ASIA Syndrome from Breast Implants

Asia syndrome from breast implants occurs when the immune system sees the silicone as a foreign substance and causes the body to launch an immune response. Symptoms vary from muscle and joint pain, fatigue, dermatological, and cognitive issues. Often misdiagnosed as another autoimmune disease, in 2011, this pattern of symptoms was identified as Autoimmune/inflammatory syndrome induced by adjuvant (ASIA Syndrome).

An adjuvant is a substance (pharmacological or immunological e.g. vaccines, silicone) that increases an immune response.

The most popular use of adjuvants is with vaccines. Adjuvants may be added to a vaccine to bring about a desired immune response by boosting the vaccine to give it a higher amount of antibodies and longer-lasting protection, thus minimizing the amount of injected foreign material.

Historically, adjuvants were generally considered to be materials that posed little or no threat to a person. However, continuing research with animal studies as well as reports of human diseases has clearly demonstrated the ability of adjuvants to inflict diseases by themselves.

Why silicone is considered an adjuvant

Silicone acts as an adjuvant because it stimulates an immune response. (Remember an adjuvant is a substance that increases immune response—this could be good or bad.) In some genetically predisposed women, when they receive silicone breast implants, they have an undesirable immune response causing serious autoimmune issues and results in ASIA Syndrome from breast implants.

ASIA Syndrome has five autoimmune conditions that fall under its umbrella:

  1. Post-vaccination phenomena: abnormal immune response from receiving vaccinations low grade fever, sore throat, skin reactions.
  2. Macrophagic Myofasciitis Syndrome (MMF): microscopic lesions found in muscle biopsies that show infiltration of muscle tissue. Studies at the University of Paris have shown that MMF lesions result when the aluminum hydroxide adjuvant from a vaccine remains embedded in the tissue and causes a steady immune reaction.
  3. Gulf War Syndrome (GWS): chronic and multisymptomatic disorder affecting returning military veterans and civilian workers of the 1990–91 Gulf War.
  4. Siliconosis: exposure to silicone gel where one develops musculoskeletal pain syndrome characterized by overwhelming fatigue, arthralgias, and myalgias.
  5. Sick Building Syndrome (SBS): people in buildings suffer from symptoms of illness or feel unwell for no apparent reason. Frequently pinned down to flaws in the heating, ventilation, and air conditioning (HVAC) systems where people inhale small particles and these particles act as an adjuvant. 

An adjuvant by itself causing a disease is rare. Typically there is an environmental trigger, such as a viral illness or prolonged exposure to certain toxic chemicals plus additional genetic risk factors. Meroni 2011; Schoenfeld and Agmon-Levin, 2011).

Extensive research has identified the genetic background contributing to the development of ASIA Syndrome. HLA typing reveals alleles HLA-DRB1 and HLA-DQB1 are typically associated with rheumatic diseases. This means if you carry these alleles, there is a greater chance you will have an abnormal response to an adjuvant leading to the development of full-blown autoimmune diseases.

In order for a positive ASIA Syndrome diagnosis, patients must present at least, 2 major criteria or 1 major and 2 minor criterion. Yehuda Shoenfeld and Nancy Agmon-Levin created the major and minor criteria proposed for ASIA Syndrome.

ASIA syndrome criteria chart

Some comments about these criteria that we have experienced over years of diagnosing ASIA syndrome.

  1. In our experience, the shorter the time frame between exposure and symptoms, the easier it is to diagnose. If problems develop years apart, it becomes harder.
  2. Some of these criteria are not very practical—a vaccine can’t be removed, getting a biopsy on all involved organs is not likely.
  3. The most practical view of this table is if you get an implant or a vaccine and out of nowhere you develop positive antinuclear antibodies, the likelihood of ASIA Syndrome is high.
  4. Vaccinations—if a family member has an autoimmune disease, and you are debating giving a vaccine to a child, we recommend getting the child tested for HLA class II phenotypes. If DRB1 or DQB1 is present, the risk of developing an autoimmune disease is probably quite high.

Focus on Siliconosis
Silicone breast implants are most commonly composed of a silicone elastomer envelope filled with silicone gel.

