Breast Implant Safety: an Overview of Current Regulations and Screening Guidelines

Do breast implants not cause an increased rate of abnormal electrocardiograms (ECG)?

BACKGROUND

Breast implants interfere may interfere with surface ECG recording. The goal of this study was to evaluate if the presence of breast implants can lead to abnormal electrocardiogram (ECG) using a large database in adults.

METHODS

Using ICD 10 codes for breast implants and abnormal ECG, we evaluated any association between abnormal ECG coding in adult women with breast implants compared to women without breast implants utilizing the National Inpatient Sample (NIS) database. Using different age cutoffs showed similar results.

RESULTS

A total of 252,200 women in the NIS database had coding for abnormal EKG over age 18. There were no differences in the presence of abnormal EKG in women with or without breast implants (0.28% vs 0.3%, P = 0.64, OR: 1.02, CI: 0.72-1.32, p = 0.89). After multivariate adjustment for age, baseline characteristics, and comorbid conditions, women with or without breast implants had similar rates of abnormal ECG.

CONCLUSION

Using a large database, we could not find any effect of breast implants on ECG recording suggesting that breast implant has no significant interference with ECG.

Major Clinical Adverse Events of Breast Implant in the Manufacturer and User Facility Device Experience Database

OBJECTIVE

Search the Manufacturer and User Facility Device Experience database to collect information on adverse events of breast implant. We analyzed the local complications and the breast implant illness (BII) of silicone breast implants, as well as saline breast implants separately, aim to provide a reference for women who want to breast augmentation.

MATERIALS AND METHODS

The Manufacturer and User Facility Device Experience database was queried for events reports related to the breast implant between July 1, 2012, and June 30, 2022. Event year and reporting year were summarized. Patient problem was collected and analyzed to distinguish between local complications and BII.

RESULTS

A total of 108,728 adverse events in the past 3 years were analyzed, silicone breast implants accounted for 62.1% and saline breast implants accounted for 37.9%. The most common local complication of women receiving silicone breast implants was "Capsular Contracture," accounting for 48.73%. However, the incidence of "capsular contracture" in women who received saline breast implants was only 17.49%. The most common BII was "fatigue/weakness" in both women receiving 2 different breast implants, 17.20% in women receiving silicone breast implants and 24.71% in women receiving saline breast implants. Of note, in all the reports, there was a wide variation in the timing of reporting as compared with the timing of the adverse event.

CONCLUSIONS

Although the adverse events of breast implant cannot completely be determined from this study, we provide a reference for women who want to get breast implants, so that they can choose breast implants more carefully. In addition, a better understanding of BII may allow them to think further about whether the benefits of breast implants outweigh the risks.

Plastic Surgeons' Perspective on the FDA Breast Implant Regulatory Mandates

BACKGROUND

In 2021, the US Food and Drug Administration (FDA) issued a new checklist, labeling and rupture screening recommendations for breast implants to improve the decision-making process.

OBJECTIVES

This study aims to understand the plastic surgeon's perspective on these changes and their perceived impact on clinical practice.

METHODS

In September 2023, a 27 multiple-choice cross-sectional survey was distributed to 4,352 active members of the American Society of Plastic Surgeons to evaluate attitudes on the FDA's black box warning, informed decision checklist, and updated rupture screening recommendations.

RESULTS

A total of 591 responses were collected (13.6%). The majority of respondents were between the ages of 45 to 64 (58%) and had been in practice for more than 20 years (52%). Surgeons felt like some additions were appropriate, however the majority (57%) stated that the informed decision checklist did not have a positive impact on workflow; 66% were also neutral or disagreed with the reported incidence rates related to complications and cancer. Nearly half of respondents (47%) did not feel the black box warning improved their patients' understanding of the risks and benefits. Additionally, 47% of respondents also believed these requirements, in combination, did not improve the overall patient experience with implants.

CONCLUSIONS

Respondents had an overall positive response towards the addition of risk information provided by the FDA issued guidance and updates to rupture screening recommendations. However, they remain divided as to whether the black box warning and patient decision checklist had an overall positive impact on clinical practice patterns.

Breast implant illness: Is it causally related to breast implants?

