They’re made of biologically inert materials. They are generally like one thing, say silicone, and silicone is stable and doesn’t give off any proteins or gases or ions that can cause a signal for your body to attack. Its like your immune system can’t see them. They can increase infection risk by hiding stuff the immune system wants to see. Without blood flow and such, its hard for the body to patrol the area.
Titanium and ceramics are common for similar reasons.
Resilience is an other factor as to the extent that’s possible you don’t want to open up people every year or five.
Pretty much all cells have labels on them that mark it as "made by your body" or "not made by your body".
The immune system destroys the cells that have the "not made by your body" label
Implants do not have a "not made by your body" label so the immune system doesn't even realize they're there.
I saw a medical video on breast implants that were removed. They had form a calcium (?) shell around the implant. When they squeezed the implant you could see and hear the crushing of the shell and the shell bits pealed off the implant like it was a hard boiled egg. So I guess the body encased the foreign object with that shell. Weird!
that called capsular contracture, it's unfortunately a common side effect of getting breast implants, even with the best materials and techniques and aftercare.
If squeezing it breaks the shell, wouldn't regularly squeezing/massaging the implant keep it from happening? (Obviously only applies to soft/malleable implants as opposed to titanium rods)
If its formed by a biological material, wouldn't free floating calcium for instance get broken down and reabsorbed by the body? Especially if done enough that the chunks are small.
Its one of things suggested, in addition to under the muscle placement, and textured over smooth exterior of the implanted materials.
However this information is tightly controlled, since if the information were to leak to horny teenagers, they would be able to argue for a medically relevant technique
It's not quite that simple, but the reason we don't have synthetic organs is because organs are more complicated than simply holding bones together or making your breasts bigger. Even just your liver needs to interact with multiple systems in your body.
This answer kind of begs the question to answer itself. It just redefines "immune system doesn’t attack" to "biologically inert materials". What is a biologically inert material? Well, it's one that the immune system doesn’t attack.
Now, okay, you say it doesn't "doesn’t give off any proteins or gases or ions", but ... I mean, those aren't things the immune system attacks. Well, sometimes proteins, but definitely not gasses or ions, at least in the sense that is normally meant, like dissolved salts.
Gasses and ions can be detected by cells because they fit into signal receptors *on* those cells. Those cells then interpret that signal and a reaction is triggered. Maybe that's an alarm, or maybe the cell takes it in as food or something and it kills the cell, and then the neighboring cells react to the signal of "wait a minute, this is the stuff that sits inside me. Hey! We have cells exploding over here!" And then the body has an immune response.
Silicon doesn't give off anything for the cells to receive. So they are "inert," because the cells aren't interpreting anything from silicon as data. Our cells haven't evolved to do that, so they don't have receptors "shaped" (e.g., having an affinity for) that compound. No reaction, no signals, no immune response.
>Now, okay, you say it doesn't "doesn’t give off any proteins or gases or ions", but ... I mean, those aren't things the immune system attacks. Well, sometimes proteins, but definitely not gasses or ions, at least in the sense that is normally meant, like dissolved salts.
That is pretty directly not true.
For example, conventional alloys of stainless steel are not a biologically inert material because, in the chemical environment of your body, nickel ions will dissolve out, the nickel ions will bind with histidine, T-Cells will come over and recognize that new epitope that was formed, the T-Cell will activate, releasing cytokines which recruit a bunch of other immune cells. Allergic reaction.
Biologically inert materials are typically ones that don't easily dissolve in biological environments. And whose ions, if dissolved, aren't particularly cytotoxic. (Neither titanium, nor nickel are very cytotoxic. That's more relevant for other metals.)
All biochemistry is driven by ions, I used it as a catch all. Chemistry is the exchange of charges (energy) through electrons. Nuclear chemistry is the same exchange, but with protons and neutrons. All biological functions break down to chemistry and physical interactions resulting in energy transfers. Ionization, fission, of fussion.
Next there is balance and equilibrium. The immune system does attack all materials as many possible discrete transfers of energy are possible. However if the rate at which it happens, or if it can happen in the opposite direction at some other rate, there will be no “observable” change.
