on helping patients detox and reduce inflammation post-surgery.

Nutrition

Supporting detoxification with medical-based detox programs and supplements to support liver function and mineral stores (important for detoxification enzymes) can help restore body balance. Additionally, immune support can be helpful, especially if the presence of infections or biofilms is suspected (or lab-confirmed, in the case of mold).

Nutrition plays a significant role in a medical detox program. A whole food, high phytonutrient diet is commonly suggested to assist the body with reducing toxic load. Foods like organic berries, cruciferous vegetables such as broccoli or Brussel sprouts, ginger, turmeric, bone broth, and other anti-inflammatory foods are prescribed.

Each patient will receive a personalized approach to their detox based on their symptoms and lab results.

*Note: Detox programs should always be done under the care of a healthcare practitioner to ensure proper guidance and support.

Healing Modalities

Post-surgical healing modalities such as red light therapy and hyperbaric oxygen therapy may be helpful. However, more studies are needed to evaluate these modalities, specifically explant recovery. Currently, studies pertain more to post-surgical wound healing.

Summary

Breast implant illness (BII) is a worthy consideration in individuals with implants who are suffering from a variety of symptoms that aren't seemingly attributed to any diagnosis. Challenges with diagnosis include the vast array of potential symptoms, overlap with other chronic conditions, and lack of specific testing to confirm BII. For individuals pursuing an explant surgery, a functional medicine approach pre- and post-explant can help reduce inflammation, support lymphatic drainage and detoxification, and address whole-body health.