Stacked DeckThe True Costs of Breast Implants

Image by Adam Voorhes/Gallery Stock

This article was published in Plastic Issue #91 | Summer 2021

Our society cherishes big boobs. It doesn’t matter much whether they’re fake or real, as long as they look good. Anyone who came of age in the ’90s and early aughts was taught by Pamela Anderson, Hugh Hefner’s Playboy bunnies, Victoria’s Secret models, and other stars that this perfect female figure could be achieved through breast implants. Meanwhile, shows such as Nip/Tuck and Extreme Makeover normalized our comfort with the procedure. More than 200,000 women received breast augmentations in the year 2000. Fast-forward to today, and it’s clear we were premature in praising implants for blessing womankind. More and more women believe their implants are causing them harm—and they’re determined to have them removed. Chandler Fuller, a 33-year-old registered nurse in Visalia, California, has experienced a constellation of symptoms, including chronic fatigue, brain fog, and joint pain, since getting a pair of Mentor non-textured saline implants at age 20.

In Knoxville, Tennessee, 43-year-old Brandi Fleming is also struggling, yet her symptoms—chronic fatigue, joint pain, anxiety, and depression, among others—manifested about a decade after receiving Mentor saline implants. Fuller and Fleming belong to a ballooning community of women seeking an explant (or breast implant removal) because they suffer from breast implant illness (BII). This umbrella term includes side effects such as headaches, skin rashes, food intolerance, hair loss, insomnia, heart palpitations, anxiety, and depression. Women also report symptoms associated with autoimmune diseases, including rheumatoid arthritis, Sjogren’s syndrome, and Hashimoto’s thyroiditis. Diagnosing BII is a guessing game that involves countless specialists and years of tests. Sometimes, people with BII are tipped off by a friend or doctor, but most often they self-diagnose after researching their symptoms. For instance, the Facebook group Breast Implant Illness and Healing by Nicole, which boasts more than 142,000 members at the time of publication, is full of people at all stages of the explant journey, swapping surgeon recommendations and before-and-after photos.

Those who’ve reclaimed their lives post-explant use such groups to encourage those still burdened by the synthetic bags with a collective sentiment: It will get better. And it usually does—as long as you can afford it. Explants are covered by insurance only under certain circumstances, like if you got them as part of breast reconstruction after a mastectomy. The cost of a total capsulectomy—a procedure that removes both the implant and the surrounding scar tissue—starts at around $6,000 without insurance. A total capsulectomy is important because the capsule can be tested for diseases and contaminants, including leaked silicone, mold, or heavy metals such as arsenic, mercury, and chromium. But it’s also more expensive than a simple removal because it’s more complicated. It requires a surgeon snipping every remaining bit of scar tissue—which may have attached itself to the pectoral wall or ribs—out of the body. That investment varies by state and surgeon, but it can soar to $15,000 for women who want a fat transfer or lift to reshape their breasts. Paying for a full capsulectomy out of pocket is inconceivable for many women with BII because debilitating daily symptoms such as fatigue, joint pain, and brain fog often make it difficult to maintain a regular work schedule.

Fuller was a nursing student when BII struck. “I would call into work all the time because I just couldn’t get up to do anything,” Fuller says. Fleming once worked as a waitress but is unable to maintain a steady job due to physical limitations that include interstitial cystitis, a painful autoimmune disorder that affects the bladder. Her anxiety and depression pose an equal barrier to employment. “I quit one of my last jobs because I had a horrible panic attack and just couldn’t go back. I used to have a ton of friends. I’ve isolated myself from pretty much everybody,” Fleming says. In another Facebook support group, Breast Implant Illness Research & Recovery, Inc., a woman named Zsa Zsa said she got implants to move up the ranks as an exotic dancer, a profession she’d taken to after years of abuse. She now sneaks behind the curtain between songs to sip air from her oxygen tank, which at age 36 she can’t live without. The financial burden of living with breast implant illness, compounded by the sheer weight of the implants themselves, can make life harder than it ever has to be. This flags an important consideration at the heart of it all: Why do people get implants? 

