Sam Jejurikar, Dallas Plastic Surgeon, Analyzes Controversy on Breast Implants Making Patients Sick

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Breast implants have gained widespread usage over the past 20 years, with breast augmentation and breast reconstruction being two of the most commonly performed procedures in the United States. Dr. Sam Jejurikar of Dallas can attest.

In fact, according to the American Society of Plastic Surgeons, some 100,000 breast implants are used every year in the U.S. in breast reconstruction surgeries for patients who have been diagnosed with breast cancer, while another 300,000 implants are used in breast augmentation.  For this reason, women with implants must be aware of the potential risks associated with breast implants, in order to detect any dangerous symptoms early enough, and get to their doctors on time.

Study Finds Association between Implants and Rare Diseases

In September of 2018 an important study was conducted by researchers at the University of Texas MD Anderson Cancer Center to assess long-term safety in patients with breast implants.  This study found that some rare diseases, autoimmune disorders, and other conditions could be associated with silicone breast implants, although the study did not establish a direct causative relationship between implants and these diseases.

The study was conducted at MD Anderson’s Department of Plastic Surgery and published in the Annals of Surgery. Researchers evaluated almost 100,000 patients who had either saline or silicone implants. Their findings were consistent with other studies that have previously researched the safety of breast implants, based on data derived from the database of the U.S. Food and Drug Administration (FDA) collected since 2005, when the U.S. lifted its moratorium on silicone breast implants.

The FDA ruled that breast implant manufacturers must perform follow-up studies on breast implant patients in order to evaluate the long-term safety of breast implants, and particularly to assess the possible association between breast implants and rare systemic diseases.

The team’s senior investigator was Mark W. Clemens, M.D., Associate Professor of Plastic Surgery at MD Anderson Cancer Center.  Dr. Clemens explained that the team focused specifically on certain rare diseases. Their findings indicated an association between silicone breast implants and some autoimmune diseases and cancers, including melanoma and scleroderma.  “Fortunately, many of the diseases and conditions that have an association with implants are quite rare,” reiterates Dr. Clemens, “this is why awareness is that much more important.”

The study reported data provided by two implant manufacturers, and patients were divided into two groups by implant brand. They found that reports of melanoma, scleroderma, rheumatoid arthritis, and Sjogren syndrome were reported with 2 to 8 times more frequency in one group of implant users when compared to the general population.  The other group reported more than twice as many incidences of scleroderma, Sjogren syndrome, and dermatomyositis as those reported among the general public. The study found one case of anaplastic large cell lymphoma associated with the use of breast implants.

While the study did not establish a direct link or causative relationship between breast implants and these rare diseases, Clemens noted, “It is important to understand a limitation of the study was that some diseases were reported by patients and not necessarily diagnosed by a physician,” and points out the need for further research in this area.

The research team also studied such factors as patients’ overall wellness, satisfaction, and reproductive health, finding no correlation between breast implants and conditions such as fibromyalgia or suicidal tendencies, while reproductive outcomes were reported as inconsistent.  While the MD Anderson study turned up a higher rate of patient-reported stillbirth, preterm birth, and neonatal intensive care, the team found no correlation with miscarriage.

Interestingly, the study group found a lower rate of patient reported birth defects and congenital malformation among women with silicone implants than the rates reported by the general public, leading to the conclusion that these two areas require additional studies in order to better understand underlying issues.

“All surgical procedures and implantable devices have potential complications and side effects,” notes Dr. Clemens.  “As plastic surgeons, it’s our responsibility to continually monitor the long-term safety of breast implants and make sure that all patients and physicians are aware of any possible adverse outcomes. This ensures that patients and their healthcare providers can weigh the potential risks and benefits together to make the best possible decisions on augmentation and reconstruction.”

Doctors Respond to Concern around Breast Implant Safety

While the FDA has found no direct causal relationship between implants and these rare diseases, the study and press surrounding the research findings have prompted many women to question the safety of their implants, leading many others to opt for implant removal.

“Patients are seeking an assurance of safety,” states Dr. Clemens. “The FDA has deemed breast implants reasonably safe and effective, and being educated about potential complications is an important part of good health.”

