Pathology
Discuss with your surgeon beforehand to take pictures of the implants and capsules, what you would like to be sent to pathology, and what tests to have done. Pathology is typically concerned with the diagnosis of disease and only checks for atypical cells leading to cancer cells when examining capsule tissue. They may not check for infections from bacteria or fungus, nor do detailed descriptions unless directly requested to do so by the surgeon. Pathology reports tend to be very general unless you insist for them to be more detailed.
1. List of Potential Pathological Materials
- Capsules
- Swabs of Chest & Capsules
- Implants
- Rarely: potential lymph node (if deemed oversize) and seroma/effusion aspirate for CD30 (if there is fluid collection).
If you have implants and develop unilateral swelling, seroma, enlarged lymph nodes, breast mass, or even capsular contracture, you should push for CD30 ALCL testing. This is especially important with textured implants (silicone and saline). There is a Facebook ALCL support group and currently there are 60+ women with the diagnosis.
Update: As of July 2017, Dr. Mark Clemens states the FDA has received 464 adverse event reports in relation to BIA-ALCL and 12 deaths. See here for this report.
As of September 2015, of the reports received by the FDA, 50 percent of BIA-ALCL cases are with textured implants, four percent are with smooth implants, one percent have a history of both and 45 percent do not specify whether they were textured or smooth implants. – FDA
Capsules & Swabs:
During surgery you can have the surgeon take swabs of your chest and capsules, and also have them take pictures of the implants and capsules. Capsules and swabs can be sent to pathology and tested for: bacteria, fungi, atypical cells, ALCL (CD30), white blood cells, and foreign materials (gel bleed: silicone, silica, talc, polyurethane). These tests are additional costs to the surgery, please inquire beforehand.
1. Bacteria – Biofilm is adherent bacteria that covers the surfaces of implants and can cause low grade chronic bacterial infections, chronic inflammation, and capsule contracture. It is very common to have biofilm/bacteria form around medical devices and it can be a good idea to test for it. In 2016 there was a research study done on the microbial epidemiology of breast implant infections where 17 species of bacteria were identified.
2. Fungi – The occurrence of fungi is rare, but has been found around saline and silicone breast implants. Saline implants that have valves are susceptible to microbial growth around them and inside the saline solution. Saline valves are permeable and allow body fluid/tissue in and allow colonization of microorganisms inside the implant. See saline implants and mold for more information. Mold can also occur around silicone implants as they disintegrate and allow body fluids to permeate the shell and implant. There have been reports of the fungus candida being found on silicone implants. Textured implants, both saline and silicone, allow body fluids to be soaked up by the textured surfaces, and therefore this also attracts fungus and provides an ideal breeding ground. Fungus thrives in warm and wet areas. Please note, fungi are slow growing and hard to detect on regular cultures, it can be a waste of money to check in most cases, especially for silicone implants.
3. Atypical Cells and ALCL (CD30) – If you have implants and develop unilateral swelling, seroma, enlarged lymph nodes, breast mass, or even capsular contracture, you should push for CD30 ALCL testing. This is especially important with textured implants.
4. White Blood Cells – Checking for lymphocyte infiltration, foreign body giant cells, and granulomas can be indicative of chronic inflammation and a foreign body reaction.
5. Foreign Materials – If you have silicone implants you can request for pathology to check for the foreign materials of silicone, silicon, and silica. If you have the earlier versions of the implants before 1991, you can request for them to check for talc, silicone, silicon, and silica in your capsules. If you have polyurethane implants, you can request for them to check for polyurethane, talc, silicone, silicon, and silica. For more info see Stanford Pathology.
Resources for capsule testing:
DNA Connexions has a Full View Test that identifies: “bacteria, viruses, fungi and parasites in removed teeth, blood, tissue, implants, bone grafts or other biological samples. It tests for 88 different pathogens, including tetanus, botulism, diphtheria, HPV 16 and HPV 18, Candida albicans and more. Using PCR, one of the most advanced tools in molecular biology today, specificity of this test is one in a trillion or greater and the sensitivity of the test is the ability to detect the DNA of between 1 and 10 microbes.”
The Carlson Company in Colorado is a toxicology lab that can do heavy metal and chemical testing of explanted capsule tissues. This test is very expensive to have done.
Implants:
If you have saline implants, Mycometrics and Real Time can test saline fluid for mold and microorganisms. It costs about $180 per implant and results generally take 3-4 weeks. If you want your implants back after the testing you have to specify it with them beforehand.
