Thursday, Aug. 1, 2019 | 2 a.m.
The misdiagnoses could fill a medical textbook. During the course of 15-plus years, burlesque dancer and cocktail waitress Jennifer Affronti, aka Ms. Redd, knew something was dreadfully wrong with her body. But neither she nor an army of doctors and specialists could figure out what.
The price of surgery
The surgery to remove a breast implant is more challenging and time-consuming than the initial surgery to place it. This is especially true when patients opt to have the capsules (scar tissue encapsulating the implant) removed. With implants that have been placed under the muscle, the scar tissue can even get stuck to the bone. “You’ve got to slow down the process and … just kind of etch it off of the rib cage,” says Dr. Brian J. Parker. The fastest removal he’s ever done was about 90 minutes. The longest was five and a half hours, because the patient had a lot of scar tissue from multiple surgeries. “We weren’t going to leave till we got it out,” he says.
The industry average cost for an implant is $5,000-$6,000. For a explant, $5,500-$12,000
The fiery redhead’s symptoms seemed inconsistent with her youth and vibrancy. Even as she was performing burlesque numbers and working at some of the most exclusive venues on the Strip, she suffered from debilitating exhaustion, brain fog, intestinal distress, vertigo and more. Doctors told Affronti that she had multiple sclerosis, celiac disease, severe gluten intolerance, depression, the flu, appendicitis, diverticulitis, Crohn’s disease and mitral valve prolapse (a double heartbeat). At one point she had to take time off from work at the Bellagio because a catheter bag, installed to help with mysterious bladder problems, couldn’t fit under her uniform.
“This had been going on for years; nobody was able to figure it out. I couldn’t physically get out of bed and move. I couldn’t do anything that I love,” Affronti recalls of her mystery condition. “I felt like I was a 90-year-old in this body. I had this overwhelming sense of ‘you’re dying.’ ”
To make matters worse, some doctors insinuated the symptoms could be in her mind. “I go, ‘I’m not f*cking depressed, and you’re not putting me on Prozac. I’m not crazy. … I might be blue; I might be panicked, because yes, I feel like I’m gonna die,’ ” she recalls.
Affronti resigned herself to her debilitating condition until a pivotal moment with her stepfather, who suffered from ulcerative colitis. “The night before he died, he said, ‘Promise me you’ll find out what’s going on with you. Don’t live like this,’ ” Affronti says.
She redoubled her efforts to no avail until a friend, model Sara Mills, suggested her breast implants may be the problem. Mills planned to have her own implants removed and directed Affronti to the website healingbreastimplantillness.com. “As I started to read everything, I just started crying,” Affronti says. “Because I realized that this was my problem.”
How many Las Vegans have implants?
Breast implants are as much a fixture in Las Vegas as buffets and gambling. They embody glitz, glamour and the more-is-more aesthetic of a neon-bright resort town. And this is no new phenomenon: Burlesque legend Tiffany Carter, who won Miss Nude Universe 1975, remembers she and her friends visiting a plastic surgeon in the downstairs portion of a casino in the late ’70s and early ’80s.
The attraction to large breasts is rooted in Darwinian evolution, according to Dr. Alan Matarasso, president of the American Society of Plastic Surgeons. Fertility is associated with the hourglass figure.
But it’s notoriously difficult to determine the exact number of people who have implants. The ASPS does not keep track of surgeries by state or city, but it does report that Region 5 (which includes Nevada, California, Arizona, and Mountain and Pacific states) has the most breast augmentations in the nation at 36 percent, whereas other American regions max out at 17 percent. In contrast, the annual number of breast reconstructive surgeries, which typically happen after breast cancer or a similar illness, are evenly distributed across the regions; in 2018, there were 101,657 such surgeries in the U.S., with 21 percent in Region 5.
