Breast augmentation is a significant decision, involving various techniques and considerations. Each method has distinct risks and potential complications, including the development of capsular contractures, nerve pain, chronic pain, postural problems, and the increasingly discussed Breast Implant Illness (BII). A thorough understanding of these issues is crucial for informed decision-making.

In-Depth Analysis of Breast Implant Placement Techniques

1. Submuscular Placement

• Biomechanics: Ideal for individuals with minimal natural breast tissue.

• Risks: Longer recovery, animation deformity, potential nerve damage.

• Signs and Symptoms: Movement of the implant with muscle activity, persistent post-operative pain, unusual breast shapes during muscle use.

2. Subfascial Placement

• Biomechanics: Balances natural appearance and muscle interference.

• Risks: Implant visibility and palpability, moderate risk of capsular contracture.

• Signs and Symptoms: Visible implant edges, breast firmness, mild discomfort.

3. Subglandular Placement

• Biomechanics: Suitable for those with adequate natural breast tissue.

• Risks: High risk of capsular contracture, increased visibility, mammogram interference.

• Signs and Symptoms: Breast hardening, visible implant, screening challenges, discomfort.

Breast Implant Illness (BII): An Emerging Concern

Breast Implant Illness (BII) is a term used to describe a wide range of symptoms that some individuals report experiencing after undergoing breast implant surgery. It’s important to note that as of today BII is not officially recognized as a distinct medical diagnosis in the broader medical community. However, the symptoms and concerns reported by patients are taken seriously by healthcare professionals. We like to think of it as a syndrome which by definition is “a group of symptoms which consistently occur together, or a condition characterized by a set of associated symptoms.”

Understanding Breast Implant Illness

1. Symptomatology: BII encompasses a diverse range of symptoms, which can vary greatly in severity and type. Commonly reported symptoms include fatigue, joint and muscle pain, memory and concentration problems (often referred to as “brain fog”), breathing difficulties, sleep disturbance, rashes and skin problems, dry mouth and eyes, anxiety, gastrointestinal issues, and others.

2. Cause and Etiology: The exact cause of BII is not clearly understood. Several theories have been proposed, including:

• Autoimmune Response: Some believe that the body’s immune system may react to the implants, causing systemic symptoms.

• Inflammatory Response: The implants might trigger a chronic inflammatory response in the body.

• Toxicological Factors: Concerns about silicone leakage or other materials used in implants causing systemic illness.

• Psychosomatic Factors: There is also a perspective that some symptoms may be related to psychological or emotional factors related to having implants.

3. Prevalence: Determining the prevalence of BII is challenging due to the lack of a formal diagnostic criteria and the variability of symptoms. Reports of these symptoms have been noted by a significant number of women with implants.

Diagnosis and Treatment

1. Diagnosis: Diagnosing BII is complicated, as there is no specific test to identify it. Diagnosis typically involves a process of exclusion, ruling out other potential causes for the symptoms.

2. Treatment: The primary treatment for BII reported by patients has been the removal of the breast implants, known as explant surgery. Many women have reported improvement or resolution of symptoms following explantation, though this is not universal.

3. Multidisciplinary Approach: Given the range of symptoms, treatment may require a multidisciplinary approach, including input from specialists in immunology, rheumatology, neurology, and mental health.

Research and Recognition

1. Current Research: Research into BII is ongoing, with efforts to better understand its potential causes, mechanisms, and effective treatments.

2. Medical Community’s Stance: The medical community, including plastic surgeons and other specialists, is increasingly acknowledging the concerns of patients with BII and working towards a better understanding of the condition.

3. Patient Advocacy: There is a growing movement of patient advocacy, pushing for more research, awareness, and recognition of BII.

Breast Implant Illness remains a complex and somewhat controversial topic. While not officially recognized as a distinct medical condition, the symptoms are real and impactful for those experiencing them. The medical community’s response involves ongoing research, patient support, and a careful approach to both diagnosis and treatment, highlighting the need for individualized care and informed decision-making regarding breast implants.

Capsular Contractures: Everything You Should Know

Capsular contracture is a common complication associated with breast implants and involves the formation of excessive scar tissue around the implant. Understanding its pathophysiology helps explain how it can lead to chronic pain and dysfunction.

Pathophysiology of Capsular Contracture

1. Normal Response to Implants: When a breast implant is placed, the body naturally forms a capsule of fibrous scar tissue around it. This is a normal response to any foreign object in the body.

2. Excessive Scar Tissue Formation: In capsular contracture, this scar tissue thickens and tightens (or contracts) around the implant. The exact cause of this excessive and abnormal scarring is not fully understood, but several factors are thought to contribute:

• Bacterial Contamination: Subclinical bacterial infection around the implant may stimulate an excessive fibrotic response.

• Hematoma: Blood collection around the implant site can lead to inflammation and increased scar tissue formation.

• Seroma: Accumulation of fluid around the implant can also provoke an inflammatory response, leading to more scarring.

• Implant Surface and Material: The texture and type of implant material can influence the likelihood of capsular contracture.