Optionally as an extra measure, swabs of the implant surfaces can be taken as well if you want to check for biofilm/bacteria or fungus. Although if you do the swabs of the inner layer of the capsule that may be enough.
Generally implants are sent to pathology more for the purpose of having their appearance and labeling recorded with any identifying marks, characters or numbers. This may be useful for those interested in legal proceedings. Plastic surgeons may be able to do this too. See the article, “The Importance of Documenting the Appearance and Status of Breast Implants at Time of Explantation.” If you do send your implants to pathology, ensure that they are not destroyed and will be returned back to you.
You can also request for your breast implants to be weighed.
Lymph Nodes:
Removing lymph nodes is a controversial topic. Foreign substances in the breast have the potential to migrate to local and occasionally distant lymph nodes. Silicone from ruptured or intact implants can be found in lymph nodes. Textured implants can have shell fragments flake off and those may also be found in the lymph nodes and be associated with ALCL.
Normally lymph nodes are no larger than 0.5 in (1.3 cm) in diameter and are difficult to feel. They can enlarge to greater than 2.5 in (6 cm). It is not recommended for lymph nodes less than 0.5 cm to be removed. Lymph nodes are an important part of the immune system and they help the body recognize and fight off infections. Silicone and shell fragments are very difficult to break down and therefore removal of large silicone-filled lymph nodes may be appropriate in some cases. See here for more information on lymph node pathology.
Explant expert, Dr. Lu-Jean Feng, shares her expertise on silicone and lymph nodes on her YouTube Channel, webinar + transcript, and website. Click here to expand.
“Dr. Lu-Jean Feng has performed extensive research on silicone lymphadenopathy over the last 20 years as a result of breast augmentation. As a result of this research, she has published a peer-reviewed paper [Pathology of Lymph Nodes From Patients With Breast Implants] with scientists from the Armed Forces Institute of Pathology in Washington, D.C. as well as from Case Western Reserve University in Cleveland.
The study concluded that silicone in the lymph nodes can be diagnosed by ultrasound and localized by needle localization for precise removal. The polyurethane covered gel filled breast implants are associated with extensive silicone lymphadenopathy in the axilla, retropectoral, internal mammary, and sometimes neck nodes, but never in nodes below the diaphragm. The saline implants are never associated with silicone lymphadenopathy. Ruptured gel implants are only sometimes associated with silicone lymphadenopathy.”
Dr. Lu-Jean Feng’s Webinar Transcript, pg. 9:
“The silicone in the lymph nodes first has to be detected by ultrasound, which is probably the best way because it has a very specific signal. But to remove it you really have to have it needle localize, meaning that particular node has to be specified through needle localization and that can only be done by a radiologist. You can’t tell which [lymph nodes] have silicone and which [lymph nodes] do not if you just blindly go into the axillary space. They really have to be localized. Most of the silicone that I see in the lymph nodes are incredibly small and not alway accessible.
Some of this silicone lymph nodes are actually behind the ribs. They are very close to the lung, and the only way to remove these lymph nodes is to take out a rib to remove them. Some silicone in the lymph nodes are very high up in the chest near the axillary vessels. They are very hard to be localized. So, yes, you can approach it in those areas but which ones are you going to take? Are you going to take it all or are you going to take a few? So, unless the lymph node can be localized I wouldn’t take them out because you could take out normal lymph nodes and that certainly wouldn’t be good.
So if the lymph node is enlarged, if the lymph node is painful, if the lymph nodes can be localized, then these are all the conditions in which you could take our the lymph node. Otherwise if it too small, too inaccessible, you can’t get to it. The most important thing is how did it get there? So it is more important to remove the implant and capsules that really remove the secondary effect of implantation.”
Seroma/Effusion:
If fluid collection is found, request for it to be sent to pathology and do the CD30 test for ALCL. Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is a cancer of the immune system. One of the presenting signs of lymphoma is seroma and it is highly recommended for it to be analyzed for the possibility of ALCL. There is a Facebook ALCL support group and currently there are 60+ women with the diagnosis. It is more commonly found in textured implants. Don’t assume the doctor will test for fluid collection or send capsules off for testing, these can easily be discarded unless requested by the patient before the surgery.
