Below, Plastic Surgery Practice sits down with Constance M. Chen, MD, FACS, a New York-based board-certified plastic surgeon and breast reconstruction specialist, to discuss the latest trends in breast implants and whether concerns surrounding breast implant illness are overblown or valid.
Plastic Surgery Practice: What are the most common problems patients encounter with breast implants?
Constance M. Chen, MD, FACS: The most common problems are capsular contracture, which is a thickening, hardening, and squeezing of the scar tissue that forms around breast implants; infection; and implant rupture. Also very common are asymmetry, rippling, and breast implant illness.
Breast implant illness, or BII, is a collection of symptoms such as brain fog, joint aches, skin changes, visual problems, and other autoimmune-type symptoms that are described by patients but go away when the breast implants are removed. BII is not recognized by the medical community.
PSP: What best practices should plastic surgeons keep in mind when performing explant surgeries?
Chen: The absolute best practice is removal of the implant with a complete en bloc capsulectomy, meaning removal of the entire capsule (or scar tissue around the implant) including the posterior capsule that is on the chest wall. If a patient has early-stage Breast Implant-Associate Anaplastic Large Cell Lymphoma (ALCL), an extremely rare (0.2%) cancer of the immune system that affects the scar tissue around breast implants, then implant removal with complete en bloc capsulectomy should be curative.
Most patients will not have BIA-ALCL, however. In this case, plastic surgeons who perform explant surgeries should keep patients safe. For this reason, many plastic surgeons will feel more comfortable leaving the posterior capsule of the breast implant on the chest wall, as it can be very difficult to peel off the capsule from the chest wall when the breast implant was placed underneath the pectorals muscle.
PSP: Breast implant illness is certainly a hot-button issue in the plastic surgery arena. Do you think it’s overblown or not?
Chen: Breast implant illness is a hot-button issue because hundreds of thousands of patients with breast implants believe that they are affected with it, and then their symptoms go away when their implants are removed. With social media, breast implant patients communicate their symptoms and their resolution with each other. Many BII patients have seen many different types of physicians and undergone numerous tests without a diagnosis, and their symptoms have often been dismissed.
That said, there have also been numerous studies in the medical literature demonstrating a higher incidence of autoimmune diseases such as rheumatoid arthritis, scleroderma, Sjogren’s disease, etc. with breast implants—especially silicone breast implants. Over the years, I have explanted many breast implants and have been surprised at how quickly and decisively symptoms have almost always resolved after breast implants were removed. Thus, I think it is not fair to dismiss patient concerns as overblown, and physicians and surgeons in the medical community owe it to their patients to take their concerns more seriously.
PSP: In your practice, what trends are you seeing among breast implant patients?
Chen: Among breast implant patients, there is a trend toward placing breast implants above the muscle, smaller implants, and considering saline implants for its safety profile. In addition, due to a significantly higher rate of BIA-ALCL with textured implants as opposed to smooth implants, there is a trend toward using smooth, round implants instead of textured-shaped implants.
PSP: You’re known for helping mastectomy patients regain nerve function. What do you want to tell these patients about their options for nerve regeneration?
Chen: For mastectomy patients who want soft, warm, living breasts that look and feel as much as possible like normal breasts, the gold standard is to undergo natural tissue breast reconstruction with sensory restoration. This can either be done at the time of mastectomy, or long after mastectomy if the patient has not had breast reconstruction or had an implant-based breast reconstruction.
To reconnect the nerves for sensory restoration, the nerves from the patient’s donor site tissue are reconnected along with the arteries and veins under an operating microscope to recipient nerves, arteries, and veins in the chest wall. While the return of sensation is variable for different patients, reconnecting the nerves greatly increases the chances of having breasts with feeling. For many women, being able to feel their breasts again after mastectomy goes a long way toward making them feel more normal. For these women, the fact that they underwent bilateral mastectomies becomes a fading memory as they move on to live long and healthy lives.
