[WARNING: Images and video in this story may be too graphic for some audiences]
(3TV/CBS 5)-- Angie Everhart was dominating the modeling world in the 1990’s. Her red hair and personality broke typical beauty norms. The athletic beauty was featured in Sports Illustrated and on magazine covers. She seemed to be everywhere-- attending celebrity and red-carpet events, acting in movies and dating stars, including Sylvester Stallone and Joe Pesci.
During the height of her popularity, Angie says she was convinced to get breast implants. The operation did not go as planned. She says that while she was asleep on the operating table, the man she was dating (a celebrity) pressured the doctor to give her bigger implants than the C-cups that she was expecting.
“A boyfriend of mine came into the operating room. When I was under sedation, he convinced the doctor to give me double-D’s -- while I was asleep.” Angie said. She says the implants damaged her modeling career. Bringing down the size of her breasts took multiple surgeries-- each one gradually reducing the size of the implant to avoid sagging.
Angie says she was finally fed up with implants when one ruptured after the birth of her son. “I just couldn't take anything else. I was like, ‘Just take them out. Get rid of them!’” At the time, Angie was convinced that the breast implant removal surgery (referred to as "explanting") would end her ordeal with implants but over the next ten years she developed unexplained health problems-- the most debilitating was losing the ability to concentrate enough to form sentences. “They call it ‘brain fog’ for a reason. You’re in a fog. I couldn't be in front of the camera anymore because I couldn't remember my lines. I couldn't remember what I was doing-- even going to the bathroom. I couldn't remember words.”
On top of memory issues, migraines and constantly feeling sick, Angie says, she suffered pain radiating through her neck and shoulder. Years of doctor’s appointments and trips to specialists didn’t provide any answers. And as her health problems escalated, so did the crushing medical bills.
“I lost years of my life. I lost my marriage. I lost my career. There was a lot of pain and suffering. People thought I was crazy like, ‘Oh you're sick again?’ And I was like, ‘I'm just not a sick person.’ But we couldn't figure it out,” Angie said.
Confidence was not something the strong-willed redhead struggled with until she started to struggle with words. The challenges of carrying on simple conversations caused her to avoid the spotlight, and the insecurity of not being able to find words was so anxiety-inducing that she began avoiding red carpets and other celebrity events where she would have to speak. Acting was out of the question.
Angie was desperate for answers that doctors couldn’t provide, but the turning point came when a friend, Talia Maddox, suggested that she was suffering from breast implant illness and asked Angie if she had her capsules removed with her implants.
In ten years, Angie says not one doctor had ever ask her about the capsules. She confirmed with her surgeon that her capsules were left inside of her when her implants were removed. Although capsules are something every woman with implants develops, they are often overlooked, understudied and rarely discussed. Capsules are the formation of scar tissue that develop around every implant-- both silicone and saline. The scar tissue encapsulates the implant as the body’s way of protecting it from a foreign object.
Skeptical that the capsules were the problem but desperate to feel better, Angie flew from Los Angeles to Florida where Dr. David Rankin’s practice focuses primarily on removing breast implants and capsules.
Angie says her health and life have changed dramatically in the four months since having the capsules removed. “I'm in a better mood almost daily because I'm not in pain. I don't have pain in my body. I don't have shoulder pain. I don't have neck pain.”
Beyond the physical changes, Angie describes major and life-changing cognitive improvements. She says she knew the moment her brain fog lifted-- describing a feeling like an air-conditioning clicking on inside her head. Suddenly, she was no longer struggling for find words. “I was like, ‘Oh, my God. I feel like I'm talking really fast!’” Angie lights up with excitement when she talks about being able to carry on conversations. “I couldn't have done that before. There was no speaking fast because I couldn't find the words.”
