By: Sammy Cusimano
Dr. Stephen Metzinger holds a firm place in the elite pantheon of plastic surgeons in the Greater New Orleans area. For nearly 35 years, Dr. Metzinger has dedicated his medical career to helping patients improve their quality of life through his well-established plastic surgery practice, Aesthetic Surgical Associates. With a masterful foundation of innovative medical techniques and methods, Dr. Metzinger is always broadening his expertise in his respective field by keeping his “finger placed firmly on the pulse” of all the most cutting-edge developments in the realm of plastic surgery. One of the most current medical conditions that requires the care, counsel and treatment of a plastic surgeon is known as Breast Implant Illness.
Not to be confused with Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), Breast Implant Illness (BII) is a separate medical entity altogether. The two medical conditions are non-related, even though a patient could possibly develop both diseases. “The media has lumped the two illnesses together, and we would like to clear that up,” states Dr. Metzinger. There is presently no diagnostic code for BII mainly because it is not officially diagnosable as a medical condition; however, the seriousness of this illness is undeniable. It is vital for women who experience chronic symptoms of BII to consult with a medical professional who can help diagnose the disease, along with proper treatment options.
The symptoms of Breast Implant Illness (BII) include but are not limited to: fatigue, chest pain, hair loss, headaches, chills, photosensitivity, chronic pain, rash, body odor, anxiety, brain fog, sleep disturbance, depression, neurologic issues and even hormonal issues. Patients who have self-identified as having Breast Implant Illness (BII) encompass a diverse spectrum of medical cases, including both textured as well as smooth surface implants and saline as well as silicone implants.
Awareness of BII is growing each day thanks to the power of social media. An increase in patients reporting possible cases of BII is largely, in part due to platforms such as Facebook groups, which help educate and bring together individuals who may be experiencing the symptoms of Breast Implant Illness. In August of 2019, a single Facebook group for Breast Implant Illness awareness had a stunning 86,000 members.
The root cause of Breast Implant Illness is not the actual saline or silicone contained within a given implant product. The biofilm, possibly carried in with the implant when it was placed within the body during surgery, is the most likely cause of Breast Implant Illness. “The biofilm can be aerobic or anaerobic bacteria, it can be a mycobacterium or it can be a fungus,” states Dr, Metzinger. He continues, “We have actually seen all of these after removing implants that have been cultured.” Presently there is no scientific data to prove that silicone, itself, causes any kind of disease. The focus of research and testing related to BII is on the biofilm associated with the implants.
Currently, the Aesthetic Surgery Education and Research Foundation (ASERF) and the research faction of The Aesthetic Society (ASAPS) are focused on establishing a diagnostic test for BII. Although there are no direct tests available at this time for BII, there are tests for autoimmune diseases that may help narrow down possible diagnoses of BII in symptom-reporting patients.
Treatment options for women who are experiencing the symptoms of BII are mainly directed at implant removal via capsulectomy. For patients who exhibit symptoms of autoimmune diseases that may or may not be connected to Breast Implant Illness, complete removal of implants yields varying results ranging from: 1) no improvement 2) temporary improvement 3) permanent resolution of symptoms. It can take many years of research and testing to reach a scientific conclusion as to the most effective treatment for BII. What the current treatment option of capsulectomy (removal of the entire breast implant and surrounding capsule) does offer patients is a ruling out of the possibility of BII as the cause of the given symptoms; however, Dr. Metzinger elaborates, “If a patient’s symptoms resolve after implant removal, the presumptive diagnosis is BII.”
Dr. Metzinger prefers to remove the implant and capsule “en bloc” as one piece to prevent any potential spillage. This is purely a cautionary measure to ensure the safety of the patient. “At the time of capsulectomy we also do cultures for aerobic and anerobic bacteria, mycobacterium and fungus,” states Dr. Metzinger. He explains, “Something new that we are doing is DNA sequencing, which is more specific and also seems to be a bit more sensitive.” With so many factors that can affect a patient’s interaction with her implants, the more specific the testing, the better understanding that medical professionals will have when diagnosing whether the individual has actually developed Breast Implant Illness.
While diagnosis and treatment options for Breast Implant Illness (BII) presently continue to be developed, Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is being tested and treated as a cancer. This disease has been linked to a certain brand of textured implant. The FDA recalled all of the biocell implants of the specific brand that has been connected with BIA-ALCL. Dr. Metzinger states, “We want to get this information out to women who have these types of implants so that they can contact a board-certified plastic surgeon and talk about options.”
The confirmatory test for BIA-ALCL in patients with the textured implants associated with the disease is derived from a fluid located between the breast implant and the capsule. The fluid is extracted and sent for an immunohistochemical test (CD-30). If the test results come back positive, then the treatment of choice is to remove that implant and the entire surrounding capsule. “As long as there has been no spread of the disease, it is believed that it is curative to remove the implant and the capsule,” states Dr. Metzinger.
With each individual case of breast implant-related disease that is diagnosed and treated successfully, Dr. Metzinger’s devotion to helping patients live the highest quality of life possible is the driving force behind his ever-evolving medical practice. While Dr. Metzinger is renowned for his ability to enhance the aesthetics of the human body, he is equally dedicated to ensuring his patients’ vital health and wellness. “We are seeing an increasing number of cases as people learn more about these illnesses,” states Dr. Metzinger. Bringing awareness of these illnesses to people is Dr. Metzinger’s first goal. Diagnosis and treatment come next. Ultimately, saving lives and enhancing patients’ health is the final and most important step of this noble endeavor that Dr. Metzinger is helping to move forward in the Greater New Orleans area.