3. Stages of Severity: Capsular contracture is often graded using the Baker scale, which ranges from Grade I (breast is soft and appears natural) to Grade IV (breast is hard, painful, and appears abnormal).

Chronic Pain and Dysfunction

1. Constriction and Hardening: As the scar tissue contracts, it can cause the implant (and the breast) to feel hard and firm. This constriction can put pressure on the surrounding tissues and nerves, leading to pain.

2. Displacement of Implant: In severe cases, the contracting capsule can distort the shape and position of the implant, leading to asymmetry, discomfort, and sometimes pain.

3. Impact on Nerves: The pressure exerted by the tight scar tissue can compress local nerves, causing nerve pain, sensitivity, or numbness in the breast area.

4. Aesthetic and Functional Issues: Apart from pain, capsular contracture can lead to cosmetic deformities and functional limitations. The breast may look unnaturally round, high, or uneven, and the tightness can limit the natural movement of the breast, affecting physical activities.

5. Psychological Impact: The chronic pain and aesthetic changes can also have psychological effects, potentially impacting a person’s self-esteem and quality of life.

Breast Implants: Postural Problems and Chronic Pain

Postural Changes

Breast implants, especially larger ones, can alter the body’s center of gravity, leading to postural changes. This shift can increase the strain on the back, neck, and shoulders, potentially leading to chronic pain and musculoskeletal issues.

Chronic Pain

The added weight and altered biomechanics can strain muscles and ligaments, leading to ongoing discomfort. Submuscular placement, in particular, can affect chest muscle function, contributing to chronic pain in the chest, back, and shoulders.

Signs and Symptoms

Indicators of postural issues include back and neck pain, shoulder discomfort, and changes in spinal curvature. Chronic pain symptoms may manifest as persistent aches, muscle fatigue, and discomfort in the chest and surrounding areas.

Management Approaches

Addressing these issues often involves chiropractic manual therapy, physical therapy, targeted exercises to strengthen core and back muscles, and posture correction techniques. Manual therapies like massage and myofascial therapy can also be beneficial in relieving muscle tension and pain.

Manual therapy and posture correction play significant roles in managing chronic pain and nerve pain related to breast implants. These non-surgical approaches are often the first line of treatment, especially when the pain is attributed to muscular tension or postural imbalances. However, if these measures fail, surgical intervention may be considered, which comes with its own set of risks and considerations.

Manual Therapy and Posture Correction

1. Relieving Muscle Tension: Manual therapy techniques, including massage and myofascial release, can help alleviate muscle tension around the chest, shoulders, and back, which may be exacerbated by the presence of breast implants.

2. Improving Circulation and Reducing Inflammation: These therapies can also improve blood circulation, potentially reducing inflammation and aiding in the healing of nerve tissues that might be affected by the implants.

3. Correcting Postural Imbalances: Breast implants, especially if large, can alter a woman’s center of gravity, leading to postural changes. Posture correction exercises and physical therapy can help strengthen the back and core muscles, reducing the strain on the spine and potentially alleviating pain.

4. Nerve Pain Management: For nerve pain, therapies like manual nerve mobilization and gentle stretching exercises can be beneficial in relieving nerve compression caused by tight muscles or scar tissue.

5. Customized Approach: It’s important that these therapies are tailored to the individual’s specific needs and conditions. At Movability we employ a multidisciplinary approach involving chiropractors, physical therapists, acupuncture, massage therapists, and naturopathic doctors to offer comprehensive care.

Surgical Intervention

1. Indications for Surgery: If manual therapy and posture correction do not provide sufficient relief, or if the pain is directly associated with complications like capsular contracture, surgery may be considered. This could involve implant removal, replacement, or repositioning.

2. Risks of Surgery: Surgical intervention carries its own risks, such as infection, bleeding, anesthesia complications, and the potential for further scar tissue formation. Each additional surgery can increase the risk of complications and can impact the aesthetic outcome.

3. Creation of New Scar Tissue: Any surgical intervention will result in the creation of new scar tissue. This scar tissue can potentially contribute to future complications or discomfort, similar to the original issues.

4. Post-Surgical Rehabilitation: Post-operative care and rehabilitation are crucial. This may involve a return to manual therapies and posture correction exercises to aid in recovery and address any new muscle imbalances or scar tissue formation.

5. Consideration of Benefits vs. Risks: The decision to undergo surgery should be made after a careful consideration of the potential benefits and risks. This decision-making process should involve thorough discussions with healthcare providers, including the surgeon and possibly a pain management specialist.

In summary, manual therapy and posture correction are vital non-surgical approaches to managing breast implant-related chronic and nerve pain, focusing on relieving muscle tension, improving circulation, and correcting postural imbalances. If these measures fail to provide relief, surgical intervention may be considered. However, surgery carries its own risks, including the potential for additional scar tissue formation, and should be approached with careful consideration of the benefits and risks.

Conclusion

Breast augmentation, while enhancing aesthetics, carries the potential for significant health implications, including postural issues, chronic pain, and the enigmatic BII. Understanding these risks and managing any complications with a combination of therapy, posture correction, and, when necessary, surgical intervention, is vital. Prospective patients should engage in detailed discussions with healthcare professionals to make well-informed decisions.