Breast Implant Illness as a Clinical Entity: A Systematic Review of the Literature

Experiences of women who self-report Breast Implant Illness (BII): a qualitative evidence synthesis

It has been postulated, but not empirically validated, that breast implants may cause a range of systemic symptoms, recently aggregated into a syndrome termed Breast Implant Illness (BII). Research literature has focused on exploring these symptoms and possible aetiologies, however, it has not been formally recognised as a medical condition. The psychosocial experience of women who self-report BII is not well understood. This review aimed to synthesise findings from qualitative literature relating to BII. A systematic review and evidence synthesis of qualitative research was conducted and analysed using thematic synthesis. Searches were conducted in MEDLINE, CINHAL, Scopus, PsycINFO and secondary sources. Findings from nine studies were included, representing the experiences of women who had breast implants for reconstructive and cosmetic reasons. Four themes were identified: the decline in women's psychosocial wellbeing, the search for answers to their ill health, a lack of solicitude from healthcare professionals and industry, and surgery viewed as both the problem and solution. Women reported an array of distressing challenges that affected their overall quality of life. Findings highlight the need for psychosocial support and enhancing the integration of patient-entered perspectives. Further research is warranted to understand how these women can be better supported.

Heavy Metals in Breast Implants and Implications for Breast Implant Illness: A Systematic Review of the Literature

PURPOSE

Breast implant illness (BII) has raised concerns about breast implant safety, with some suggesting that heavy metals released from implants could contribute to systemic symptoms. This systematic review examines the presence of metal residues in breast implants and surrounding tissues, and their potential role in BII.

METHODS

A systematic literature search following PRISMA guidelines was conducted using EMBASE, Web of Science, and PUBMED for studies published until January 2024. Inclusion criteria targeted material science and clinical research on metal residues in patients with breast implants. Data on metal concentrations, detection techniques, sample types, and clinical outcomes were extracted.

RESULTS

Our search identified 304 titles, from which seven unique studies met inclusion criteria. Platinum, the most frequently detected metal, was detected in implant gel, capsular tissue, and systemic samples (blood, urine, and hair), in concentrations ranging from 0.001 to 125.27 μg/g. No consistent correlation was identified between metal levels and BII symptoms. Tin, aluminum, arsenic, and zinc were detected at low levels, below established toxicity thresholds, and often attributed to environmental exposure due to their presence in control groups. Inconsistencies in metal concentrations across studies were linked to variations in metal detection techniques and sample preparation.

CONCLUSION

We highlight the presence of metal residues, particularly platinum, in breast implants and adjacent tissue, but without a definitive link to BII. Current evidence does not support heavy metal toxicity as a primary justification for total capsulectomy in BII management. Further evidence-based clinical guidelines are needed to better inform management of BII.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Increased FGF-19 levels following explantation in women with breast implant illness

Breast Implant Illness (BII) is characterized by a cluster of systemic and local symptoms affecting a subset of women with silicone breast implants. While symptom improvement is frequently observed following implant removal, the underlying mechanisms remain poorly understood, and the absence of reliable biomarkers complicates clinical decision-making. Here, we investigate inflammatory protein profiles in 43 women with BII, comparing pre- and post-explantation levels using the Olink Target 96 Inflammation panel and Meso Scale Discovery technology for absolute quantification. Sixteen inflammatory proteins, including MCP-1, CD8A, and CCL11, were elevated post-explantation, with FGF-19 showing the most pronounced increase (64%). FGF-19 levels increased from a median of 136 pg/mL to 195 pg/mL (p = 0.001), comparable to levels in women with silicone breast implants but no BII. We propose that explantation may alleviate FGF-19 signaling disruption, restoring its metabolic benefits. These findings suggest FGF-19 as a potential diagnostic and therapeutic marker for BII, warranting further investigation.