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Breast implants are a common solution to enhance a person’s figure and self-confidence. According to The Aesthetic Society, breast augmentation surgery was the second most common surgical procedure in 2021. It is estimated that over 300,000 women undergo cosmetic breast augmentation annually. For those with a thyroid condition, it is essential to be abreast  -- pun intended! --  of how implants may affect thyroid function and overall health.

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Breast implants are medical devices. They help increase breast size or reconstruct breasts due to cancer, trauma, or developmental defects. Your provider can place implants under the breast tissue or behind the chest muscle. The FDA has approved two types of breast implants: saline-filled and silicone gel-filled. Both have an outer shell made of silicone. Breast implants vary in size, shell thickness, texture, and shape.

There are different brands of breast implants available on the market, and the ingredients (fillers and outer shells) may vary depending on the brand you use. Your surgeon should give you a complete list of the ingredients in the implants and the process used to create them.

Silicone gel-filled breast implants are a popular choice. The silicone gel that is used in most breast implants today is medical-grade. The process for making silicone gel-filled breast implants is complex, and there are many steps to forming this type of implant. Along with silicone elastomer, platinum may also be on the ingredients list. Platinum helps cure the gel inside the shell and maintain softness.

Saline breast implants are filled with sterile salt water and maintain a uniform shape. They tend to be firmer to the touch than silicone implants. Their outer shell can either be textured or smooth. If a saline implant ruptures, your body absorbs and removes the extra fluid.

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Surgery to augment breasts has been available for nearly 60 years. Over the years, research has unveiled more about the long-term risks and complications of breast implants. In fact, the FDA removed silicone breast implants from the market in 1992 due to safety concerns. After manufacturers addressed those safety concerns, silicone implants came back on the market in 2006.

Some complications and risks of breast implants include:

Capsular contracture occurs when the scar tissue around the implant hardens and tightens, causing the breast to feel firm or appear distorted. Capsular contracture can be painful and may require additional surgery to correct.

Rupture or leaking of the implants can occur due to aging, trauma, or a faulty implant. When a saline implant ruptures, the saline solution is harmlessly absorbed by the body. However, if a silicone implant ruptures, it may leak silicone gel into the surrounding tissue, leading to inflammation and potential health risks.

Changes in nipple sensation or breast shape occur in some women after breast implants. These changes may be temporary or permanent, depending on the individual and the type of implant used.

Other complications include: 

• Complications secondary to surgery, such as infection, bleeding, or anesthesia side effects
• The need for revision surgery due to pain, rupture, leakage, or other adverse symptoms
• Certain types of cancers
• Scarring
• Incorrect positioning of the implant
• Capsular contracture from scar tissue that pushes on the breast implant
• Skin wrinkling
• Persistent breast discomfort

Studies are also investigating the relationship between silicone breast implants and autoimmune thyroiditis. Indeed, one of the most significant debates in plastic surgery medicine is whether breast implants increase the risk for, or severity of, an autoimmune disease.

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Understanding Hashimoto's Thyroiditis

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Hashimoto’s is an autoimmune disorder in which the immune system mistakenly attacks the thyroid gland. Over time, this leads to inflammation and potential damage to the thyroid. This can result in hypothyroidism (low thyroid hormone levels). When hypothyroidism occurs, the thyroid gland can’t produce enough thyroid hormone.

Limited data suggests a link between breast implants, especially silicone ones, and autoimmune diseases. But, researchers are only beginning to learn more about the relationship between Hashimoto’s and silicone.

Autoimmune/inflammatory syndrome induced by adjuvants (ASIA)

An immune reaction occurs when the immune system detects a foreign invader in the body, like germs. During the immune response, a cascade of immune system-mediated events is triggered, focused on eliminating the foreign invader. An adjuvant is a foreign substance that can start an immune reaction. When adjuvants trigger an immune response, it is called autoimmune/inflammatory syndrome induced by adjuvants (ASIA).

Silicone implants can leak small amounts of silicone polymers in your body for years before you even know they are leaking. Silicone is an adjuvant, meaning it can stimulate an immune response. When this occurs, thyroid symptoms and autoimmune thyroid disorders may develop. The link between ASIA and autoimmune disorders is reported in many case reports. However, few studies support the association between ASIA and breast implants.

Based on case reports, it appears the longer you have breast implants, the higher your risk of ASIA. In one case report, a patient had implants for about 15 years before developing non-specific symptoms. Imaging studies confirmed an enlarged thyroid gland, leading to a diagnosis of hypothyroidism. In another case report, the patient had implants for over ten years and had thyroid antibodies detected in their blood. Thyroid antibodies indicated the presence of an autoimmune disorder in this case.

While reports associated with silicone breast implants and Hashimoto’s are limited, implants have been linked to other autoimmune conditions, including:

• Fibromyalgia
• Lupus
• Scleroderma
• Rheumatoid arthritis
• Sjögren’s syndrome

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If you have breast implants, you might have heard the term “breast implant illness” (BII). BII is not an official medical diagnosis, but in 2020, the FDA recommended that implant manufacturers label potential side effects due to the number of women claiming to have BII. BII has become a popular term in social media. Some healthcare providers use Bll to describe symptoms that are perceived to be associated with breast implants.

Individuals with a personal or familial history of autoimmune conditions are more likely to seek treatment for BII. It is usually considered an autoimmune/inflammatory condition that looks different for each person and occurs following augmentation or reconstructive surgery.

Some symptoms of BII include:

• Fatigue
• Headaches
• Brain fog
• Joint pin
• Cognitive difficulties
• Hair loss
• Photosensitivity
• Chills
• Chronic pain
• Rash
• Chest pain

Currently, there is no scientifically proven link between breast implants and BII or Hashimoto’s disease.

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Breast implants are not intended to be lifelong devices. The longer you have breast implants, the more likely you will need them removed, re-operated on, or will develop an adverse reaction. The American Society of Plastic Surgeons recommends that patients who have compromised immune systems or autoimmune conditions should avoid breast augmentation.

Some people find that their autoimmune conditions improve once their breast implants are removed. If you are struggling to manage your thyroid symptoms and you have breast implants, meet with your thyroid specialist to discuss the possibility that your implants may be agitating your Hashimoto’s symptoms. For those who wish to have their breast implants removed, finding a plastic surgeon who specializes in breast implant removal can help lead to the best outcome.

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