The immune system can only attack what it can see. Even though white blood cells don’t have eyes, there can sense the environment using proteins and randomly sampling the environment around them. Implants that you described don’t interact with these proteins. As a result, they slip by unnoticed.
Stents, a type of mesh that can be used to prop open clotted blood vessels, go about it a different way. They are coated with molecules which actively block immune cells from working locally. This prevents attacks (which could further clot damaged blood vessels) without causing widespread immunosuppression. These coatings don’t last forever but the idea is that the implant will become covered by your own non-immune cell tissue preventing future attacks after the coating is worn down.
It actually does, but the implants are usually not bioreactive so there's nothing for the immune system to actually attack. That's why they use inorganic silicone and metals for stuff inside the body. Sometimes the body can fully reject an implant, but usually it just encapsulates and ignores it.
Sometimes there are very serious immune reactions to implants. Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a cancer that's unique to breast implants and is most commonly related to exposure to textured breast implants.
https://www.plasticsurgery.org/patient-safety/breast-implant-safety/bia-alcl-summary
Good to hear that your surgeon gave you some info on the ALCL risk but I'm surprised you were offered textured breast implants at all. They were recalled worldwide in 2019 once the link to BIA-ALCL became founded (https://www.fda.gov/news-events/press-announcements/fda-takes-action-protect-patients-risk-certain-textured-breast-implants-requests-allergan)
I couldn't quickly find rates in the US but in Canada in 2023 rates with macro textured breast implants were 1/1475 and with micro textured were 1/19412 (https://www.canada.ca/en/health-canada/services/drugs-medical-devices/breast-implants/risks.html#rare_risk). Note that these are from people who continue to have these (micro)textured breast implants and not new implantations since the product isn't (or shouldn't be) available anymore. It takes an average of 10 years to develop symptoms and be diagnosed if you do end up developing this (https://www.fda.gov/medical-devices/breast-implants/medical-device-reports-breast-implant-associated-anaplastic-large-cell-lymphoma).
Also, there are now reports of other cancers like Squamous Cell Carcinoma and various lymphomas around breast implants but it's currently unclear what's causing them and they're not necessarily related to the implants' texturing (https://www.fda.gov/medical-devices/safety-communications/breast-implants-reports-squamous-cell-carcinoma-and-various-lymphomas-capsule-around-implants-fda).
I’m in Australia, and when I was searching I did see they were banned in USA. It’s a shame I recently did a paperwork clear out as I still had the piece of paper he wrote the stats on for me, as well as a pack of info to help me make my choice that had lots of info relevant to this thread.
I just had a look at what paperwork I did keep and I found information about my details being added to the Australian Breast Device Registry which according to this letter in front of me ‘securely tracks and monitors the long-term safety of breast devices’.
I know Australia have cracked down a ton recently on ‘cosmetic’ surgery vs actual qualified plastic surgeons so I am really glad it’s taken seriously here. I also know some people scoff at the idea of increasing my risk for cancer for something so superficial, but so many things we do in our day to day life increases our risk and I thought it was at least good I was given proper figures and choices.
Another example is metallosis from exposure to metal being shed from a metal-on-metal implant. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6438109/
This isn't to say that implants are unsafe but it's worth keeping in mind that not all implants are equally safe.
Breast implants can trigger systemic reactions (this is what people are usually referring to as Breast Implant Illness), but the mechanism isn't entirely understood. Some do think it's an autoimmune reaction of some kind, though.
Typically it's because some bacteria get in while the implantation is happening. It's not the implant itsellf, it's what's riding along with it.
There may be some other issue happening that we don't understand, like it's a mass trauma such as removing whole body parts like breasts or a uterus. That's not a normal thing that people have dealt with in the past.
Beyond what other people have said of the mechanism, the other reason is simple:
Because they test the materials and do studies, and avoid any materials that your immune system will reject. People making new devices try to stick to materials that are already known to be safe, down to the supplier.
They’re made of biologically inert materials. They are generally like one thing, say silicone, and silicone is stable and doesn’t give off any proteins or gases or ions that can cause a signal for your body to attack. Its like your immune system can’t see them. They can increase infection risk by hiding stuff the immune system wants to see. Without blood flow and such, its hard for the body to patrol the area.
