Breast implants are widely used for both cosmetic and reconstructive purposes, but some individuals report various health concerns following placement. Among the symptoms frequently reported is difficulty breathing (dyspnea) or a persistent feeling of chest tightness. While implants are generally considered safe, this respiratory concern warrants careful investigation. Breathing issues can stem from direct physical effects on the chest wall or from a systemic reaction within the body. It is important to explore the potential mechanical and inflammatory mechanisms that may link breast implants to changes in respiratory function.
Physical Restriction and Placement
The mechanical impact of a breast implant on breathing is primarily related to its size and its position relative to the chest wall muscles. When implants are exceptionally large (macromastia), the added volume and weight exert pressure on the chest cavity. This pressure may restrict the full expansion of the lungs and diaphragm, leading to tightness or difficulty taking a deep breath.
The placement of the implant, whether submuscular (under the chest muscle) or subglandular (over the chest muscle), also influences this mechanical interaction. Submuscular placement requires the pectoralis muscle to be lifted and stretched, which can cause postoperative discomfort and tightness that temporarily impedes deep inhalation. In the long term, the implant beneath the muscle can alter the function of the chest wall, especially during physical activity.
A significant physical cause of breathing restriction is severe capsular contracture, the most frequent complication of breast augmentation. This involves a hardening and tightening of the natural scar tissue capsule that forms around every implant. In advanced stages, this firm scar tissue acts like a constricting band, mechanically limiting the movement of the rib cage necessary for full respiration. Studies have shown measurable restrictive effects on the chest wall in patients with capsular contracture, with breathing capacity improving after removal.
Systemic Symptoms Associated with Breast Implant Illness
Beyond direct physical restriction, breathing problems are a commonly reported systemic symptom linked to Breast Implant Illness (BII). BII describes a collection of non-specific symptoms experienced with any type of breast implant, including chronic fatigue, joint pain, neurological issues, and shortness of breath. This collection of symptoms is not currently a formal medical diagnosis but is a recognized clinical syndrome.
The breathing difficulties in BII are believed to be systemic, stemming from the body’s inflammatory or immune response to the foreign device. Experts propose that BII represents an autoimmune/inflammatory syndrome induced by adjuvants (ASIA), where the implant material triggers a chronic inflammatory state. This chronic inflammation, rather than physical obstruction, contributes to symptoms like persistent chest tightness and dyspnea.
In rare cases, a ruptured silicone implant can lead to the migration of particles into other tissues, causing respiratory issues. This leakage can trigger chronic pulmonary silicone embolism, where particles travel to the lungs and cause inflammation and fibrosis. The presence of the implant is also sometimes associated with autoimmune conditions like sarcoidosis or Sjögren’s syndrome, which directly affect lung function. The systemic nature of these symptoms means they can appear at any time after the initial surgery.
Determining the Cause of Breathing Difficulty
Individuals with breast implants experiencing breathing problems require a thorough diagnostic process to determine the root cause. Dyspnea can be caused by numerous common and unrelated factors, such as anxiety, asthma, or cardiac conditions, which must be ruled out first. A comprehensive patient history and physical examination are the starting point for distinguishing between mechanical restriction, systemic BII symptoms, and other medical issues.
Diagnostic tests are employed to assess lung and heart function. These include chest X-rays to visualize the lungs and pulmonary function tests (PFTs) to objectively measure breathing capacity. Cardiac issues are ruled out through an electrocardiogram or other heart-specific evaluations. If other common causes are excluded, the focus shifts to the implants, potentially involving imaging like ultrasound or MRI to check for capsular contracture or implant rupture. The goal is to isolate the problem, differentiating a purely mechanical restriction from a systemic reaction or a coincidentally occurring medical condition.
Options for Resolution
If a medical evaluation confirms that breast implants are the source of the respiratory issue, explantation is the definitive treatment path. Explantation is the surgical removal of the implants. For mechanical problems caused by severe capsular contracture, the implant and the surrounding restrictive scar tissue (the capsule) must be removed.
This procedure, called a capsulectomy, involves surgically removing the capsule along with the implant. A total capsulectomy removes the entire capsule, while an en bloc capsulectomy removes the implant and capsule as a single unit. Explantation is the standard intervention for patients with systemic BII symptoms, with many reporting significant resolution of their symptoms, including breathing difficulties.