The ASPS reports that there were 313,735 breast augmentations in the U.S. in 2018, but that number doesn’t specify whether the surgeries are first-time implants or replacements/update surgeries. In 2014, an article on the website fivethirtyeight.com estimated that about 4 percent of women in America had breast implants, using a complex set of calculations and guesstimates.
“I think it’s really common everywhere, but [Las Vegas] is one of the more popular places for breast implants, to be sure,” says local plastic surgeon Dr. Brian J. Parker. He says that while smaller, more natural implants are on trend nationally, Las Vegas women still prefer larger boobs.
THE RULES OF ENHANCEMENT
Despite their perks, breast implants have had a tumultuous history. They’re not lifetime devices, so recipients are pretty much guaranteed to undergo repeat surgeries. They have a fair amount of known complications, such as rupture, hardening and an unsightly scar tissue condition known as capsular contracture. Silicone implants were even temporarily banned in the 1990s, but overall, the FDA declared them safe for general use.
“It’s a remarkably safe operation,” says Dr. Alan Matarasso, president of the American Society of Plastic Surgeons. “It’s always the most common or second-most common operation performed in plastic surgery. Millions of women worldwide are very happy and safe and fine with their implants.”
But amid such ample popularity, some women have suffered adverse effects that they believe are connected to the implants. Their symptoms tend to involve autoimmune issues, connective-tissue disease and problems stemming from chronic inflammation or infection, amounting to what has been dubbed breast implant illness.
The term isn’t yet recognized as an official medical condition—making it impossible to get statistics on prevalence—but if it were, Affronti would be a textbook case. Her symptoms were severe enough to change the course of her life. If she could go back in time to tell her younger self not to get breast implants, she says she absolutely would. “I would tell myself, ‘You’re going to lose  years of your life. … Don’t you dare do that.’ I would smack myself.”
THE INTERNET AND ADVOCACY
In the past, women might have suffered alone, unable to find answers. But thanks to social media and the internet, they have banded together to fight for awareness of breast implant illness. One Facebook group, Breast Implant Illness and Healing by Nicole, has more than 86,500 members. They support each other, answer questions, post before-and-after photos and even do political advocacy.
Part of the challenge is that the science studying long-term effects is lacking. Thus, doctors aren’t trained to recognize the symptoms and may even be skeptical when a patient introduces the idea of the illness.
The medical community is beginning to catch up with the experiences of these women.
“There’s a number of studies in the pipeline now. There are task forces and committees and grants being submitted to study this as we speak,” Dr. Matarasso says. “This is something that we take very, very seriously. We have, obviously, our patient safety and best interests at heart. So we are going to look at this and get our arms around it a lot more.”
In March, the FDA held a two-day meeting about breast implant safety, during which women called for clearer implant warnings and for the banning of textured implants, which are believed to be connected to a rare form of cancer called Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). The FDA also sent warning letters to two breast implant manufacturers for failing to comply with post-approval study requirements.
On March 15, the FDA released a statement acknowledging that implants may make some women sick: “A growing body of evidence suggests that a small number of patients may have biological responses to certain types of materials in implantable or insertable devices. For example, they develop inflammatory reactions and tissue changes causing pain and other symptoms that may interfere with their quality of life.”
Explant insurance coverage
Whether or not insurance will cover your explant depends on a host of factors determined by your insurance company. Generally, the procedure is covered if it’s deemed “medically necessary” but not if it’s considered “cosmetic.”
For example, Aetna’s policy says that a removal is medically necessary if it’s because of cancer, extrusion of the implant through the skin, severe contracture and rupture of silicone implants. However, rupture of saline implants are not covered by Aetna (unless the original implant was medically necessary).
If the original implant was deemed medically necessary (for example, reconstruction after a mastectomy), then insurance is more likely to cover subsequent surgeries. Otherwise, the rules are more strict.
At this time, breast implant illness is typically not considered a viable reason to insurance companies.
In early April, France, the Netherlands and Canada banned the types of breast implants most likely to cause cancer, and the FDA followed in late July with a voluntary recall.