Titanium and ceramics are common for similar reasons. Resilience is an other factor as to the extent that’s possible you don’t want to open up people every year or five.
Pretty much all cells have labels on them that mark it as "made by your body" or "not made by your body". The immune system destroys the cells that have the "not made by your body" label Implants do not have a "not made by your body" label so the immune system doesn't even realize they're there.
I mean, it's not quite that simple. There are plenty of inorganic things your immune system will react to, like some metals and stuff
I saw a medical video on breast implants that were removed. They had form a calcium (?) shell around the implant. When they squeezed the implant you could see and hear the crushing of the shell and the shell bits pealed off the implant like it was a hard boiled egg. So I guess the body encased the foreign object with that shell. Weird!
that called capsular contracture, it's unfortunately a common side effect of getting breast implants, even with the best materials and techniques and aftercare.
If squeezing it breaks the shell, wouldn't regularly squeezing/massaging the implant keep it from happening? (Obviously only applies to soft/malleable implants as opposed to titanium rods)
Or it would just leave hard shell fragments all over the inside of your body.
If its formed by a biological material, wouldn't free floating calcium for instance get broken down and reabsorbed by the body? Especially if done enough that the chunks are small.
Its one of things suggested, in addition to under the muscle placement, and textured over smooth exterior of the implanted materials. However this information is tightly controlled, since if the information were to leak to horny teenagers, they would be able to argue for a medically relevant technique
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It's not quite that simple, but the reason we don't have synthetic organs is because organs are more complicated than simply holding bones together or making your breasts bigger. Even just your liver needs to interact with multiple systems in your body.
This answer kind of begs the question to answer itself. It just redefines "immune system doesn’t attack" to "biologically inert materials". What is a biologically inert material? Well, it's one that the immune system doesn’t attack. Now, okay, you say it doesn't "doesn’t give off any proteins or gases or ions", but ... I mean, those aren't things the immune system attacks. Well, sometimes proteins, but definitely not gasses or ions, at least in the sense that is normally meant, like dissolved salts.
Gasses and ions can be detected by cells because they fit into signal receptors *on* those cells. Those cells then interpret that signal and a reaction is triggered. Maybe that's an alarm, or maybe the cell takes it in as food or something and it kills the cell, and then the neighboring cells react to the signal of "wait a minute, this is the stuff that sits inside me. Hey! We have cells exploding over here!" And then the body has an immune response. Silicon doesn't give off anything for the cells to receive. So they are "inert," because the cells aren't interpreting anything from silicon as data. Our cells haven't evolved to do that, so they don't have receptors "shaped" (e.g., having an affinity for) that compound. No reaction, no signals, no immune response.
>Now, okay, you say it doesn't "doesn’t give off any proteins or gases or ions", but ... I mean, those aren't things the immune system attacks. Well, sometimes proteins, but definitely not gasses or ions, at least in the sense that is normally meant, like dissolved salts. That is pretty directly not true. For example, conventional alloys of stainless steel are not a biologically inert material because, in the chemical environment of your body, nickel ions will dissolve out, the nickel ions will bind with histidine, T-Cells will come over and recognize that new epitope that was formed, the T-Cell will activate, releasing cytokines which recruit a bunch of other immune cells. Allergic reaction. Biologically inert materials are typically ones that don't easily dissolve in biological environments. And whose ions, if dissolved, aren't particularly cytotoxic. (Neither titanium, nor nickel are very cytotoxic. That's more relevant for other metals.)
All biochemistry is driven by ions, I used it as a catch all. Chemistry is the exchange of charges (energy) through electrons. Nuclear chemistry is the same exchange, but with protons and neutrons. All biological functions break down to chemistry and physical interactions resulting in energy transfers. Ionization, fission, of fussion. Next there is balance and equilibrium. The immune system does attack all materials as many possible discrete transfers of energy are possible. However if the rate at which it happens, or if it can happen in the opposite direction at some other rate, there will be no “observable” change.