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Women Mind The Mold

According to a Facebook poll of BII patients, the longing for larger, perkier breasts is far more complex than what reality television might have you believe. Whether it’s to quell a husband’s demands, correct a breast deformity, contribute to gender affirmation, or reclaim self-confidence after breastfeeding, domestic abuse, or cancer, the reasons people get implants almost always transcend the material. “When I was little, I would look through the [Victoria’s Secret] swimsuit catalogs,” Fuller says. “I would be like, ‘That’s what I’m going to do. I’m going to make sure that I can look cute in a bikini.’” Any female-identifying individual can attest that there was a turning point early on when the expectations of her body became clear. If the worthiness of being well-endowed wasn’t made explicit through television, magazines, and music, perhaps it was part of a ritual, like wearing a bikini for the first time.

The means by which this message is cemented isn’t as important as the fact that it is impossible to ignore, and yet—in a twist only patriarchy could wrench—women who’ve gotten sick from their implants bear the full responsibility of the decision they made. “We got the implants for a reason: because we were insecure, or wanted to feel better, or were pressured,” Fleming says. “We did this to ourselves, and now we’re suffering not only physically but [also] psychologically and emotionally.” Breast implant illness patients often aren’t taken seriously, especially by doctors who don’t have prior experience with such complications. “There is such a thing as gaslighting. If the doctor can’t explain it…they’ll just throw it on depression, that it’s all in your head,” Fuller says. “I’ve experienced that a lot.” BII is misunderstood in the medical community because it doesn’t have an ICD-10 diagnosis code from the Centers for Disease Control and Prevention (CDC). This label, which validates a disease’s existence, would require doctors to document symptoms of BII and make it more plausible for women to file insurance claims.

However, the CDC says there isn’t enough scientific evidence to bridge the gap between correlation and causation. Its refusal to acknowledge the need for such a code is shocking, since the link between breast implants and chronic malaise has been a concern for more than 40 years. In 1982, Maria Stern filed the first lawsuit against silicone-implant manufacturer Dow Corning after experiencing a slew of painful symptoms when her implant ruptured. In 1984, Stern was awarded more than $1.7 million in damages. In the ’80s, the Public Citizen Health Research Group obtained internal government documents suggesting silicone implants could cause cancer. Throughout the following decade, implant manufacturers such as 3M, Mentor, Baxter International, Bristol Myers Squibb, and Dow Corning awarded billions of dollars in damages to women who’d been harmed by silicone-gel leakage and implant ruptures. Dow Corning was also criticized: It escalated production despite knowing its silicone-gel implants could easily leak and rupture. The controversy reached a peak in 1992, when the U.S. Food and Drug Administration (FDA) temporarily banned the cosmetic use of silicone breast implants (they remained available only for mastectomy patients). The moratorium allowed manufacturers time to test silicone implants and devise safer iterations of their products. (During this time, saline implants were marketed as an alternative, though they contain a silicone shell.) 

Breast implant illness patients often aren’t taken seriously, especially by doctors who don’t have prior experience with such complications.

The ban and subsequent lawsuits also gained traction in pop culture, with discussions of breast implant illness on talk programs such as The Oprah Winfrey Show and Face to Face with Connie Chung. These shows offered a public platform for women harmed by breast implants to share their stories and, in the case of Oprah, confront representatives from the American Society for Aesthetic Plastic Surgery and Dow Corning about who should take responsibility when medical devices fail. Fourteen years later, under heavy pressure from manufacturers, the FDA put silicone implants back on the market—even though most studies purported to demonstrate their safety were conducted by implant makers and plastic surgeons with a vested interest. It also ignored the patients and doctors who pleaded with the FDA to keep them banned. The rerelease included compliance measures that all approved manufacturers of silicone implants were required to follow to continue producing them. Today, all four major implant manufacturers—Mentor, Allergan, Sientra, and Ideal—are in violation of that agreement, which includes a commitment to conducting intensive 10-year studies to prove the implants haven’t contributed to systemic disease. (“Nothing is more important to Mentor than the health and safety of the women who choose our breast implants,” Mentor says in response.) 

breast implants one-third width image

image of a silicone breast implant against a brown background

Image by Adam Voorhes/Gallery Stock

Despite these violations, little is being done to reinforce these measures or impose ramifications. The implants continue to be marketed and sold at high rates: Nearly 300,000 breast implant procedures were performed in North American in 2019, with 85 percent of surgeries using silicone implants and 15 percent using saline. Implant manufacturers currently face additional scrutiny for the rise of a rare form of lymphoma: Breast Implant–Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), a cancer of the immune system most often associated with Allergan’s BIOCELL textured silicone implants and tissue expanders. The FDA recalled 25 devices from this line in 2019. However, cases of BIA-ALCL have been associated with both smooth and textured implants from other brands, including Mentor, Sientra, Bristol Myers Squibb, Nagor, and Silimed.

