No Spin Live Episode 73 – ASAPS Breast Implant Illness Advisory

Breast Implant Illness (BII) has been in the media spotlight as of late. It’s a catch-all term for a group of disparate symptoms that may be caused by a woman’s breast implants. As of now, there is no science in regards to breast implant illness. But this has not stopped unscrupulous surgeons from preying on patients’ fears and recommending unnecessary treatments that may even be dangerous. This is why the American Society of Aesthetic Plastic Surgery (ASAPS) recently put out a breast implant illness advisory statement. Dr. William P. Adams Jr. of Dallas, TX weighs in on the benefits of this statement with his esteemed colleagues Dr. Jason Pozner of Boca Raton, Dr. Dustin Reid of Austin, TX and Dr. Chet Mays of Louisville, KY.

Protecting Patients from Predatory Surgeons

ASAPS, which is the biggest aesthetic society in the world and to which all of our members belong, just released a position statement regarding breast implant illness. It came about in response to a flood of emails form members complaining about predatory surgeons who are exploiting patients’ fears regarding BII and recommending unnecessary treatments such as:

• genetic testing
• capsulectomy
• en bloc capsulectomy

Dr. Mays thinks that the statement is “great because we all turn to our societies for our information”. First, it puts the facts out there. There is no science that proves that either a capsulectomy or an en bloc capsulectomy is necessary. Second, it says that, as a group, we stand together in what we believe.

Patient Confusion Regarding En Bloc Capsulectomy

If you asked Dr. Mays 6 months ago what an en bloc capsulectomy was,  “I would have had very little knowledge of it”. But that has changed due to social media. Patients go online and research BII and then come into the office asking him for an en bloc removal without even knowing their diagnosis or what en bloc really means. It comes from the cancer literature where a surgeon needs to remove the cancerous tissue as a whole bloc in order to prevent it from spreading. “Breast implant illness is not cancer” explains Dr. Pozner.

En Bloc Capsulectomy Can Be Dangerous

“The statement gives us a leg to stand on” says Dr. Reid when a patient comes in demanding an en bloc removal. The procedure can not only result in serious scarring, but in certain cases if the capsule is close to the lungs, for example, removing this scar tissue may endanger the patient’s health. There are surgeons out there who “are building a business on scaring patients. They use giant incisions. They do these what can be dangerous operations for something that is not proven at all”. It’s nice to have the society backing up the position that neither a capsulectomy nor an en bloc capsulectomy is an indicated procedure for any diagnosis including breast implant illness.

There are some patients who have symptoms that “I can’t explain” says Dr. Reid. And for them, he will remove their implants and the capsule. But he will not guarantee that he will do it en bloc. No surgeon can because he or she won’t know the extent of the capsule, which is scar tissue, until surgery. There’s always the chance that the capsule is too close to the lungs.

What if the Patient Was a Family Member?

With his breast implant illness patients, Dr. Pozner always asks himself: “If this were a family member, what would I do?”. If the choice is between making a big cut and trying to remove the whole thing or making a small incision and removing the implant, he will always choose the latter. He can even remove the capsule, if the patient really wants this, in pieces through this small incision. “We base our whole careers on making small cuts. If we wanted to make big cuts, we would have stayed in general surgery”.