Bye bye implants

Breast augmentation is one of the most common plastic surgery procedures. But with a number of women with implants suffering from illness and inflammation, Nicky Pellegrino of Next Magazine finds out about the breast explant trend.

Rocks in socks – that's how her surgeon described Aviv Jones' breasts prior to putting in implants. Aviv was in her forties at the time – a fitness instructor with a great body, but after having four children all the volume had gone from her breasts. Finding herself single and on the dating scene again following a marriage break-up, she decided on augmentation surgery.
"I thought it would give me more confidence," explains the 51-year-old from Orewa. "That's what prompted me to do it. So I had the breast implants and they looked fabulous. I still miss them."
Last July Aviv had her implants removed following a series of scares. After a mammogram she had noticed a bulge out of the side of one breast. She became concerned about the risk of anaplastic large-cell lymphoma, a relatively rare cancer that has been associated with implants. And when the breast became hard, painful and misshapen, she began fearing the silicone was leaking.
"I didn't want to worry any more," she says. "I wanted peace of mind."

Aviv went to Northland plastic surgeon, David Crabb, who took out the implants and replaced them with Aviv's own fat cells, which for this procedure are taken from various sites around the body, usually the thighs and belly.
"My breasts don't look the same," she admits.
"Before they were more like half melons, now they jiggle as I walk, like normal boobs. But I can sleep on my stomach again. They're not hard and slightly painful like they were. And I'm not worried they're leaking silicone – I'm happy."
Tests on the capsules of tissue that had surrounded the implants showed chronic inflammation. Aviv doesn't know if that is the reason why she had been experiencing brain fog and fatigue, symptoms she had put down to menopause, but it is possible.

Why women are regretting their implants

Like Aviv, increasing numbers of women around the world are opting for explant surgery – or as it's become known an "un-boob job". Singer Stevie Nicks had her breast implants removed because she was concerned they were linked to her constant fatigue.
Victoria Beckham had hers taken out, saying she regretted getting them. And New Zealand model Nicola Robinson (formerly Nicky Watson) rid her body of enlargements after suffering the symptoms of breast implant illness, which can include anything from chronic pain, swelling and muscle weakness, to fatigue, brain fog and lowered immunity.
The medical community has been slow to recognise the link but evidence is now emerging that breast implants can create long-term inflammation in the body.
Sydney cosmetic surgeon Anand Deva led a study to show that textured implants have a higher chance of developing a biofilm – basically a coating of bacteria. These bacteria are perfectly friendly when they are living on the skin – in fact, we carry a lot of them. It's when they attach to an artificial surface, such as a breast implant, that they can become a problem.
"A biofilm is the bacteria's way of survival," explains Anand. "It's a protective sticky armour that stops the body from getting rid of it."
Textured implants are popular in Australia and New Zealand as they are less likely to shift out of place than smooth ones, but the downside is there are more nooks and crannies for the biofilm to cling to. And when that implant is surgically inserted deep inside the body, it can result in a low-grade infection that grumbles away until the immune system starts to fight back, creating inflammation.
There is no doubt that biofilms are the cause of a common reason for implant failure, capsular contracture, which affects seven to 10 per cent of women with implants over the first five to 10 years.
"It's the biggest reason women come back after having implants," says Anand. "They become hard and painful, and we have to take them out. But to prove bacteria was the principle cause of that took about 30 years of research."

The painful outcome that can result from breast implants

The pain Jane Galilee suffered as a result of her breast implants ended her 25-year career with the police force. Jane went through a double mastectomy and reconstruction eight years ago, after being diagnosed with breast cancer. Almost right from the start her left breast was problematic, becoming lumpy, unattractive and tender.
"Wearing a tight, stab-proof vest was unbearable for work. I'd have it on for 10 minutes and be in agony," recalls Jane.
"I started getting really bad pains in my breast, pulling and tugging sensations. And also back pain from my bra to my neckline. I was always at the physio. The pain in my chest was so bad I ended up in hospital a few times thinking I'd had a heart attack."

Jane also had brain fogs, fatigue and short-term memory loss but presumed that was due to the lasting effects of chemotherapy. The response from the doctors she consulted wasn't helpful – one surgeon told her she should be grateful to be alive and suggested she see a psychologist.
Jane, now 51, ended up medically disengaging from the police force and has moved from Auckland back to her hometown of Whanganui where she is focusing on recovering her health.
In October she had the implants removed by David Crabb.
"I woke up from surgery and the first thing I noticed was I could put my shoulders all the way back and breathe," she says. "The pain is gone and I can sleep; it's incredible. I feel so much better."

The fat grafting technique that offers an alternative to breast implants

Rather than replacing the implants, Jane opted to have the fat grafting technique David Crabb specialises in. It was a long procedure so only one breast has been reconstructed so far.
"I'm uneven at the moment," she says. "But if the left breast turns out like the right and maintains the volume I'll be very happy. It's better than being flat-chested."
There were signs of a bacterial infection and inflammation in the capsules of tissue surrounding Jane's implants, potentially the cause of all that pain.
David says this is a familiar story. When he removes an implant, it's common for him to discover scar tissue and inflammatory changes.
"The body is trying to seal the implant off and fight the low-grade infection," he explains.
Some of his patients have been seen by multiple doctors and told nothing is wrong. Even when a troublesome implant is removed, the signs of low-grade infection aren't necessarily found, as the standard swab tests don't pick it up. More sophisticated testing on the capsule itself is needed for a complete picture, says David.
"The inflammation might not be bad enough to cause capsular contracture," he points out. "So we don't know what percentage of women have a problem."
He describes the issue as being like a pyramid. At the top are a small number of people who have serious inflammation and get chronic lymphoma (cancer), then there are those women who suffer implant syndrome. And, at the bottom, there are a whole lot of women with no symptoms at all, some of whom may progress to capsular contraction.
David isn't a fan of implants – in fact, he doesn't work with them at all. "I haven't done for several years," he says. "I can do everything I need to do without using an implant."
He believes fat grafting is safer and gives a more natural result. Some patients require a single procedure, while others may need more, depending on how much tissue is left and the amount of scar tissue.

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