Breast Implant Illness (BII) is a term that still has limited use in the medical literature, though there is a growing awareness that some women may have adverse reactions to breast implants. The most common symptoms reported to the FDA's database for patients with breast implants include fatigue, brain fog, hair loss, anxiety, depression, joint pain, rashes, autoimmune disease, and weight problems. While BII does not yet have a diagnostic code assigned to it and is not considered by all in the medical community to be an official diagnosis, the current evidence supports that some patients with implants experience systemic symptoms that resolve upon explant surgery.   

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CC: Fatigue, Headaches, Hair Loss, Anxiety, Alternating Constipation/Diarrhea that began within a year of getting Breast Implants

Nora was a 36 yo female complaining of several symptoms that began the year she decided to get breast implants. Nora complained of fatigue, regular headaches, hair thinning and loss, anxiety, and constipation, none of which she had experienced before her implant surgery. During her initial visit, Nora was three years post-implants, and her symptoms had worsened over that timeframe. She had chosen silicone-gel implants.

Before her implant surgery at age 33, Nora was healthy and did not report ever having any health issues other than the occasional winter cold. She had always had a regular menstrual cycle (28-29 days), though now she sometimes experiences PMS-type symptoms the week before her period, which Nora stated was new for her post-implants. She had never taken hormonal birth control and has no children.  

Nora reported that fatigue and anxiety were the first symptoms she noticed, which she initially chalked up to getting a promotion at work and having more demands on her plate. However, the fatigue and anxiety continued to worsen to the point where Nora was having caffeine all morning and taking an anti-anxiety medication at night to get through her work day. The next symptom she noticed was hair loss, which started about a year after her implant surgery and has worsened despite changing her hair care and starting a hair-growth supplement.

Additionally, Nora reported that she experienced bloating and constipation for the first time in her life after her implant surgery. She stated she was always fairly regular and had always eaten healthy. So, her digestion never concerned her, though now she often went 3-4 days without a bowel movement and felt that "everything" made her feel bloated. When she did have a bowel movement, it tended more towards diarrhea and was often loose.

Lastly, Nora started experiencing headaches about 18 months after her implant surgery and now was experiencing them 2-3 times per week. She did not take any medication for them as she wanted to be "clear" at work, though she often had to shut the lights off in her office and lay on the floor for a while when they would occur. Nora didn't feel they coincided with her menstrual cycle.

Nora's work schedule involved 10-12 hour days Monday through Friday, though she admitted she loved her job and didn't mind the hours. She lives at home with her husband, who was very supportive of her current health journey. Nora ate primarily plant-based, with some chicken and fish 1-2 times per week. At the time of her initial consult, she was taking several supplements to alleviate her symptoms, including a B complex, ashwagandha, an omega-3 supplement, and occasionally a laxative to alleviate her constipation.  

Lab Work

The following specialty labs were run:

Comprehensive Stool Test Results

• Pancreatic Elastase Low
• Fecal Fat High
• High fecal sIgA
• Elevated candida spp., opportunistic bacteria species
• Low commensal bacterial spp.

Silicone Hypersensitivity Panel Results

Strong reactions to Candida albicans, Silicates/silicon dioxide, Formaldehyde, benzene, silicone

Moderate reactions to titanium dioxide, vinyl chloride

Micronutrient Panel Results

Low: Vitamin D3, Vitamin C, Vitamin B5, Vitamin B6, Zinc, Vitamin K1, Glutamine, Vitamin B12, Selenium, Total Omega-3, CoQ10, Glutathione, Magnesium

Heavy Metal Testing Results

Unremarkable

Additional Lab Results

We worked alongside Nora's plastic surgeon, as she was already considering an explant surgery when she came to see us. Her surgeon also did an ultrasound, which did not find any ruptures in her implants. 

Lab Analysis 

Nora's lab work points to a few different problems that are contributing to her symptoms.