The recall affects Allergan Biocell textured implants (and tissue expanders), and the FDA said in a press statement that it would continue to monitor the situation and may take action regarding other implants in the future “if warranted.”
The manufacturer opted to remove its Biocell implants from shelves globally, but the FDA is not recommending that asymptomatic women have their implants removed. It does, however, recommend that anybody “considering a breast implant of any type be informed of the risk of developing BIA-ALCL” and that health care providers continue to provide “routine care and support” to patients with implants.
“Plastic surgeons are on the forefront of collaborating with our patients and ensuring their safety. We want to make sure that every woman who has this operation is safe long-term,” says Dr. Matarasso, who is communicating with women’s groups about implant safety and how to improve it. He says there’s more research and collaboration happening now than at any time in the past 50 years.
“There are women with real issues,” Dr. Matarasso says. “We 100 percent acknowledge that. And we want to work with them and get to the bottom of why certain people don’t respond well. [We want to] make sure that people come in fully informed about the operation, about the process, about the fact that it is an implant and so on. But the vast majority—the vast majority are having a good experience with it. And the FDA recognized that at the hearings.”
LOOKING FOR A CURE
Because completed studies are lacking, there’s no hard scientific consensus behind breast implant illness. Patients often arrive at a diagnosis only after eliminating all other conditions first. But the proposed cure is simple enough: remove the implants and the surrounding capsule of scar tissue.
Possible symptoms of breast implant illness
Remember: See your primary care doctor to first rule out other possible health issues. “There are other health problems that that can cause all of these symptoms,” Dr. Brian J. Parker says.
• Fatigue/low energy
• Cognitive dysfunction (brain fog, memory loss)
• Joint and muscle pain
• Hair loss, dry skin
• Recurring infections, slow healing, easy bruising
• Swollen lymph nodes and glands
• Gastrointestinal issues (cramping, abdominal pain, bloating, gas, diarrhea, constipation, leaky gut)
• Irritable bowel syndrome, small intestinal bacterial overgrowth
• Problems with thyroid and adrenals
• Hormonal imbalance, low libido, early menopause
• Weight problems
• Chronic inflammation
• Poor sleep and insomnia
• Throat clearing, cough, difficulty swallowing, choking, acid reflux
• Metallic tastes
• Vertigo, ears ringing
• Fevers, night sweats, intolerant to heat/cold
• Sudden food intolerances and allergies
• Heart palpitations, heart rate changes or heart pain
• Swollen and tender lymph nodes
• Frequent urination
• Numbness/tingling sensation in upper and lower limbs
• Cold and discolored limbs, hands and feet
• General chest discomfort, shortness of breath
• Pain and/or burning sensation around implant and/or underarm
• Liver, kidney, gallbladder or pancreas dysfunction or inflammation
• Anxiety, depression and panic attacks
• Symptoms of autoimmune diseases such as Raynaud’s syndrome, rheumatoid arthritis, scleroderma, lupus, Sjogren’s syndrome, nonspecific connective tissue disease, multiple sclerosis
• Symptoms of BIA-ALCL or a diagnosis of cancer
“Most of my patients come in here after feeling symptoms for a number of years,” says Las Vegas plastic surgeon Dr. Brian J. Parker, who performs approximately two to five explant surgeries a week. “When patients come in, I listen to them. I make sure they understand that the surgery isn’t necessarily going to fix them because the surgery is a bit of an experiment in and of itself. But I think most people have gotten to the point where they’re willing to try anything in order to feel better.”
Dr. Parker says his patients often improve after explant. “Everybody has said that they feel somewhat better. Some people say that all of their symptoms have resolved. So it’s pretty impressive.”
As a man of science, Dr. Parker sticks to medical consensus, which states that implants are safe. Would he dissuade a patient from getting implants? “I don’t think I would do that,” Dr. Parker says. “I still do get the impression that most people do well with implants. Some people don’t.”
