Hugh Hefner’s wife, Crystal Hefner, made headlines this summer when the former Playboy Playmate decided to remove her breast implants. On a lengthy Instagram post, she explained that she felt she had “Breast Implant Illness.” Her symptoms included recurring infections, severe fatigue, and unexplained back pain.
This news story inevitably raises red flags about this common surgery. This isn’t the first time.
In 1992, the U.S. Food and Drug Administration (FDA) placed a moratorium on silicone-gel-filled breast implants while they were under review for safety and effectiveness. This was because, when breast implants first came on the market, the FDA did not require a high level of review. In other words, it was a retroactive demand on the breast implant manufacturers. The FDA approved the use of saline implants in augmentation surgeries in 2000. Silicone implant approval followed in 2006. Throughout this period, there were limited allowances for these implants in reconstructive and revision surgeries.
The FDA says reports of connective tissue disease (which include autoimmune diseases such as rheumatoid arthritis, systemic sclerosis, and systemic lupus erythematosus) are rare and that further studies need to be conducted in order to know if this risk is real. There is, however, some evidence that women with implants experience a small increased risk of developing anaplastic large cell lymphoma, a rare type of cancer. Dr. David H. Song, president of the American Society of Plastic Surgeons and chief of plastic surgery at University of Chicago Medicine, estimates that there are only about 200 documented cases of this cancer associated with breast implants. For reference, according to the the American Society for Aesthetic Plastic Surgery (ASAPS), there were an estimated 305,856 breast augmentations in 2015 and 5,390,873 since 1997, when the organizations first started tracking the surgeries.
There are, of course, risks when getting implants. The surgery is invasive — it involves the use of anesthetic — and putting a foreign object into a body can always cause complications. “Any time we implant a foreign body in a human being, there are risks of infection, encapsulation, rejection, and so forth,” says Song. (Encapsulation, also called capsular contracture, is a hardening and tightening of the implant that can cause distortion and pain; there is a 2 to 3 percent chance of infection, and a 10 percent change of encapsulation on average.)
Furthermore, implants will likely have to be replaced or removed eventually. “I tell all of my patients they’re going to last 10 years,” says Dan C. Mills, president of the American Society for Aesthetic Plastic Surgery. “I believe the more cohesive ones [called ‘gummy bears’] are going to last longer than that, but we won’t know that until they’ve been in longer.” This means going under the knife again someday.
Mills says there is debate about whether women should consider replacing their implants preemptively or only after they’ve broken, something that may have to be confirmed through a scan if the implants are silicone. Surgery tends to be less complicated if it’s done before an implant breaks.
When saline implants break, the breast flattens quickly and the body absorbs the salt water. When a silicone implant (including gummy bears) breaks, the gel doesn’t move all that much because it’s a fairly solid substance. “The vast majority of a time, when an implant breaks […] the contents of the implant are maintained in the shell, in the capsule that has been created by one’s own body,” says Song. Most women who have silicone implants won’t even notice when their implant breaks, which is why keeping up to date on follow-up appointments post-surgery is important.
There are some instances where women feel pain, tingling, numbness, or burning following a break. It’s also the case that the longer a silicone implant is ruptured, the more likely it is that the silicon could leave the tissue capsule and migrate to other parts of the body. The effects of this are unknown, but if a woman thinks her implant has broken, she should discuss that with a medical professional as soon as possible.
Other worries that are often brought up about breast implants is that they could lead to loss of feeling in the nipples and that they drastically reduced the effectiveness of mammograms. Song says that the latter concern has been completely debunked: Mammograms can (and should) be modified for women who have implants. As for loss of sensation, Songs says it’s very rare in women who have implants for aesthetic reasons. Women who have had mastectomies lose sensation as a result of the surgery to remove their breast tissue but may regain some feeling over time.
As for Hefner’s Breast Implant Illness? Hefner learned about this illness through a website and a Facebook group devoted to this condition and identified personally with what she read. This disorder, however, is not an official medical diagnosis and is not discussed in scientific literature.
Crystal Hefner, after her surgery.