Dysbiosis and Malabsorption

Nora's stool test showed low pancreatic elastase and high fecal fat, indicating low digestive enzyme function and likely malabsorption. This can lead to difficulty absorbing nutrients from food and can contribute to bloating and digestive issues such as constipation. Additionally, she showed an elevated growth of candida spp. And several opportunistic bacterial spp, with low growth of several beneficial commensal species, indicating dysbiosis in her microbiome. An imbalanced microbiome can lead to constipation, hormone dysfunction, inflammation, and a slower detoxification ability. Last, common gastrointestinal complaints that have been reported in association with implants are abdominal pain or changes in bowel movement patterns consistent with irritable bowel syndrome (IBS), often alternating diarrhea and constipation.  

Hormone Imbalances

Nora had borderline high TSH and low free T3, indicating hypothyroidism that could be contributing to fatigue and may have been happening in response to inflammation or nutrient deficiencies in her body. Low thyroid function can also lead to hair thinning over time, and there have been some published case studies of a potential connection between breast implants and thyroid problems. Additionally, she had low morning cortisol and borderline low afternoon cortisol, which also can contribute to fatigue. Last, Nora also showed low progesterone and borderline low testosterone. Low progesterone can cause anxiety, while low testosterone may also lead to feeling tired. 

Silicone Hypersensitivity Panel Components

Nora showed strong reactivity to several components of the silicone hypersensitivity panel, including silicone itself. She also had a strong reactivity to candida albicans, which may be worsening some of her inflammatory symptoms as she had overgrowth of candida spp. in her gut microbiome test. Silicone is an adjuvant in implants that may stimulate the immune system leading to chronic inflammatory symptoms. Additionally, Nora's liver enzymes (ALT, AST) were slightly elevated - it has been found that the liver is a common place for silicone deposition, which may lead to stress on the liver and elevated enzymes.  

Elevated Inflammation Markers

Nora showed a high omega-3 index and elevated C-reactive protein (CRP), indicating the presence of inflammation in her body. Lastly, Nora also had elevated ANA, a non-specific marker for autoimmune activity in the body.

Multiple Micronutrient Depletions

Nora had several vitamin and mineral depletions apparent on her micronutrients testing, including Vitamin D3, Vitamin C, Vitamin B5, Vitamin B6, Zinc, Vitamin K1, Glutamine, Vitamin B12, Selenium, Total Omega-3, CoQ10, Glutathione, and Magnesium. Many of these micronutrients can contribute to fatigue, decreased immune function, headaches, and other symptoms Nora had been experiencing when not at optimal levels. Vitamin D deficiency, in particular, has been identified as a risk factor for developing BII or ASIA syndrome.  

Interventions

Nora decided to get an explant surgery and did so six weeks after we started working together. We prepped her for surgery by addressing the inflammation and nutrient deficiencies in her labs, as well as working to strengthen her gut prior to her procedure. Post-op, we continued with anti-inflammatory interventions and gut microbiome support while supporting her hormones. Upon explant, it was found that Nora's left silicone implant had a small tear not seen on her initial ultrasound, making it possible that the materials had been leaking into the circulation, which may explain the strong reactivity on the silicone hypersensitivity panel.  

Pre-Surgery:

• Start comprehensive digestive enzyme to help support food breakdown and nutrient absorption (Apex Energetics Enzymix-Pro)
• Started fish oil supplement at 3g combined DHA/EPA per day to address inflammation (stopped ten days prior to explant surgery)
• Started Magnesium Glycinate, 400mg at night
• Started Vitamin D3, 2000IU once/day (Apex Energetics Liqua-D)
• Added in a greens powder (Organifi Green Juice) to increase nutrient intake and support healthy detoxification function, one scoop per day in water
• For three weeks, supplemented with Solaray Yeast-Cleanse (oregano-oil and other antifungals) once/day, along with 1-2 capsules of BIND (Systemic Formulas binder, charcoal-based) in the evening to help address yeast overgrowth and elimination
• Started probiotic (Metagenics Ultra-Flora), two capsules per day
• Nutritionally, we emphasized an anti-inflammatory, whole food, nutrient-dense diet rich in fruits, vegetables, healthy fats, and protein, including adding in some dark chicken meat, grass-fed beef, and coldwater fish to help address Nora's micronutrient levels. Nora eliminated gluten-containing grains and dairy in the six weeks leading up to her procedure to further help reduce inflammation.

