Neuroimaging in Breast Implant Illness, an fMRI Pilot Study

BACKGROUND: Some women with breast implants report systemic and cognitive symptoms known as breast implant illness (BII), which are very similar to those of fibromyalgia. Functional MRI has shown altered brain activity in fibromyalgia patients.

OBJECTIVES: In this pilot study, we investigated whether brain alterations could be observed in BII patients using fMRI.

METHODS: Women aged 18 to 76 with silicone breast implants for cosmetic reasons were recruited through a Dutch online BII support organization (MKS) and through Maastricht University Medical Center. Twelve women with BII and twelve women without symptoms were included. Participants completed questionnaires regarding demographic characteristics, medical history, psychosocial complaints (4DSQ), cognitive failure (MSSE), pain intensity and pain-related disability (CPGS). Subsequently, brain images of all participants were obtained using resting-state fMRI (rs-fMRI) and Diffusion Tensor Imaging (DTI) at a 3 Tesla MRI scanner (Siemens Medical System, Erlangen, Germany).

RESULTS: Eleven BII patients and 12 healthy controls were included for analysis. Baseline characteristics were similar in the two groups and the mean silicone exposure was 15 years. Patients scored significantly higher on both pain intensity and disability than controls. Patients scored worse on depression, somatization, distress, and anxiety compared to asymptomatic women. MMSE scores were normal. However, the analyses of both functional connectivity and structural integrity showed no significant differences between the two groups.

CONCLUSIONS: This pilot study showed no evidence of brain alterations in BII patients. However, patients scored significantly worse on psychosocial symptoms than controls. Psychological factors appear to play an important role in BII and should be further investigated.