Angie’s Experience Is Not Unique
Talia Maddox, who first told Angie about capsules, was drawing on her own experience. She shared the story of her struggle with Arizona’s Family [in part]:
I explanted two years and seven months ago with an explant surgeon here in Dallas, Texas. Upon waking up, he told me he got all of the capsules and implants out. But in recovery he told my family that there was a little, tiny bit of the capsule stuck to my rib cage and chest wall that he couldn’t get out, but not to worry, it was very tiny, and he cauterized the tissue. I felt incredibly better almost immediately after explanting. Within three weeks, I noticed the blues or mild depression hitting me. It was a strange symptom and something I hadn’t felt before with BII (Breast Implant Illness). I had anxiety but never a doom and gloom feeling. I just chalked it up to detoxing and changes my body was going through without the implants. Overtime, that depressive state continued to worsen. While many of my BII symptoms I suffered for 10 years remained gone, a few new symptoms appeared, and a couple of the old ones came back. I kept telling myself it was normal and to give it time and give my body time to heal. I constantly felt bloated and inflamed. I could not figure out what was going on. Many times, my stomach look like I was 6 to 9 months pregnant. I hired a personal trainer and began all sorts of new workout routines, hoping that would help me feel less bloated and inflamed, but in fact, it made my symptoms worse. I felt like I was being poisoned again. When I would get hot or worked out, I knew something wasn’t right. The brain fog started slowly coming back as did some of my food allergies. My depression was at an all-time high. I was having daily neck and shoulder pain and pain in my armpits and my rib cage. I felt more inflamed than ever. My clothes did not fit me anymore. As an advocate for women and someone who talks to women on a daily basis counseling them on the importance of making sure all of the capsule is removed, I started hearing my own words resonate with me. I was key in helping Angie figure out what was wrong with her. When I point blank asked her if she still had her capsules in and she said yes, I said, 'Oh Angie, you need to stop spending money on trying to figure out what’s wrong with you and get those capsules out.' Ironic that here I was two years and six months later, I was chasing my tail trying to figure out why my body was starting to fall apart. One day my family looked at me and said, “Mom, maybe you should take your own advice and go have an exploratory surgery to see if the doctor really removed all of your capsule or if there’s a lot more in there than we know.” I flew from Texas to Jupiter, Florida, on Jan. 31. Dr. Rankin performed a capsulectomy (removal of scar tissue) on me. He found almost full capsules in each breast pocket. He found capsules all the way up in my right armpit where my pain had been for the last eight months. He spent three hours meticulously removing everything that my previous explant surgeon lied and left behind. My pathology report came back with chronic inflammation in each capsule. Since Dr. Rankin removed my capsules, I feel like a new human. My energy has shot through the roof. My depression is completely gone. My clarity is back. I am full of energy all day long, ready for bed at 10 o’clock at night and wide awake bright and early in the morning. The inflammation is falling off my body daily and I’ve had a remarkable recovery. I’m finally getting a taste of what healthy feels like again.
Arizona’s Family continues to hear from more women who removed their implants but didn’t see long-term health improvements until they had additional surgeries to remove their capsules. Jiwon Eun is one of those women. “My first surgeon in France told me it was absolutely fine I leave the capsules. I felt great right after surgery. Some symptoms went away right away, but I felt bad again few months later-- weight gain and hair loss. I booked a surgery with Dr. Dev in Florida and I'm super happy everything is out now. No more hair loss! Back pain [was] gone when I woke up from surgery,” Eun said.
Dr. Rankin expects to perform up to 500 surgeries this year. On top of removing implants and capsules, an increasing number of women are undergoing exploratory surgery to determine whether surgeons left capsules behind when their implants were removed.
There are no tests to determine whether implants or capsules are affecting a wide range of unexplained symptoms-- now known as Breast Implant Illness (BII). Dr. Rankin says if a woman chooses to remove her implants for health reasons, it’s "a leap of faith," but he points to health improvements that he’s witnessed. “The statistics seem a little crazy, but 95 percent of my patients are feeling better after this procedure.”
A New Mexico woman named Kelly Hunt underwent exploratory surgery after she claims her surgeon lied to her about removing her capsules. A 2018 surgery report she provided to Arizona’s Family shows the doctor documented a capsulectomy (removal of scar tissue). Kelly says the doctor and nurse assured her they got “100 percent of the capsules out.’” The surgery left her breasts mutilated. Kelly says she suffered infections and her overall health deteriorated.
