Blog — Notes of a Plastic Surgeon

Welcome to my blog. I am a plastic surgeon in Seattle and have been in private practice since 1991. I've seen more than a few interesting faces and cases through my years spent in the exam room, the operating room and the emergency room. And I have an opinion on just about everything relating to plastic surgery (and a lot of unrelated stuff). If you like my blog, let me know. Thanks for reading! Lisa

Breast Implant Illness – a seasoned plastic surgeon’s humble opinion. Updated October, 2017.

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“This stuff online just scares me to death.”

Warning:  This is a long one.  A really, really long one.

I recently counted up all of my operations for 2016 and I removed more breast implants than I put in.  Last year I removed implants from 44 women. Twenty-seven of those women had removal for the usual reasons:  “I don’t like them anymore, they make me look fat, they are too hard, I finally divorced that s.o.b., I’m becoming a nun, etc.”  But 17 women had breast implant removal because they believed their implants were ruining their health.  I have gotten to know these patients (and many more from prior years) and their families, have heard their concerns, looked at their medical histories, examined them and removed their implants.

I have given this topic of breast implant illness a lot of investigation and thought.  This blog represents my opinion based of what I have read, what I have heard from patients and my colleagues, what I have seen in the exam room and OR in over 25+ years of practice.  I recently presented a paper on breast implant illness for the Northwest Society of Plastic Surgeons.

A very brief history:  Back in the early 1990’s, just when I was entering private practice, silicone gel breast implants came under intense fire for being linked with health problems, notably autoimmune diseases like lupus and rheumatoid arthritis.  This concern led to silicone gel implants being taken off the market in the United States for cosmetic purposes.  It also lead to large amounts of money finding its way into the pockets of trial attorneys, the bankruptcy of silicone supplier Dow Corning, and at least one case of a woman removing her own implants with a razor blade in a fit of anxiety.  This moratorium on gel implants lasted well over a decade.  For over ten years, the only gel implants I used were used in one of the several studies of gel implants in which I was an investigator.  Finally, in late 2006, after exhaustive analysis of many implant studies, gel implants were again approved by the F.D.A. for cosmetic use.  Interestingly gel implants remained available for post-mastectomy reconstructive use during the moratorium.  I always thought it was odd that the it was okay for patients with a history of breast cancer to have the same silicone gel implants that were deemed too risky for a healthy woman.  And I thought it was odd that the FDA was not recommending the removal of implants that were deemed unsafe for use.    So did breast cancer survivor and congresswoman Marilyn Lloyd who asked in 1992, “How scientific is the FDA’s decision that no woman should have implants put in, and no woman should have them removed?”  Good question.

Fast forward to the past few years and I start seeing women with implants who are convinced their implants are ruining their health.  About 1/3 of them have saline implants which were never taken off the market.  These breast implant illness ladies tend to be a little younger than my average breast implant removal patients.  They tend to embrace alternative medicine and distrust the medical establishment.  And they are all connected to the online breast implant illness community.  And another thing I find so odd – some ladies with all of these symptoms often look so healthy and they ask questions like “When can I go back to teaching Pilates?”,  “Can I hike the Appalachian trail two months after surgery?”, “Is it okay if I go snowboarding after a couple of weeks?”.

Many of the symptoms of breast implant illness are a vague and/or very common complaints.  Most of these symptoms have significant overlap with the most common complaints related to common health issues including menopause, hypothyroidism, depression, anxiety, general aging and the human condition.  And some patients blame conditions with very clear etiology on their implants.  A few examples include plantar fasciitis (an overuse injury of the foot seen in runners and dancers), chronic Epstein-Barr virus (cause by a ….. virus!), Lyme disease (a tick-borne bacterial infection) and dental cavities (caused by the acid produced by sugar loving bacteria).    And then there are the fringe disorders such as leaky bowel, chronic candidiasis, multiple chemical sensitivity, etc.  To quote the very smart Dr. Marcia Angell, former editor of The New England Journal of Medicine: “These much discussed but elusive disorders remain entirely speculative …. they are variously said to consist of just about every symptom imaginable in biologically improbable and shifting combinations.  Since they have yet to be objectively and consistently defined, it is impossible to study whether they have anything to do with breast implants.”  For some really good reading and a wonderful primer on the scientific method and statistical analysis by Dr. Angell, you should really check out her book:  Science on Trial:  The Clash of Medical Evidence and the Law in Breast Implant Cases by Dr. Marcia Angell This book is a decade old but its lessons are very timely.

If a patient goes to enough alternative health providers, they will eventually find one willing to take their money to tell them that they have one, two or more of these disorders and that it’s their implants that are at fault.  They may even offer $50,000 worth of testing and treatment (as reported by one of my plastic surgery colleagues). I have one patent who saw seven naturopaths before she found one who told her what she wanted to hear. Did she ever go at an actual rheumatologist for her autoimmune symptoms?  Of course not.  She could not trust a rheumatologist.  I have patients who pay hundreds of dollars for hyperbaric oxygen treatment that does not involved a pressurized capsule.  Ladies, if you are sitting in a room without an airlock you, are not getting hyperbaric oxygen!   Several months ago I saw a middle aged lady who after reading one of the breast implant illness websites was worried that her implants were causing her sleep disturbance, brain fog, low energy and general feeling of malaise.  Then she told me that those symptoms had recently resolved.  Upon further questioning, she told me her primary care doctor had diagnosed depression and had put her on an SSRI.  After a week or so on medication, she was feeling so much better.  And her implants not only looked fine, they looked great!  This lady did not have breast implant illness.  She had depression.  She needed medication and a boost in her seratonin, not an operation.  Oh, and then a few weeks ago my nurse took a call from a lady who was in a panic about needing her 10+ year old implants removed the next day before they killed her.  I was scrubbed in the OR and could not talk to her.  My nurse explained that she would need to come in for a consultation and that it may be a few weeks before I had the OR time to do her surgery.  She berated me, my nurse, the universe and then hung up before we could get contact information on her.  I have no idea what has happened to her but whoever in the BII community scared her silly about her breast implants did not do her a favor.