Once believed to be completely inert implants, Silicon Breast Implants (SBIs) have been shown to be able to induce a chronic inflammatory response in the body which can lead to a variety of possible manifestations ranging from the most common capsular contraction to rarer conditions such as malignancies and autoimmune diseases. Among the latter, new syndromes have been consistently recognized: Breast Implant Illness (BII) and autoimmunity/autoinflammatory syndrome induced by adjuvants (ASIA syndrome/Shoenfeld's Syndrome). The pathophysiological mechanisms underlying such syndromes are not yet clear and the overlap they show with other common conditions have sparked an important debate in the scientific community regarding their existence and their cause-effect relationship with SBIs. In this article Professor Cohen Tervaert and Professor Bassetto, leading experts in the field, are going to present arguments in favor and against such causal relationship according to the latest scientific evidence. Professor Cohen Tervaert is going to demonstrate how the evidence available is enough to prove a causal relationship as defined by the Bradford Hill's criteria. Professor Bassetto is going to highlight how the many biases that afflict the available evidence prevent us from drawing such conclusions. Professor Shoenfeld is going to moderate the discussion with its insightful conclusions.

Breast Implant Illness: Surgical, Autoimmune, and Breast Reconstruction Associations

Breast implant illness refers to a combination of different symptoms related to breast implant surgery, including fatigue, brain fog, and arthralgias. This malaise occurs after cosmetic and reconstructive breast surgeries, although it has not been proven to be a disease. Even recent studies have reported concluding statements of the etiology, diagnosis, and treatment as unclear and widely unknown. Therefore, this review aimed to determine the associations between the manifestations of breast implant illness in surgery and breast reconstruction, as well as the autoimmune responses involved. Complications associated with breast implants include breast pain, capsular contracture, infections, as well as other manifestations specific to breast reconstruction. Moreover, patients with implants may present with new-onset systemic sclerosis, Sjögren’s syndrome, and connective tissue diseases. However, the incidence of capsular contracture has steadily decreased with each generation of implants, particularly since the development of textured implants, as well as with the use of antibiotics and antiseptic pocket irrigation. However, the incidence of anaplastic large cell lymphoma has increased with the use of textured implants. Remarkably, the autoimmune response to these implants remains unclear. Therefore, close follow-up, careful observation of any symptom presentation, and evidence-based treatment decisions are necessary for patients with breast implants.

Perceptions and attitudes toward unusual complications following breast implant surgeries among Saudi female patients: How knowledgeable are our patients?

Background:

The number of breast implant-related procedures has rapidly increased. Given the current increase in social media coverage and its influence on the decision to undergo breast implant surgeries, it is critical to identify patients’ misinformation about unusual complications related to breast implants. Therefore, the present study aimed to assess the perceptions and attitudes toward unusual complications related to breast implants among patients who underwent breast implant surgeries.

Methods:

In the present cross-sectional study, a questionnaire was distributed between April 2021 and May 2021 among patients who had undergone breast implant surgeries between 2016 and 2021 at King Saud University Medical City in Riyadh, Saudi Arabia. The 26-item questionnaire was distributed online to assess the participants’ perceptions about breast implant illness (BII), capsular contracture, and breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). Data were analyzed using Statistical Package for the Social Sciences (SPSS), version 23.0.

Results:

In total, 106 patients who underwent breast implant surgeries were included in the present study (response rate: 73.6%). Their mean age was 43.68 ± 10.69 years. The reason for undergoing breast implant surgery was cosmetic in 41.5% of the participants and reconstructive in 58.5%. Moreover, 22.6%, 23.6%, and 24.5% of the participants had knowledge about BIA-ALCL, BII, and capsular contracture, respectively.

Conclusions:

The present findings indicate that it is important for plastic surgeons to discuss unusual complications related to breast implants with patients on a regular basis. Despite the obscurity of these complications, such discussions are important to provide best available information to patients.

Public Awareness of Breast Implant-associated Anaplastic Large Cell Lymphoma in Saudi Arabia

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) was first reported in 1997. Since then, the number of reported cases has been increasing, and patients' knowledge and perceptions about this condition are unclear. This study aimed to evaluate the public knowledge and perceptions toward BIA-ALCL and its association with cosmetic/reconstructive breast implants in Saudi Arabia.

Methods

In this cross-sectional, online survey-based study, women aged 18-60 years in Saudi Arabia were the target population on social media platforms. Questions included data on demographics, experience of implants, and knowledge and concerns regarding BIA-ALCL.

Results

A total of 543 women participated in this study, with a mean age of 34 years. Only 1.9% had breast implants due to cosmetic or reconstructive reasons, whereas 9.8% expressed their desire of having implants in the future. More than half (57.3%) of the respondents had never heard of BIA-ALCL in comparison with 21.7% who had an established background. After reading the highlights on BIA-ALCL, 60% of the women with breast implants still wanted to keep their implants and 42.5% of the ones who desired breast implants would still aim to have them. Almost all the sample stated that BIA-ALCL should be included in the written consent.

Conclusions

Nearly half of Saudi women have not heard of BIA-ALCL, and report that it is an important part of the surgical consultation and informed consent. Our role as plastic surgeons is to raise the awareness of BIA-ALCL through social media and health care settings to maximize the safety of women with breast implants.