After more than a year of suffering, Kelly underwent exploratory surgery with another surgeon who found large portions of the capsules. She says she was astonished to see how much of her capsules had been left inside her. "With my capsules finally out, so many of my symptoms have gone away. I am feeling like a whole new person. Just so thankful to be alive!”
Select surgeons are now willing to take pictures of implants and capsules after they are removed. Breast Implant Illness support groups warn women to avoid doctors who refuse to take pictures or return breast implants after they are removed.
Arizona’s Family has done Emmy award-winning investigations into claims that breast implants made women sick. Topics include incomplete and inconclusive studies on the safety of implants, contamination, mold, rotting tissue, silicone bleeding through shells, autoimmune diseases, issues over the years with FDA (Food and Drug Administration) panels examining implant safety and more.
[SPECIAL SECTION: Breast Implant Illness Investigation]
Now, the increasing number of women who report symptoms after having their implants removed raises another question:
Can leaving the scar tissue make women sick?
Removing breast implants can be done through various procedures. Dr. Rankin is among a growing number of surgeons who recommend a procedure called ‘en bloc’. It is the most complicated of the procedures which involves removing the breast implant and scar tissue as one unit. The scar tissue is left intact surrounding the implants-- in an effort to prevent any contamination or silicone inside the capsule from being released into the body.
If an en bloc is not possible, removing the capsule in pieces is called a capsulectomy. The least invasive procedure involves pulling the implant out through an incision, which leaves the capsule behind-- this is the type of procedure Angie initially underwent when she decided to remove her implants.
Capsules and Conventional Medicine
The main warning from surgeons, breast implant manufactures and the FDA regarding capsules is that they may harden and squeeze the implant, a condition known as capsular contracture. According to the American Society of Plastic Surgeons, capsules typically do not need to be removed when an implant is removed-- unless the tissue is hard. “Often, the scar tissue that forms after the placement of an implant is soft and does not need to be removed, but it may harden-- causing pain and discomfort. This is often a reason to have the implants and scar tissue removed,” said a representative with the American Society of Plastic Surgeons.
Phoenix plastic surgeon Dr. Robert Meger does not recommend capsule removal-- citing a lack of science proving health benefits, additional costs and potential health risks. “There are downsides… It takes longer and it costs more to have more time in the operating room. It increases the risk of certain complications, such as bleeding and damage to the chest wall, to try to remove a soft capsule that doesn't necessarily need to come out,” he said.
But not all experts agree.
Possible Complications From Scar Tissue
The former Senior Scientific Advisor to Canada’s Health Department, Dr. Pierre Blais, studies medical device failures. His research includes more than 20,000 breast implants. “People who don't get well or who get worse are those who have just the implant removed and then this space is sutured and closed. When the implants are removed and the scar tissue is left behind, the scar tissue creates pockets that can fill with fluids.” Dr. Blais said. “This is the way that the breast looks best after explanting because the space refills with blood and serum. This becomes a classical abscess and infected as a rule. These people do get sick and they remain sick.”
A previous Arizona’s Family investigation highlighted Dr. Blais' research connecting breast implants and unexplained illness to issues including mold, microorganisms, contamination, potential design flaws and rotting capsules.
As part of an ongoing investigation, CBS 5's Kris Pickel followed three women with breast implants who claim they were suffering from numerous health symptoms, all of which disappeared after the implants removed.
Dr. Blais says infected pockets in the scar tissue can develop over time and may explain why some women feel better immediately after their implants are removed, but then eventually get sick again. In addition to fluid collection and infections, Dr. Blais warns capsules can cause neck pain, shoulder pain, breathing issues and heart problems. “The implant sits in the middle of what is a lot of machinery. There are blood vessels which go to the heart. There are lymphatic vessels that deal with your immune system. There is a nerve center.”
If the surgeon has done a good job putting in an implant, Dr. Blais says, then the implants and capsules should not immediately cause problems. As time passes, though, the capsules can lock into the surrounding tissue. “We call that adhesions… the whole area contracts. Blood vessels close, disappear altogether or move to the surface-- resulting in unsightly veins on the surface for implant users. Alternatively, the implant can sit on blood vessels, which feed the heart. All the sudden, people begin to show heart symptoms, but the EKGs and ECGs are normal. It is something intermittent,” Blais said. Breathing issues and the feeling of “pinched nerves” in the shoulders and neck can be additional problems experienced by women, warns Dr. Blais.