2. Request Detailed Pathology Report
You can request for a very detailed pathology report, noting the following:
Pathological lesions, if there is any foreign material (such as silicone), lymphocyte infiltration, chronic inflammation, and histologic features.
Note: Nearly every patient receives “synovial metalplasia” in their capsule pathology reports.
3. Other
Please note that pathology will apply a fixative of formalin or formaldehyde to the capsules and will generally make slides of some of the capsule tissue. Fixatives permanently tamper the capsules and prevent any future form of testing on them. The lab will either hold the capsules for a certain amount of time or destroy them after analysis unless you would like them returned to you, which would need to be prearranged. The capsules tell the story of your body’s reaction to the implant. There is an expert, Dr. Pierre Blais, who examines breast implants and capsules but he is currently back logged. You may wish to have the capsule returned to you or ensure it is kept by the lab so that Dr. Blais may one day analyze them.
I have mentor memory gel implants that were placed 2005. & now have been diagnosed with Sjogrens, lupus & bilateral parenchymal lung scarring. Major shortness of breath & fatigue. I see the plastic surgeon for consult on Explant tomorrow. Wish me luck!
Best of luck, Carla! Here is a list of questions to ask.
Mentor MemoryGel silicone breast implants were conditionally approved on November 17, 2006. Before then, from 2000-2006, women who had them were supposed to be placed in premarket approval studies and followed up on. Please report your symptoms and study follow-up to the FDA: MedWatch Online Voluntary Reporting Form. See here for some of the other reports submitted.
I had silicone implants put in in 2004 and I cannot find my paperwork on them. The plastic surgeon that performed the implant surgery is unable to perform anymore due to a loss of thumb in an accident. I have been ill for a year and extreme pain in my left breast .burning, and stabbing pains in neck, shoulder, chest and left arm. I have had multiple tests run and nothing showed up til I did the heavy metal test. It showed nickle content to be 12.2. I went to plastic surgeon prior to the heavy metal test and he said I had a lot of scar adhesion and my implants had pushed up higher. He also said he would not know if they were leaking til he got in there. Is there a site to pull up which implants I have by the Dr who was in the study? I’m scheduled the end of March to take out and replace with new ones. However; I’m afraid I may be toxic and could end up with some kind of disease. I need guidance and help on this issue. Please help. Thx R
Hi Rebecca,
You likely have either Mentor or Allergan implants, as these were the U.S. manufacturers enrolling women in silicone breast implant premarket studies in the early 2000s. Unfortunately, there is not a website to lookup the implant you have by the doctor who was involved in the study. However, you can try to contact Mentor and Allergan.
There was a lady in the breast implant illness groups who had luck with contacting Mentor and found out information in regards to the study she was enrolled in and her implants. She called the Mentor Cincinnati office (now Ethicon, a subsidiary of Johnson & Johnson) and spoke with a clinical study administrator (Kelly Gregory at the time). The contact for that office (Ethicon in Cincinnati) is 513-337-7000, you can try to call and ask to speak with a clinical team/study administrator. You can try to also contact Allergan and ask to speak to a clinical team/study administrator.
Nickel is one of the many heavy metals used in manufacturing silicone breast implants, for the complete lists please see the Mentor MemoryGel SSED (refer to pg. 8) and the Allergen Natrelle SSED (formerly Inamed, refer to pg. 6).
Replacing implants is not recommended, symptoms will continue to progress. In the scientific article, “Systemic inflammatory disease resolution following cosmetic silicone breast implant removal” a lady replaced her implants and continued to have symptoms, it was not until removal that there was dissolution and recovery. This is commonly seen in the community, as the body can not heal until all foreign interference has been removed. Do not be worried about having a toxic disease, the most important part is to focus on proper explant with full capsule removal.
Hi!
I am having explant on Jan 12. I want my capsules and implants. I’m told I need a request in writing from an attorney. The request needs to have the specifics, such as solution and packaging or the hospital will send them to “the main lab” and they will be “cleaned” and then sent back to me, minus the capsules, “because they are considered Biohazard”.
Can you please help me with this?
Hi Lynne,
Please seek the advise of an attorney. For the specifics on solution and packaging you can try to contact the expert Dr. Pierre Blais, I will email you his contact. In case you can not reach him in time for your upcoming explant, I will also send you a document from Dr. Blais that contains some information on capsule/implant solutions for storage that you may find helpful.
Having 2 sets of polyurethane textured silicone implants rupture in 1989, 1992.
