What is breast implant illness?


Although silicone breast implants were temporarily removed from the market in the 1990s, numerous studies have failed to find an association between silicone breast implants and autoimmune disease.  Yet, a certain subgroup of woman with silicone implants have experienced nonspecific immunologic symptoms, seemingly without explanation.  Recently, two new hypothesis have emerged as potential explanations for these symptoms: 1) Autoimmune Syndrome Induced by Adjuvants (ASIA) and 2) Low level bacterial contamination.

In ASIA syndrome, an adjuvant (in this case silicone) is something that is stimulating the immune system and is causing symptoms such as fatigue, joint or muscle pain, memory loss, or other symptoms.  Diagnostic criteria include some combination of: exposure to an adjuvant before the onset of clinical symptoms, symptoms as described as above, and improvement with removal of the adjuvant.  These patients may have immune system markers positive in blood tests as well.  Currently, there are very few studies evaluating the outcome of explantation in patients who are suspected of having ASIA syndrome.  The limited evidence that is available suggests that around 50% of women will improve with explantation, although symptom relief may be transient.

For more information, visit https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-118

Another potential theory is that women who experience these symptoms may have a low level of bacterial contamination in their implants.  Recently, an association was discovered between textured silicone breast implants and the development of Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL).  It is thought that the presence of a certain type of bacteria may help trigger the development of this condition through a prolonged immune response.  Similarly, it is possible that in other patients, rather than developing BIA-ALCL, the immune system responds to the bacterial presence by releasing inflammatory mediators, which can cause the previously mentioned symptoms.

For more information, visit https://www.ncbi.nlm.nih.gov/pubmed/26890506


Frequently asked questions about breast implant illness and Dr. Hirsch


Credentials and Facility Affiliations


Dr. Hirsch is a board certified plastic and reconstructive surgeon.  He is the Chairman of the Division of Plastic Surgery at Providence Ceders Sinai Tarzana Medical Center, and is also affiliated with Providence St. Joseph's Medical Center and Valley Presbyterian Hospital.  He operates at several surgery centers, all of which are fully accredited.

Explant Surgery Details


Dr. Hirsch is very experienced with explant procedures and performs over 100 each year.  Typically, an en bloc capsulectomy (without breast lift) takes around 2 hours or so.  En bloc capsulectomy with breast lift is a 3 to 3.5 hour procedure depending on the breast size and implant size.  Antibiotics are given intravenously within 1 hour of incision time per standard of care.  These surgeries are performed under general anesthesia.  He is happy to return implants to the patients if desired, and will take pictures/video as well. 

In most cases, drains are used during the procedures to help prevent fluid build up (seroma), which can increase inflammation and prolong healing.  The drains are removed at the first postoperative visit which takes place one week after surgery. 



Post-operative details


The post operative discomfort is worst in the first 24-48 hours and gradually improves with time.  By the end of the first 2 weeks, most patients are feeling almost normal and can resume full activities by 4-6 weeks postoperatively.