Leaky Truths

Though implant manufacturers should conduct rigorous research on their products, third parties unassociated with these corporations should conduct an equal amount of independent studies. Currently, the relationships between implant manufacturers and researchers raises significant ethical concerns. For example, one ongoing clinical trial intended to study breast implant illness could help create an ICD-10 code. However, the study is unlikely to demonstrate evidence of BII—not because BII doesn’t exist but because Allergan paid the study’s author, Caroline Glicksman, MD, more than $400,000 between 2013 and 2019, according to public data. The results of Glicksman’s trial will likely be weighed heavily by the FDA and members of the plastic-surgery community, since the study is being funded by the Aesthetic Surgery Education and Research Foundation, a well-respected nonprofit. The organization’s vice president, Bruce W. Van Natta, MD, is also an adviser to Allergan. However, recent research confirms that silicone implants put patients at a higher risk of developing autoimmune syndrome induced by adjuvants (ASIA), which is when the silicone triggers an immune-system response that results in autoimmune disease. It can be difficult to prove that implants actually caused the onset of such autoimmune diseases, but additional independent surgeons are conducting their own research to prove symptoms of breast implant illness improve or completely disappear after explant. One study showed that between 60 and 80 percent of patients with implant-related autoimmune diseases show a significant improvement in symptoms after explantation. These results are echoed in a study coauthored by Lu-Jean Feng, MD, a plastic surgeon who specializes in explants and is a champion for women with BII. Feng’s study, which was published in July 2020 and sought to understand which specific symptoms improved after a total capsulectomy, found that post-explant, women demonstrated significant and sustained improvement across 11 major symptom categories.

Linda Maez, an Ojai, California, high school student, is photographed in 1998,after she had her breasts enlarged so they would look the same as Pamela Anderson’s. (Photo credit: Paul Harris/Getty Images)

One of the most important ways to reduce the number of people who get sick from implants is to improve the transparency surrounding their potential risks. In 2020, the FDA added a black-box warning to breast implant labelling. As the agency’s strictest classification, the warning is added to devices that hold potential for serious injury or death. This move came after the FDA listened to a mountain of testimonies from both patients and their care providers, who chronicled the suffering breast implants have wrought. Breast cancer survivor and Breast Implant Safety Alliance (BISA) board member Robyn Towt, who was harmed by breast implants, recommends manufacturers provide patients with a detailed checklist, written in layman’s terms, outlining the potential risks of owning breast implants. “That’s pretty much our mission, to make sure that information gets into the patient’s hands and it’s easy for them to read and understand so they know what they’re getting into,” Towt says. Her work focuses on passing an informed consent law in Arizona, but multiple other states are following suit.

Open conversations about health history could also protect women from harm: Current research shows that having preexisting allergies or being otherwise predisposed to autoimmune diseases may make it more likely for someone to have an adverse reaction to implants. Having the right information is key, especially because most women who’ve suffered the lasting effects of BII and other complications say they’d never have gone through with the procedure had they known what was potentially ahead. “Before I knew what BII was, I contemplated suicide because I didn’t want to live the rest of my life this way,” Fleming says. Such regret runs rampant in the BOO community—but should it? Perhaps the choice to get breast implants springs from the same well that makes a woman buy lingerie at Victoria’s Secret, dress as a Playboy bunny for Halloween, or buy lip plumper from Kylie Jenner’s makeup line. We all make decisions that obey the fundamental narrative by which women are bound, but the pursuit of perfection only keeps us from having full ownership of our bodies. Acknowledging the whole picture of harm caused by breast implants breathes life back into poisoned patients, bolsters positive outcomes for women with breast cancer, and empowers women everywhere to make safe choices that unburden us all. 

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by Michelle Polizzi
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Michelle Polizzi is an independent writer with 7 years of experience. Her work has appeared in WELL+GOOD, Healthline, Explore, The Daily Beast, and more.