Ultimately replaced with saline implants in 1995. Experienced the gamut of symptoms and illnesses discussed. In 2000 opted for explanation of the saline implants.
In 2002, lymph node resection and of course pathology was indicative of silicone.
Chronic bladder issues with microscopic hematuria and bowel problems from UC to IBC. Just recently thyroid issues, biopsy suggested strongly for malignancy. Surgeon doing ultrasound told me in general thyroid is crapping looking. Total thyroidectomy was done and no malignancy but cystic, gelatinous, deep orange colored nodules, felt to be silicone related. I feel better now the thyroid has been removed. Discomfort in neck and jaw going up to my ear is gone.
I am sure in 2000 when saline were removed, en bloc technique wasn’t done. Just scrapping the chest wall. Was told by surgeon there was a lot of silicone left in my tissues, described as chards of glass.
SO…should I consider having surgery done to go back inside and see what things look like? I am relatively highly functioning even though I have a lot of symptomology. I would appreciate your thoughts/suggestions. Thank you, Nina
Hi Nina,
Polyurethane textured silicone breast implants were some of the most harmful implants created. They were in production from about 1980 to when the manufacturer voluntarily withdrew them in 1991 due to significant safety concerns. They were made with aggressive chemicals on the surface to deter and weaken the immune system from forming scar tissue, thus they were a “new” attempt to reduce capsular contracture (a frequent problem with earlier implants). Among other things, adverse reaction reports indicated that the foam disintegrated and dissolved into the body, meaning it broke down into fragments and/or was “partially digested,” to the point where the foam surface disappeared – explanted implants in some cases had little to no coating left on them. Research found the polyurethane foam to breakdown into 2,4 toluenediamine (TDA), a known carcinogen. It was the first time breast implants were linked to cancer, which is interesting to note because modern textured implants are the second time breast implants have been linked to cancer (ALCL), and what they both have in common is a chemically abrasive fuzzy surface.
“The F.D.A. data show that the dissolution of the polyurethane begins immediately after implantation and that in some cases…the coating may dissolve almost completely within five years. The greater the rate of dissolution, the greater the cancer risk, the scientists said they believed.” Source: Scientists tie breast implants to cancer (link).
This background on the implants is important to note because it sheds light on their toxicity. Since those implants were prone to having their surfaces dissolve and the fact that you had two ruptures, the capsules must be completely removed. The capsules were in direct contact with the implants, containing and absorbing the silicone, chemicals, and heavy metals that came out of them. Do you have your explant post-operative report? It may no longer be available, but you can try to request your medical records to see what is noted about the capsule being removed. Many times surgeons who aren’t experienced in explants do not bother to fully remove them, and in your case you probably had multiple capsules forming from the three sets of implants. I would consider seeing Dr. Feng or Dr. Chun (he is less expensive), both are excellent options as top explant surgeons who are committed to full capsule removal and can handle complex cases. After removal of any remaining capsules, you can work on detox. Silicone toxicity expert and pathologist, Dr. Shanklin, did research on silicone detox and recommended taking inositol, see his inositol protocol. You can also research boosting your detox systems (lymphatics, liver, kidneys/bladder, skin, gut) and promote elimination of toxins. Diet is the best source of natural detoxification followed by gut health. See detoxification and healing for more information.
Ugh…so scary all this stuff!!!
On my thyroid pathology does the doctor have to specifically request for indications of silicone exposure?
They felt certain I had a malignancy and on examination after thyroidectomy it was benign although I was told my thyroid was crappy looking. Cysytic, gelatinous, hyperplasia etc. I have not seen my surgeon yet post op. I did tell him prior to the surgery about the silicone rupture. If necessary wondering if they can re examine my thyroid.
Generally pathology only checks for atypical cells and therefore additional things need to be requested, such as checking for silicone. In a scientific article investigating the dispersal of silicone droplets and silicone plaques in a woman with ruptured silicone breast implants, silicone droplets were found in the thyroid (see Table 1, page 2) along with silicone plaques (see Figure 6, page 6). It may be of use to show that research to your surgeon and pathologist.
I have asked a couple Dr’s and plastic surgeons now and they all have said I have to find a lab that will take the implants for testing
I am confused by this but really want to get a lot of these tests done, just a little overwhelmed on where to start when calling labs
Hi Shannon,
What kind of implants do you have and what kind of tests are you interested in? Generally it’s the capsules that need testing, not necessarily the implants unless they are saline and you want the fluid checked for mold or microorganisms.
