There is not yet a standardized grading or staging system for breast implant illness. Breast implant illness does not necessarily progress from mild to severe. Patients may have minimal symptoms that never get worse, while others develop a severe, progressive autoimmune disorder. I propose the following staging system as a method to standardize how we speak about breast implant illness. I developed this system over time and I use it to evaluate patients every single day.
Stage 1:
Early Symptoms
Patients at this stage exhibit minimal or no inflammatory or autoimmune system symptoms. They may have concerns about breast implant illness and the potential for developing inflammatory or autoimmune conditions in the future.
The recommended treatment is explantation with en bloc capsulectomy. This procedure assures patients that all foreign materials and implant-related components have been removed, helping to rule out breast implants as a cause if they later develop inflammatory or autoimmune conditions. The capsulectomy also ensures that the pocket which held the implant will close completely and that the muscle and chest wall are restored to natural anatomical positions.
Stage 2:
Progressive Symptoms
These patients have begun to develop inflammatory or autoimmune symptoms and have ruled out other causes. They have often consulted various medical providers without finding resolution.
The case for explantation with en bloc capsulectomy in these patients is to remove the foreign body and any associated materials, with the goal of alleviating symptoms and preventing future progression, should that be a concern.
Stage 3:
Multiple Systems Affected
Patients in this category present with autoimmune or inflammatory conditions affecting 3 or more organ systems. Symptoms may include neurological changes such as brain fog, skin alterations, dry eyes or vision changes, endocrine issues like hypothyroidism, and gastrointestinal problems such as irritable bowel disease or inflammatory bowel disease. A significant number of patients with breast implant illness fall into this category, and the indication for surgery is en bloc explantation and capsulectomy.
Stage 4:
Severe Autoimmune or Inflammatory Disorder
This stage includes patients diagnosed with serious autoimmune or inflammatory disorders, such as rheumatoid arthritis, Sjögren’s syndrome, Rheumatoid Arthritis, Systemic Lupus Erythematosus (SLE or lupus), Myasthenia Gravis, Hashimoto’s Thyroiditis, Psoriasis or Psoriatic Arthritis, Crohn’s disease, or Ulcerative Colitis to name a few. The indication for surgery remains en bloc capsulectomy. These patients often feel frustrated, as their autoimmune inflammatory symptoms develop despite seeking treatment that appears ineffective.