Breast implants illness is a topic that has gained pace among breast implant patients in recent years. There is a lack of sufficient data on when and why it occurs, which often leaves individuals unattended to, even though they are struggling with a slew of symptoms. As more information emerges about this condition, doctors learn how to spot the signs and address people’s needs better.

In the paragraphs that follow, we have summed up the most important details about breast implant illness in Singapore and its effects on patients. If you are planning to get breast augmentation or have already gone under the knife, you may want to read this.

What is Breast Implant Illness after Breast Augmentation?

BII is a condition with a range of symptoms that has not yet been officially classified as a diagnosis in Singapore and around the world. It occurs after breast implant surgery for augmentation purposes, affecting a small percentage of patients, and can manifest itself in various ways.

What are the symptoms of breast implant illness? The signs, as seen in Singapore patients, are:

  • Breathing problems
  • Joints and muscle pain
  • Anxiety
  • Dry skin
  • Hair loss
  • Headaches
  • Depression
  • Skin problems and rashes
  • Sleep problems
  • Memory issues
  • Chronic fatigue
  • Gastrointestinal problems
  • Dry eyes and dry mouth

Since the symptoms are so random and nonspecific, they cannot be categorised into a single disease entity. Hence, the condition is often left misdiagnosed. A lot of them can occur immediately after breast surgery or years after that, making it difficult to link them to breast implants. From what we know, there is a possible association between BII and autoimmune diseases, as well as other disorders like scleroderma, rheumatoid arthritis, and lupus.

Different studies have provided evidence for and against it throughout the years. More recent research has found a link between autoimmune diseases and breast implant surgery, regardless of implant type. Yet, textured implants seem to be more dangerous.

According to one of these studies 1, breast augmentation with silicone implants and saline implants can increase the odds of developing certain diseases. Textured implants carry the highest risk, they say, especially if capsular contracture in the chest wall occurs. Even though it is a rare occurrence, it needs further investigation and conclusive evidence to help both plastic surgeons and their patients make better decisions.

What is BIA-ALCL (Breast Cancer) after Breast Implants?

Woman against breast cancer

Unfortunately, in addition to these unpleasant symptoms, silicone breast implants, and textured implants in particular, have been associated with a rare form of cancer known as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). It is not yet clear as to what is causing this but scientists believe that textured surfaces are more prone to bacterial infections, which in turn give rise to a robust immune response. When the immune system attacks its own cells, this can lead to breast cancer and other medical conditions. Further treatment is necessary. As advised by the doctor, it can be anything from targeted immunotherapy to chemotherapy, radiation, and even surgery to remove the lumps. As for the breast implants in place, they will have to be removed in a separate procedure.

Symptoms of BIA-ALCL include capsular contracture of breast implants (resulting in thick scars), fluid accumulation around the implants after breast augmentation, and continuous swelling around the operation site. The good news is, it can be successfully treated if diagnosed early.

For the most part, BIA-ALCL occurrences are nothing but low. To date, there is only one reported case of BIA-ALCL in Singapore according to medical records. Luckily, the patient was diagnosed early and has recuperated.2 Mortality rates remain low. Despite that, the Health Sciences Authority (HSA) has raised awareness among experts. It informed relevant healthcare professionals about the associated risks and even made breast implant manufacturers put cautionary statements list in the package inserts of all breast implants registered in Singapore. In addition, it has disallowed Allergan Natrelle breast implants to be sold in Singapore as a precautionary measure. The Allergan Natrelle breast implant appeared to be the only available macro-textured implant back in 2019 for aesthetic surgery.

How Common is BII?

The American Society of Plastic Surgeons has reported that the current risk of BIA-ALCL, in particular, is around 1 in 86,000 and 1 in 2,000. There are two different rates based on the type of breast implants used.

What Causes BII and Who Suffers Greater Risk of Getting It?

BII is more likely to occur in patients with allergies, autoimmune conditions, fibromyalgia, chronic fatigue, irritable bowel symptom, and other conditions. However, this doesn’t mean healthy individuals don’t run any risk of developing BII after breast implant surgery. Medical records have shown that there are women who have been diagnosed with BII, even though they are otherwise healthy.

The reason behind BII is not well understood but there is a theory among medical experts that some people are just intolerant of certain materials like the ones that are used to make breast implants. Research has found that sometimes small parts of the implant device can escape into the surrounding tissues of the body, which causes an immune reaction. More information is needed on that.

How Is BII Diagnosed after Breast Implant Surgery?

A mammologist makes breast ultrasound scanning

Truth be told, there are no diagnosis standards for BII because, as we mentioned earlier, it is not regarded as a medical condition. However, there are different diagnostic tools and approaches in Singapore that doctors can still use. Many times, they will try to rule out a number of other diseases before they can confirm a link between the implants and the ongoing symptoms.

What your doctor or surgeon will look out for is thick scarring around the implant, which may be signalling the presence of a tumour (breast cancer) in the chest wall. They will check out the patient with an ultrasound and may order blood tests and X-rays to get an insight into the body’s overall condition. They will also search for abnormal breast mass (lumps) which may be a sign of other cancerous cells being present in the breasts. A biopsy may be needed.

The route to diagnosing BII is long. Patients with breast implants may be unsuccessfully treated for other diseases, which doesn’t improve their condition and leads to confusion and desperation. In most cases, BII starts to be suspected after all medical routes and testing have been exhausted. It is at this point that specialists may look at breast implants as a possible cause.

Treatment of BII in Singapore: Breast Implant Removal

If symptoms are triggered by BII, the only way in which the issue can resolve is by breast implant removal. Basically, this means taking out the textured breast implants and any scar tissue capsules that may have formed in the chest wall. Then again, every plastic surgeon has a different approach to it.

Some breast implant removal experts like to get rid of the capsule and silicone breast implant in one piece which is believed to keep bacteria from seeping into the body and causing more harm. This is known as the ‘en bloc capsulectomy’ method. It also helps to prevent fluid accumulation in the area and speeds up the healing process. If bacteria make their way outside of the breast implants, they can cause infection. The latter is not uncommon with any breast implant surgical procedure.

Plastic surgery and cosmetic surgery are both roads more travelled, but they carry some risk despite that.

Another technique for breast implant removal that is used all the time is complete capsulectomy. It has the same outcome, only the capsule and implant are removed separately. Most patients don’t have to stay overnight in the clinic. The initial recovery period involves swelling and nipple sensation due to the incision that the plastic surgeon has to make.

People who make up their mind to undergo a breast implant removal procedure, whether they have silicone textured breast implants or saline breast implant type, are advised against getting new smooth-surfaced implants. The reason is that the symptoms may re-emerge over time. If you developed BII the first time around, chances are you will again. It’s just that some people are predisposed to getting such an immune response. Of course, your plastic surgeon will be a better judge of that after collecting your medical and personal data and looking at the details.

There is no conclusive research on breast implant removal but a lot of women report improvement in their symptoms soon after the procedure is over and up to 3 months after that. The rate varies from 69% to 89%3 and they reflect global reports. There is not much data about Singapore patients in particular.