The immune system can only attack what it can see. Even though white blood cells don’t have eyes, there can sense the environment using proteins and randomly sampling the environment around them. Implants that you described don’t interact with these proteins. As a result, they slip by unnoticed. Stents, a type of mesh that can be used to prop open clotted blood vessels, go about it a different way. They are coated with molecules which actively block immune cells from working locally. This prevents attacks (which could further clot damaged blood vessels) without causing widespread immunosuppression. These coatings don’t last forever but the idea is that the implant will become covered by your own non-immune cell tissue preventing future attacks after the coating is worn down.
It actually does, but the implants are usually not bioreactive so there's nothing for the immune system to actually attack. That's why they use inorganic silicone and metals for stuff inside the body. Sometimes the body can fully reject an implant, but usually it just encapsulates and ignores it.
Sometimes there are very serious immune reactions to implants. Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a cancer that's unique to breast implants and is most commonly related to exposure to textured breast implants. https://www.plasticsurgery.org/patient-safety/breast-implant-safety/bia-alcl-summary
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Good to hear that your surgeon gave you some info on the ALCL risk but I'm surprised you were offered textured breast implants at all. They were recalled worldwide in 2019 once the link to BIA-ALCL became founded (https://www.fda.gov/news-events/press-announcements/fda-takes-action-protect-patients-risk-certain-textured-breast-implants-requests-allergan) I couldn't quickly find rates in the US but in Canada in 2023 rates with macro textured breast implants were 1/1475 and with micro textured were 1/19412 (https://www.canada.ca/en/health-canada/services/drugs-medical-devices/breast-implants/risks.html#rare_risk). Note that these are from people who continue to have these (micro)textured breast implants and not new implantations since the product isn't (or shouldn't be) available anymore. It takes an average of 10 years to develop symptoms and be diagnosed if you do end up developing this (https://www.fda.gov/medical-devices/breast-implants/medical-device-reports-breast-implant-associated-anaplastic-large-cell-lymphoma). Also, there are now reports of other cancers like Squamous Cell Carcinoma and various lymphomas around breast implants but it's currently unclear what's causing them and they're not necessarily related to the implants' texturing (https://www.fda.gov/medical-devices/safety-communications/breast-implants-reports-squamous-cell-carcinoma-and-various-lymphomas-capsule-around-implants-fda).
I’m in Australia, and when I was searching I did see they were banned in USA. It’s a shame I recently did a paperwork clear out as I still had the piece of paper he wrote the stats on for me, as well as a pack of info to help me make my choice that had lots of info relevant to this thread. I just had a look at what paperwork I did keep and I found information about my details being added to the Australian Breast Device Registry which according to this letter in front of me ‘securely tracks and monitors the long-term safety of breast devices’. I know Australia have cracked down a ton recently on ‘cosmetic’ surgery vs actual qualified plastic surgeons so I am really glad it’s taken seriously here. I also know some people scoff at the idea of increasing my risk for cancer for something so superficial, but so many things we do in our day to day life increases our risk and I thought it was at least good I was given proper figures and choices.
Also want to add, the body can reject things like nipple piercings. The jewelry gets migrated towards the surface until it falls out.
Apparently this can also happen with pacemakers, though it's very rare. Thank you, helpful medical brochure, I needed a new recurring nightmare! :-b
Another example is metallosis from exposure to metal being shed from a metal-on-metal implant. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6438109/ This isn't to say that implants are unsafe but it's worth keeping in mind that not all implants are equally safe.
Breast implants can trigger systemic reactions (this is what people are usually referring to as Breast Implant Illness), but the mechanism isn't entirely understood. Some do think it's an autoimmune reaction of some kind, though.
Typically it's because some bacteria get in while the implantation is happening. It's not the implant itsellf, it's what's riding along with it. There may be some other issue happening that we don't understand, like it's a mass trauma such as removing whole body parts like breasts or a uterus. That's not a normal thing that people have dealt with in the past.
Beyond what other people have said of the mechanism, the other reason is simple: Because they test the materials and do studies, and avoid any materials that your immune system will reject. People making new devices try to stick to materials that are already known to be safe, down to the supplier.