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Improvement Of Pulmonary Function After Removal Of Breast Implant And Total Capsulectomy­­: An Objective Outcome Assessment In Breast Implant Illness
Corinne Wee1, Joseph Younis1, Kelsey Isbester1, Arvin Smith1, Katherine Grunzweig1, Sam Boas1, Donald J. Harvey1, Anand Kumar1, Lu-Jean Feng2.
1Case Western Reserve University, Cleveland, OH, USA, 2The Lu-Jean Feng Clinic, Pepper Pike, OH, USA.

PURPOSE: Breast Implant Illness (BII) after aesthetic breast augmentation remains a poorly defined syndrome. Patients attribute a spectrum of symptoms to breast implants. Previously published series have observed a subjective improvement in breathing following breast implant removal and total capsulectomy. We hypothesized that patients presenting with BII would have significant improvement in pulmonary function tests after removal of their breast implants and capsules (explantation).
METHODS: A retrospective study of all patients presenting to a single-surgeon practice over 2 years who elected removal of breast implants and total capsulectomy due to a number of systemic complaints was conducted. Paired T-tests were used to compare PFTs before and after removal of breast implants and capsules. For patients with multiple post-op PFTs, highest post-op PFT scores were analyzed. Multivariate analyses and linear regression models were used examine the impact of patient- and implant-related factors on PFT changes. RESULTS: Sixty-nine (69) patients met inclusion criteria. Forced vital capacity (FVC) (mean pre: 3.67 +/- 0.61 L vs. post: 3.82 +/- 0.55 L), forced expiratory volume (FEV1) (2.78 +/- 0.44 L vs 2.89 +/- 0.39 L) and peak expiratory flow rate (PEFR) (5.91 +/- 1.43 L vs 6.56 +/- 0.96 L) were significantly improved post-operatively (p=0.004, 0.01, 0.0001, respectively). Forced expiratory volume at 25-75% of pulmonary volume (FEV25-75) and FEV1:FVC ratio were not significantly different (p=0.35, 0.78). Implant surface had a statistically significant impact on PFT change pre- to post-surgery, with textured implants showing a greater improvement in PFTs after their removal (p=0.009). CONCLUSION: This study demonstrates that patients presenting with symptomatic implant BII had significant improvement in pulmonary function based on standard PFT evaluation after explantation. The results of our study indicate measurable restrictive effects of implants and their capsules on the chest wall particularly with textured implants. Further investigation is needed to elucidate the cellular mechanisms associated with the restrictive chest wall mechanics and inflammatory process associated with BII.


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