From his own anecdotal evidence of being a plastic surgeon for more than 20 years, Dr. Parker says the majority of his patients have not returned to have them removed, nor have they reported symptoms of breast implant illness.
However, for women who do experience symptoms, removal can be a godsend. “Not one person has asked me to [replace] their implants after having them out,” Dr. Parker says. “I think that speaks volumes about how much better they’re really feeling.”
MY BOOBS, MY SELF
Breasts can become integral to the identity and lives of many women, especially those with implants.
After a gamut of medical tests found no official reason for her mysterious ailments, Las Vegan Michelle Haefs finally looked to her implants. The mother of four, who owns the local shop Reverent Tattoo with her husband, had her 550cc gummy bear silicone gel implants removed by Dr. Parker on March 18.
Four months later, Haefs says “life feels good again.” Her foot and back pain have diminished, her skin is less dry, her inflammation has receded, she has more energy, and she’s even noticed new hair growth. Most importantly, Haefs says that she no longer needs a hysterectomy.
“Women will continue to get implants regardless of all the cautions against it,” she says. “All we can hope for is that they become safer.” In the meantime, she’d like more regulations, warnings and public education about implants.
While Haefs feels physically better, parting with those curves was difficult. “They became part of who I am,” Haefs says. “I was a 34DD, and everything you wear revolves around fitting your breasts. … I miss my boobs. [My husband] doesn’t. He thinks I look great. People tell me I look better now. They were so large that they overpowered me.”
For Affronti and Mills, removing their implants was a no-brainer even though much of their lives were tied to them.
Today, Affronti feels as though she has her life back and is enjoying “working and just living.” She opted for a fat transfer surgery so that her figure is as bodacious as ever. The only difference: Affronti says that her all-natural boobs jiggle more than silicone.
Mills had achieved a level of global fame from a viral video of her breasts “dancing” to the tune of Mozart’s “Eine Kleine Nachtmusik” (Google “Mozart boobs” and you’ll find it.)
She opted for her original petite figure. “I feel so much better,” Mills says. She now lives in LA and works as a social media influencer and marketer. With the implants in, she’d suffered from anxiety, hormonal problems and ovarian cysts, all of which have now been resolved. However, she’s not sure she’ll ever be quite as healthy as she was pre-implants.
Types of breast implants
One size doesn’t fit all when it comes to breast implants. There are a variety of types and techniques:
• Saline: Since the implant is filled with sterile salt water, it is generally assumed to be safer than silicone implants. If the saline implant leaks or ruptures, the salt water is not toxic to the body.
• Structured saline: A saline implant with an added internal structure for an improved natural feel.
• Silicone: Silicone gel fills this implant. It gives it a more natural feel but can be dangerous to the body if it ruptures. Regular MRI screenings are necessary with this type of implant.
• Gummy bear: A silicone implant with a thicker gel better maintains its shape if the implant is broken. It requires a larger incision and is more likely to look wrong if the implant moves within the body.
• Round: Breasts look fuller and have more projection with this implant, and are less likely to look wrong if the implants move.
• • •
• Smooth: The texture is the softest feeling and least dangerous, but it’s more likely to have rippling or capsular contracture.
• Textured: The texture causes more scar tissue, which diminishes the risk of contracture and movement but creates an increased risk of cancer.
• • •
• Subglandular: The implant is placed on top of the chest muscle.
• Submuscular: The implant is placed under the chest muscle. This placement may be more difficult for women wanting to remove both implant and scar tissue because the scar tissue can grow onto the rib bones.
Since Mills took her implant issues public, she says hundreds, if not thousands, of women have reached out to her with inquiries. Sometimes, the questions are unintentionally rude. Women have asked: “How can you stand to look at yourself now?” or “How do you not hate yourself with your small boobs?”