The plastic surgery community has responded to these concerns, and doctors have upgraded the post-procedure monitoring of breast implant patients. In many cases, plastic surgeons are performing implant removal procedures at the request of concerned patients, replacing silicone with saline implants, or using fat-transfer procedures to replace the fullness and volume provided by the breast implant.

One plastic surgeon at the Dallas Plastic Surgery Institute in the Dallas-Ft. Worth area of Texas who is seeing this trend in his practice is Dr. Sam Jejurikar, a renowned, board-certified plastic surgeon, affectionately known among his patients as Dr. J.  An expert in both the areas of implant surgery and fat transfer, Dr. Jejurikar takes the potential risks of breast implants very seriously, and is closely monitoring all of his implant patients for potential long-term side effects. He pays particularly close attention to any possible developments among his implant patients that may display warning signs of any of the rare diseases noted in the Anderson MD study.

“Whether or not breast implants can cause autoimmune diseases is still a very controversial topic as clear, definitive studies linking these entities still do not exist,” explains Dr. Jejurikar.  “That being said, given the small but known association of breast implants with Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), it does seem plausible that, in a small minority of patients, an inflammatory reaction can occur which promotes more generalized illness. Although large scale data linking Breast Implants to Breast Implant Illness still aren’t forthcoming, the patients I have seen presenting their symptoms tend to be very compelling in their symptoms and stories.”

Dr. J goes on to describe his clinical observations with his own patients.  “In the past year, I’ve taken out several breast implants in patients. Most of these were for relatively standard reasons, including capsular contracture, rupture, infection, and droopiness. Some of these patients insisted they had breast implant illness, though it really seemed as though this association only was made after they spent time in an online community devoted to the subject.

In a few of the patients, however, there was a clear linkage between the onset of fatigue, joint pain, aches, and unintentional weight loss after the placement of their implants. Once their implants were removed, these symptoms went away within weeks.”

Fat Transfer as an Alternative to Breast Implants

In response to the growing concern surrounding breast implants, plastic surgeons are seeing a need to step up the options for women who want to undergo breast reconstruction or augmentation but are fearful of using silicone implants.  Many patients who already have silicone implants are choosing to replace them with saline implants, or the more natural-looking fat transfer procedure, which uses fat from one’s own body to add volume and fullness to the breasts.

Dr. Jejurikar is an advocate of the fat transfer procedure as an alternative to breast implants. This procedure is a two-part process that produces two different benefits for the patient: it extracts excess fat from target problem areas such as love handles through a simple liposuction procedure, and transfers these fat cells to the breasts, by means of a simple injection, to enhance fullness and volume in the bust line.

“Fat transfer to the breast is a viable alternative for patients who wish to have their implants removed or even for patients without implants who seek a more natural alternative to breast implants,” he explains.

Dr. J also sees some aesthetic advantages to the fat transfer procedure, in addition to the reduced risk.  “Instead of dealing with an implant and implant related complications, once the fat cells incorporate, patients can achieve a natural, softer and fuller breast.”

Naturally, there is little risk of any adverse reaction with the fat transfer procedure, because the body will easily accept and incorporate its own fat cells, producing a more natural-looking appearance.  In some cases, however, the body may absorb a portion of the transferred fat cells, and it may take more than one fat transfer process to complete the procedure in order to achieve the patient’s aesthetic goal.

Keeping Plastic Surgery Safe

Dr. Jejurikar also reiterates that in order to achieve the utmost safety in plastic surgery procedures, doctors must also educate their patients insofar as what makes any surgical procedure safer. Patients must contribute to their own well being by taking certain preventative measures when preparing for plastic surgery.

In addition to the need for suspending certain medications, supplements, and herbal remedies that may deter the healing process, one point that Dr. J emphasizes is the importance of quitting smoking and optimizing protein intaje when preparing for any plastic surgery procedure.

These two factors are extremely important to the overall safety and success of plastic surgery, and may have a significant impact on the patient’s health both during the procedure as well as during the recovery period.  He advises these healthy recommendations to not only help your body heal more quickly and effectively, but also to reduce your risk of complications, as well as contributing to an improved surgical outcome.

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