Post-Surgery:

• She continued an anti-inflammatory, whole-food Mediterranean-type diet with quality animal protein, fruits, vegetables, healthy fats like olive oil and avocado, and gluten-free whole grains. Nora felt it was very simple to eat this way and wanted to continue as she felt it improved her energy levels. We also emphasized bitter vegetables (to support digestion), pairing non-heme iron with citrus (to increase absorption), and focused on mindful eating hygiene. Estrogen-metabolizing foods such as flaxseed and cooked cruciferous vegetables were also focal points, as were seaweed, pumpkin seeds, and brazil nuts, to support the thyroid. 
• Once cleared post-op, Nora's exercise plan included plenty of walking and low-level movement, 2-3 weight training sessions per week, and one high-intensity interval session (20 minutes duration). She worked under the guidance of a certified personal trainer.
• Nora used red light therapy post-op for 15-20 minutes daily to aid in healing
• She repeated Yeast-Cleanse with BIND charcoal-based binder for three weeks post-op and then stopped these two supplements.  
• Added in The One mitochondrial optimization supplement post-op, 2x/day to support energy and cellular repair
• Added in vitamin C 500mg 2x/day
• Added in homeopathic support arnica montana - 2x per day for two weeks post-surgery
• Continued digestive enzyme, fish oil, magnesium glycinate, vitamin D, greens powder, and probiotic once OK'd by Nora's surgeon (all added back within a week post-op).
• Two months post-op, we added the following to support her hormones:

• Timed sunlight exposure to support regulation of her circadian rhythm, alongside a consistent sleep routine
• Desiccated adrenal: 2 tablets in the morning + 2 tablets early afternoon (Standard Process Drenamin)
• Bio-identical progesterone days 15-end of cycle per Nora's OB/GYN

Follow-Up Labs 4 Months Post-Op

Micronutrient Testing Follow-Up Results

Low: CoQ10, Vitamin C

Follow-Up Interpretations and Continued Interventions

Over the course of four months post-explant, Nora implemented nutritional, supplemental, and lifestyle changes with weekly coaching and support. At our in-depth follow-up visit four months later, Nora's health was very different than when we first met two months before her surgery.  

All of Nora's lab markers returned to normal ranges. However, her omega-3 index was still in the intermediate range, and her ANA titer was at 1:80, indicating her body was still recovering from the inflammation she had been experiencing. Her micronutrient deficiencies had also improved, with only vitamin C and CoQ10 still coming back at low levels. 

Nora's bowel movements were back to normal, occurring 1-2x/day for the last two months leading up to our visit. She reported her energy was back, and she could handle work stress much better. She occasionally experienced anxiety when she had a lot on her plate at work. She had started seeing a therapist to work through strategies to support better work-life balance and working through the anxious feelings. Nora had not experienced any headaches since one-month post-op, and her menstrual cycle had been regular 28-day cycles the previous two cycles before this follow-up visit, with minimal symptoms.  

While Nora's hair hadn't quite grown back to what it was pre-implant, Nora shared that her hairdresser had mentioned "baby hair growth" and felt confident it was starting to return.

Moving forward from the 4-month post-op follow-up, Nora planned on continuing her diet and intends to experiment with adding back in dairy and sourdough bread to see how she felt with these foods. She continued the vitamin D, greens powder, The One mitochondrial support, Drenamin (as needed during stressful work), Vitamin C, magnesium, and probiotics.  

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Summary

This case highlights the challenges with identifying breast implant illness, as symptoms often resemble and overlap with other conditions such as dysbiosis, hormone imbalances, or inflammatory conditions like autoimmunity. The timing of symptom appearance and health history of a given BII patient is essential in ruling BII in or out, and it remains the case that BII is often a diagnosis of exclusion - meaning that other conditions are typically ruled out before a label of BII is assigned to a given patient. While more research needs to be done on this condition, it's possible that implant surgery can be a triggering event for inflammation in the body in susceptible individuals, and it's important not to dismiss the symptoms of women in this scenario.