Mills thinks these questions reveal a deeper issue with our society. “I feel like we need to talk about that more—that kind of feeling. When people talk about body positivity, people don’t talk about breast size. I went from a DD to AA, so I’ve seen both sides. I’d rather be healthy with AA than sick with DD. But that’s not the case for everyone,” Mills says. “I guess it goes down to what makes you a woman or feminine, and I don’t think it’s boobs.”
If she’d known her quality of life might improve, Mills says she would’ve removed her implants years ago. “Then there’d be a Mozart boob-shaped hole in the Internet,” she quips, “but I’d be fine with that.”
If you're considering implants:
1. Research: A good place to start is the FDA’s page about breast implants and the American Society of Plastic Surgeons’ online guide to breast augmentation.
2. Know that breast implants are not a lifelong device. Plan to have update surgeries every 10 to 20 years.
3. Realize you are dealing with a medical device. “When you have liposuction or a face-lift, it’s your anatomy and a doctor’s skill,” says Dr. Alan Matarasso, president of the American Society of Plastic Surgeons. “When you have an implant, it’s you, the doctor and the device. So you have to be aware [that] it’s a foreign body.”
4. Choose a plastic surgeon who is board certified and a member of the American Society of Plastic Surgeons.
5. “Sit down and have an informed and well-thought-out conversation with your plastic surgeon,” Dr. Matarasso recommends.
6. When budgeting for implants, include the cost of additional surgeries, routine medical surveillance and possible removals. Do not count on health insurance to pay for these procedures.
7. Be mindful of the potential rewards and risks. “In the vast majority of circumstances, people get a satisfactory outcome. They’re very happy and everything works out,” Dr. Matarasso says. “But there are certain circumstances where you have to be aware that it may not. You have to keep that in mind for all plastic surgery. It is surgery; it’s not a haircut. Unfortunately, sometimes people lose sight of that.”
Types of surgeries associated with explants
• En bloc/total capsulectomy: “En bloc means the surgeon leaves the capsule tissue intact on the breast implant and cuts around this intact unit without disrupting either the capsule or the implant so as to avoid contamination to the body,” according to the website healingbreastimplantillness.com.
• Capsulectomy: The capsule (or scar tissue) surrounding a breast implant is removed in part or whole.
• Fat transfer: After removing implants, some surgeons will take fat from other portions of a patient’s body (generally the thighs, back and/or abdomen) via liposuction, clean the fat and then inject it into the breast tissue. This can be done to fix tiny imperfections or can be done to fully replace the implants. Since a portion of the fat can be lost after the transfer, touch-up injections may be required. Fat transfer risks include cysts, infection, microcalcification and death of fat cells. So does this procedure need to be done often?
• Breast lift: Also known as a mastopexy, this procedure “raises the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour,” according to the American Society of Plastic Surgeons.
If you're considering explants
• See your primary care doctor first to rule out other possible health issues. “There’s a little bit of danger in jumping on the bandwagon before you’ve had a workup,” says Dr. Brian J. Parker. “There are other health problems that can cause all of these symptoms.”
• Manage your expectations. Some patients feel better immediately after explanting. Others go through a longer, slower process of healing and improvement.
• Be optimistic about the cosmetic outcome. As the body heals, the skin will firm up and the breast will “fluff” up. Some women find they prefer their smaller-chested look because it makes them look slimmer overall. Others find that a breast lift or fat transfer helps them achieve their desired aesthetic.
Resources for women who think they have a problem with their implants
Because Breast Implant Illness is not yet well understood, there is not a robust support system in the same way there is for other conditions, but here are a few resources for those seeking help.
• For more information: fda.gov/breastimplants
• To report an issue with breast implants to the FDA, click here.
• Patient registry for breast implants and anaplastic large cell lymphoma
• The LemonAID support group
• The Let's Talk Breast Health show
• Facebook group: The Breast Implant Illness & Healing by Nicole
• Facebook group: The Breast Implant Illness Nevada by Rachael Robart
This story originally appeared in the Las Vegas Weekly.