In the majority of cases silicone implants are preferred over saline filled implants due to better overall aesthetic results and a decreased chance of long-term rupture; a more common occurrence with saline-filled implants. (lidar et al., 2012)

Why do implants cause problems?

Any type of implants (silicone, titanium, metal fillings) on any part of the body, absorb microbial toxins on their surface. In certain individuals, even though you may not have an infection or an infection is dormant, your body is still fighting as if you were dealing with an infection because of all of these toxins gathered on the surface of the silicone.

The only way to bring the whole inflammatory reaction down is to remove the implants. Even those with saline breast implants are at risk because the breast shell is still made of silicone, which causes the problem.

While breast implants can be removed in entirety, sometimes it is not possible to remove the entire capsule that surrounds the implant due to risks of tearing chest muscles and incurring more damage. In the cases where the capsule is left in place, toxins can still form on the capsule, but the area is much smaller and could potentially be managed by detox protocols.

Diffusion of silicone occurs when silicone bleeds through the silicone shell into the surrounding tissues.

When bleeding occurs, it is almost impossible to resolve completely because the silicone has impregnated soft tissues. In these cases, the goal is to remove the majority of the silicone by removing the implants; thereby decreasing the surface area where toxins gather.

Things to consider before breast explantation

A question we often get is how long will it take to recover?

Improvement is varied, but not immediate in most patients. Some patients report improvement in as little as a month up to 12 months or more after explantation.

A Dutch study found that among 52 women who had their implants removed, 36 (69%) reported that they felt better, and 9 of the 36 reported that their symptoms were gone. A meta-analysis, which is a type of study that combines the results from several studies, found that on average, 3 out of 4 women who removed their silicone breast implants saw improvement in their symptoms.

If you have ANY underlying infection, you need to get this under control first before explantation. We strongly recommend having bloodwork done to verify that any infection is not active before proceeding.

One woman’s story of explantation

The following video is a story from one of our patients who two years after receiving breast implants, she started experiencing neck pain. Her symptoms continued to increase until she was taking pain killers and anti-nausea medication every day for eight months.

She had underlying Lyme disease that needed to be dealt with before her explantation. Even after her bloodwork came back clear of infection, she was still not feeling well. She attributed her malaise to her breast implants and wanted an explantation.

One month after explanation, she is no longer on pain and anti-nausea medications. She contributes this to having her breasts and all foreign materials removed from her body.

She speaks openly about her decision to remove her implants, how that has affected her self esteem, and what still scares her going forward.

Controversy in the industry

The relationship between silicone implants and ASIA syndrome from breast implants has generally been refuted by consistent evidence from large-scale studies.

However, ASIA criteria were only defined in 2011, and few studies have been done since this time.

Most recently in September 2018, a study published in the Annals of Surgery  examined the data from 100,000 people who had implants and concluded that “Compared with normative data, silicone implants are associated with higher rates of Sjogren syndrome (Standardized incidence ratio [SIR]8.14), scleroderma (SIR 7.00), rheumatoid arthritis (SIR5.96), stillbirth (SIR4.50), and melanoma (SIR3.71).”

The Food and Drug Administration disagrees with the outcomes of this study stating that there were “significant shortcomings” with the “study methodology, inconsistencies with the data, and potential sources of bias.” Also adding that “the agency continues to believe that the weight of the currently available scientific evidence does not conclusively demonstrate an association between breast implants and connective tissue diseases."

“Silicone implants are associated with an increased risk of certain rare harms…long-term safety and implant-related outcomes should inform patient and surgeon decision-making when selecting implants”.

Future studies that generate long-term data on a wider scale should help clarify the association between silicone and autoimmunity. However; anecdotally, there are thousands of women who detail their severe medical issues after receiving breast implants—their personal stories and more public awareness are hard to ignore. Associations need to be further analyzed with patient-level data to provide conclusive evidence.

If you already have an autoimmune disease, breast implants could make your symptoms worse. If autoimmune disease runs in your family, you may be at increased risk of developing ASIA Syndrome from breast implants.