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Breast Augmentation Concerns for Patients with Ulcerative Colitis
You're right to ask questions and do your research. Breast augmentation is a serious consideration. Ulcerative colitis occurs in less than 0.1% of the population. There are many causative theories regarding UC and there is a presumed genetic component to susceptibility. Most believe that active symptoms in a susceptible person can be triggered by environmental factors. And most recent research does not conclude that UC is an autoimmune disease even though its treatment is similar to other autoimmune diseases. It is not clear that UC is autoimmune mediated. And there's the rub. UC can be treated with medications that fall into the following categories: Aminosalicylates (like sulfasalazine) Corticosteroids (prednisone) and Immunosuppressives (azothioprine, methotrexate) It's the last two categories that can be problematic. The problem is, things that are implanted in your body do not have a natural blood supply and thus are more prone to infection and less able to clear infection once one has started. Corticosteroids and immunosuppressives change your bodies ability to fight infection. Around the time of the operation they can cause significant infection issues. Most plastic surgeons would exercise caution in performing an elective cosmetic operation involving implanted material if you were actively being treated with steroids or immunosuppressives. There can be long term issues too. While the infection risks are greatest during the surgery and in the first month or so post-operatively those medications can cause infection problems even in breast augmentations that have healed (though the numbers are significantly lower). There are other manifestations of UC that could be of issue. Thromboembolic events have been reported with UC and any general surgery can cause clots to form in veins and should be actively prophylaxed against during surgery and potentially afterwards. The above would be the primary concerns I would discuss with my patients. Issues of autoimmune disease being triggered by implants are anecdotal and do not seem to be supported by evidence at this time. For your particular situation a close discussion with a board-certified plastic surgeon in addition to your GI doctor would be recommended.
Clinical Context
Wound healing relies on a normal inflammatory response, and the medicines used to control ulcerative colitis—steroids, immunosuppressants, and biologics—can dampen that response. This can raise infection risk and slow healing, especially during an active flare. Most surgeons prefer to operate when the disease is in remission and medication doses are as low as possible. Any changes to UC medications before surgery should be planned jointly by your surgeon and gastroenterologist, since stopping treatment abruptly can trigger a flare.