I regularly visit some of these breast implant illness websites and Facebook groups and Instagram and to be very honest, I find so much of the content just outrageous.  Several of my patients noted the onset of their breast implant illness after stumbling into one of the breast implant illness communities.  Is this the nocebo effect (the placebo effect’s evil twin a.k.a. the power of negative thinking)?  Maybe.  One thing I find very interesting is the number of women who have their implants removed and still feel ill months and years later.   Do they think that maybe their problems were perhaps not related to their implants?  No, they are told that even after removal of the implants and scar tissue, the fact that they ever had implants condemns them to a life of ill health as if implants somehow have thrown a biological switch from healthy to sick.  Some of these posts are just heartbreaking to read. And most of the advice being given by non-physicians has no basis in reality based medicine.  And then there is the dismissal of surgeons like me who spent their youth training in medicine and surgery (I completed my residency training at the tender age of 35), took the Hippocratic Oath and devote most of their waking hours doing their best to provide competent and conscientious care to patients.  I take it a little personally when someone is more receptive to the advice or opinion of someone on Facebook who posts photos of themselves having a coffee enema that to the advice of a fully trained and experienced plastic surgeon.  And then there are those who feel that banning breast implants and denying their access to women who either want to enhance or rebuild their breasts is somehow empowering.  Give me a break.  I get cranky just thinking about it.

Do I think breast implants can cause problems?  Oh yeah.  For a small number of unlucky patients, breast implants can be a mess.  Although implant construction has improved over the years, implants can still get hard, they can become too loose, too tight, too low, too high, too medial, too lateral, too anything.  They can develop thick scar capsules that can cause distortion and cause pain in the breast, chest wall, upper extremities, neck and back.  Implants can leak which will deflate a saline implant.  A leak or rupture of a gel implant can result in silicone granulomas of the breast and even the chest and abdominal wall.  And then there is the more recent worry of ALCL which is looking like it occurs exclusively with textured implants but the jury is still out on that one.  I sometimes see patients who have had 3, 4 or more operations related to implant problems.  And yes, I am the original surgeon on a couple of them.  And yes, if a woman has breast implants she will likely need an implant related procedure sometime in the future.  And one more thing – IMO the bigger the implants, the bigger the problems.  That’s why you don’t see any large casaba melons in my photo gallery!  And you will also see a lot of non implant breast surgery in my photo gallery.  If I can make a breast look nice without an implant, I will encourage the no-implant route.

Do my implant removal patients feel better after removal?   Most, but not all of them, do feel better.  One interesting finding in almost all of my breast implant illness patients is a tight implant capsule.  Sometimes it is very thin and fragile and sometimes it is thick and even calcified but they are always really, really tight.  That tight scar tissue can cause discomfort that can include the entire upper extremity, chest, back and even the neck.  Removal of the scar tissue capsule (a procedure called a capsulectomy) will often result in a lot of relief.  Sometimes in surgery, I think I can hear the pectoralis major muscle breath a sigh of relief as I remove the tight scar tissue.   Also, capsule formation is an inflammatory process and we all know that inflammation is the new bogeyman.  And then there is the placebo effect.  I have a deep belief and deep respect for the mind–body connection.  Some patients fret every day about their implant’s effect on their health.  After removal, they often report just feeling better all over.  Is it that they don’t have the constant worry anymore or something else?  I really don’t know.  I can never guarantee what effect breast implant removal will have on a patient’s health.  I think many of my breast implant illness patients are worried sick and if the object of their worry – breast implants- can be removed, I am happy to do that.   I will also go after every bit of the scar tissue around the implants if it is safe to do so.  And, if the breast tissue is healthy enough, I will do a breast lift at the same time if it will improve the appearance of the breast.  And there’s more!  I will consider doing fat transfer a few months later if the patient wants a little volume back and has some good donor fat.  And I have to say, I just love sending patients on their way to an implant-free rest of their lives with no worries about the need for further implant related surgery. I call this “graduation” from breast implants.

If you are looking for a careful and conscientious surgeon who will remove your implants and capsules and offer non-implant options to enhance your breast appearance, I’m your gal.  Come see me!  If you are looking for a surgeon who believes that breast implant surgery destroys women’s health, I am not your gal.  And really, would I use breast implants if my implant patients came crawling back to my office sick?

So, if you want your implants out for any reason, come on in.  I will  listen to your concerns and answer your questions to the best of my ability.  I’m not Marcus Welby but for a surgeon, I am really pretty nice (at least that what I have heard).

Wow, this was a long one.  Thanks for reading!   Dr. Lisa Lynn Sowder

If you want to follow me on Instagram, I would be honored.  Look for me at @breastimplantsanity. and @sowdermd.

 

 

 

Category: Breast Implant Illness, Breast Implant Removal, Breast Implants, General Health, This Makes Me Cranky.

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