Thank you for the quick response. I have Natrelle Smooth Silicone. I’ve had chronic sinus issues combined with many other auto immune symptoms with no diagnosis except the go to of Chronic fatigue syndrome and fibromyalgia and have had multiple sinus surgeries with no success, just constant infection, pain, you name it…
I wanted to have tested for metals & fungi primarily but there is so much that could be tested for I’ve become overwhelmed to be honest and want to test for everything possible in hope to get answers
Various infections thrive with breast implants. The key is the interference with the immune system that can no longer regulate them.
In general, the Silicone Hypersensitivity Panel is popular, it tests for lymphocyte sensitivity to: Silicone, Silicates (silicon dioxide), Polyvinylpyrrolidone, Tin/stannous chloride, Titanium dioxide, Petroleum by products, Xylene, Toluene, Benzene, Latex, Phenol, Formaldehyde, Vinyl chloride, Green #5, Blue #2, Violet #2, Aspergillus niger, Candida albicans, Aluminum.
More specific tests really depend on your symptoms. The APA Assay is a test for abnormal immune system response with fibromyalgia. For reoccurring sinus infections you might be interested in a MARCoNS nasal swab. “MARCoNS (Multiple Antibiotic Resistant Coagulase Negative Staphylococci) is an antibiotic resistant staph that resides deep in the nasal passage of 80% of people with low MSH (Melanocyte-Stimulating Hormone), those suffering from Biotoxin Illness and other chronic inflammatory illnesses.” Read more on this here. Chronic sinusitis has also been found to be caused by an immune system response to fungus, see: Mayo Clinic Study Implicates Fungus As Cause Of Chronic Sinusitis.
Heavy metals can be tested on hair, sweat, nails, saliva, blood, urine, or capsule tissue. Out of all of those, heavy metals in the hair, sweat and capsules would likely be most relevant for silent chronic illnesses, however these tests are expensive. The Carlson Company tests for heavy metals. A less expensive and more popular test is the Hair Trace Mineral Analysis (HTMA), which shows mineral deficiencies and heavy metal levels from chronic toxic exposure. This can be done by a functional medicine or naturopathic doctor. In the breast implant illness community there are three main professionals who do a lot of HTMAs, they are: Pippa Galea, Talismae Martin, and Dawn Strohm.
Fungi are more difficult to test for, but if you are having gut issues and food allergies then Candida IgM/IgG is a common yeast/fungal infection among us.
Thank you!
I had breast implants removed and now thru 3D Mammogram and an ultrasound they see an abnormal mass. Why can’t they tell if it’s a silicon particle or a cyst or cancer?
hi I have these death bags still inside me. . I would like to no where and what biotoxin tests I need any help?
Hi Vanessa,
Please see the tests page for a list of the biotoxin/mold tests: 1. VCS, 2. Lab Work, and 3. MRI+NeuroQuant Test.
A good starting point is with the free online Visual Contrast Sensitivity (VCS) Test and then if you are interested you can find a functional medicine or naturopathic doctor and request blood work (Alpha MSH, C4a, VEGF, ADH/Osmolality, TGF Beta-1, MMP-9, ACTH/Cortisol, Leptin, VIP) and if you have gut issues you can check for Candida IgM/IgG. Finally, the MRI+NeuroQuant test is excellent for showing brain inflammation from mold.
where do I send for analysis exactly? I’m getting procedure done very soon.
Hi Dana,
Ask your surgeon to send your capsules (scar tissue) to pathology and tell him what tests you would like to have done on them, such as to check for: bacteria, fungi, white blood cells, foreign materials, atypical cells, and CD30 if you have textured implants or ALCL symptoms. These tests are additional costs to the surgery, please inquire beforehand.
You can also request a detailed report inclusive of: pathological lesions, if there is any foreign material (such as silicone), lymphocyte infiltration, chronic inflammation, and histologic features.
Dr. Pierre Blais is a breast implant expert who analyzes them. After pathology they can be sent to him in Canada. However, he is currently backlogged and is not accepting any more material until he is caught up.
Just a friendly update – there are now 60 women Diagnosed with BIA-ALCL on the private FB Group.
Hi Terrimc,
Thank you for this important update. There is also an ALCL page, if you have anything you would like to see shared or edited on there just let us know by comment or email ([email protected]).