While studies on capsules are limited, there are a number that indicate capsules can become contaminated with silicone-- even if an implant never ruptures.
Dr. Jan Willem Cohen Tervaert, Director of the Division of Rheumatology at the University of Alberta in Canada, says contaminated capsules may trigger autoimmune diseases and other health issues. “Without a rupture, silicones can be found in the capsules and lymph nodes, which may activate the immune system so that symptoms such as fatigue, myalgia (muscle pain) and arthralgia (joint pain) may develop.”
A previous Arizona’s Family investigation highlighted Dr. Tervaert's research, which showed implants may trigger autoimmune diseases in certain women, especially those who are prone to allergies, have an autoimmune disease or a family history of autoimmune diseases.
As the Food and Drug Administration considers issuing stronger warnings for breast implants, there a debate is brewing over the content of those warnings.
Silicone contamination can occur in a capsule through a tear, rupture, gel bleed or breakdown of the implant. Every implant, even saline, contains silicone in the shell. With a gel bleed, silicone is released through an implant’s shell, without a rupture. Dr. Tervaert cautions silicone is not always completely contained within the capsule and can travel through a woman’s body. “We know that the longer the breast implants were present, the lower the possibility to recover completely. Once silicones are leaked into lymph nodes or other organs, they will continue to have the capacity to activate the immune system,” he said.
A study by Dutch researcher Dr. Rita Kappel found women suffering from health issues (who had had their breast implants removed) reported "more pronounced" health improvements when the capsules were later removed.
[Reader discretion advised: Study includes nude photos of women. Click here to view study]
Growing Movement & New Warnings
Arizona’s Family continues to hear from women who, like Angie, say their illnesses cost them their health, careers and relationships.
For decades, conventional medicine has discounted and ignored women’s concerns that breast implants left them suffering from a wide range of unexplained symptoms. However, it is undeniable that women are making progress in raising awareness about their experiences. Social media groups focusing on breast implant illness continue to grow, with hundreds of groups dedicated to the topic. At least one group, "Breast Implant Illness and Healing by Nicole," has well over 100,000 members.
But pressure from the growing movement of women online may lead to government action. The FDA tells Arizona’s Family that the removal of the capsule is advised for patients with confirmed cases of BIA-ALCL-- a cancer caused by breast implants-- but may not be necessary for other implant removal or replacement operations. The agency is in the process of evaluating potential new warnings for breast implants, including a “box warning” (sometimes called a “black box warning”)-- it is the strongest warning that a product carries serious or life-threatening risks.
The FDA is also considering a checklist of risks which doctors would be advised to go over with patients who are considering breast augmentation or reconstruction. Under “systemic symptoms,” the draft of the checklist includes the following warning regarding implant and capsule removal: "... some patients who have received breast implants have reported a variety of systemic symptoms, including joint pain, fatigue, rash, memory loss, and “brain fog” that some patients have called breast implant illness. While the causes of these symptoms are unclear, some patients have reported relief of these symptoms with removal of their implants and surrounding scar tissue capsule.”
More women come forward daily on social media with stories similar to Angie's. They say they were failed by doctors and started their path to healing only after hearing the experiences of other women. Angie wants to use her experience and voice to help women who are being ignored. “I'm a believer that the brain fog is directly connected to the capsules that are in your body. If doctors don't believe it, they need to start listening to the patients because there are so many women out there who have these symptoms. They are not lying. They are sick. They feel bad. They hurt. They feel like they are going crazy-- but it is all right there.”
Tens of millions of women have implants. It is clear not every woman will suffer health issues, but for those who believe implants made them sick, women say it’s past time for doctors in every field-- from general practitioners and allergists, to plastic surgeons, dermatologists, rheumatologists, cardiologists, gynecologists and endocrinologists-- to look at the growing evidence.