The increasing requests for explant surgery, and breast implant removal surgery, over the past several years have raised concerns within the plastic surgery industry. While still being largely researched, Breast Implant Illness (BII) is currently classified as a medical condition where women are experiencing a wide range of symptoms after undergoing breast reconstruction or cosmetic breast augmentation with breast implants. It is also known as autoimmune/inflammatory syndrome induced by adjuvants (ASIA). BII doesn't discriminate, as it's reportedly affected women who've received any kind of implant – silicone, saline, smooth surface, textured surface, round, or teardrop-shaped (gummy bear).
Some women begin to develop concerning symptoms immediately following surgery, while others develop symptoms years later. The problematic syndrome really is a case-by-case situation; no two women nor their experiences are alike. Understanding BII has been challenging, as there is still so much not known about BII and research is ongoing as more and more evidence is gathered with each and every case.
Do I Have Breast Implant Illness? Symptoms to Look Out For
If you've received breast implants or undergone breast reconstruction surgery with implants following cancer treatment and are experiencing any of the following symptoms, you may have Breast Implant Illness and should contact your doctor as soon as possible for a full medical evaluation. There are nearly 100 symptoms attributed to BII. As of August 2020, the FDA released the following updated list of common symptoms (by percentage) associated with BII:
Other unexplained effects include insomnia/sleep disturbances, digestive dysfunction, headaches/migraines, breathing complications, dry mouth, and hair loss.
How Is Breast Implant Illness Diagnosed?
There is currently no single diagnostic test that confirms breast implant illness. Instead, diagnosis typically involves a process of exclusion. Your physician will likely order bloodwork, autoimmune panels, and imaging studies to rule out other conditions such as lupus, rheumatoid arthritis, thyroid disorders, or Lyme disease. If those results come back normal yet symptoms persist, BII becomes a strong consideration.
We typically find that patients have already visited multiple specialists before connecting their symptoms to their implants. Common diagnostic steps include a complete blood count (CBC), inflammatory markers like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and thyroid function tests. Imaging such as MRI or ultrasound may also be used to check implant integrity, since silent ruptures can contribute to systemic symptoms. Keeping a symptom journal with dates and severity levels helps your surgeon evaluate whether explant surgery is the right recommendation.
Surgical Options for BII and Post Explant Aesthetics
The choice to undergo breast augmentation surgery is a deeply personal one, so it's no surprise the effects of BII can leave a woman feeling isolated, confused, and distraught. But, there is help. Many women who've experienced the frustrating, sometimes debilitating effects of BII have opted to completely remove their breast implants or explant. It is important when removing the implant to also remove the capsule, the scar tissue around the implant. Many women who are considering surgical treatment for BII have questions about what their aesthetic outcome and options are after breast implant removal.
- Implant Removal, Explant
Breast implants can thin and stretch out the breast tissue and skin over time. The larger the implant and the longer the implants have been in place, the more thinning and stretching can occur. Therefore, implant removal can initially result in an empty and deflated look to the breast. The more existing breast tissue a patient has and the less the breast tissue has been thinned or stretched, the less distorted the initial appearance of the breasts will be immediately after removal. Sometimes the change is dramatic and it is important for surgeons to take the time and care to communicate this to their patients and help support them through this process. Over the next 6 months, the stretched-out tissues start to contract and there is a "fluff" effect where the breasts begin to restore their shape. There are many BII explant support groups that can help women through the aesthetic changes that occur over time. There is also breast physical therapy that can help restore the tissues as they heal.
- Implant Removal with Mastopexy (Breast Lift)
In some cases, patients desire a lift to help tighten and remove excess breast skin that has been stretched out from the implants. Mastopexy surgery or Breast Lift can be done at the time of the breast implant removal or can be staged - meaning it is done several months later after the tissues have stabilized and healed. The advantage of performing it at the same time is that it minimizes the number of operations. The advantage of doing it staged is that after the "fluff" period, patients may be satisfied with their final breast shape and not need a lift, or if their body contracts their breast tissues over time, they may need a less extensive lift and shorter scars.
- Fat Transfer to the Breast
To restore some breast volume after implant removal, patients may undergo fat transfer to the breast. This is a surgical procedure where fat is harvested from another area or areas of the body - for example hips, flanks, back, abdomen, thighs - through liposuction and then carefully injected into the breast to restore volume and shape. As the fat that is transferred is living tissue, it must be performed meticulously for maximal fat survival and shape and to avoid complications. When performed carefully and artistically, this highly detailed procedure yields aesthetically pleasing results and offers a safe solution for women with BII who wish to restore some of the volume in their breasts after implant removal.
Common Myths About BII and What Research Actually Shows
One common question we get is whether breast implant illness only affects women with silicone implants. The reality is that BII symptoms have been reported with both silicone gel and saline implants. The type, texture, and age of the implant may influence risk, but no implant style has been shown to be completely free of association with systemic symptoms.
Another misconception is that BII is purely psychological. While the condition is not yet formally classified as a distinct medical diagnosis, a growing body of peer-reviewed research documents measurable immune and inflammatory responses in affected patients. Many women report significant or complete resolution of symptoms after explant surgery, which further supports a physiological connection. It is also worth noting that the presence of a capsule, the scar tissue your body forms around the implant, can harbor bacteria and biofilm that may trigger chronic immune activation over time.
According to a cohort study published in Cureus (2023), a significant majority of patients with self-reported breast implant illness experienced measurable symptom improvement following explant surgery.
Dr. Cat's Take
Dr. Cat receives countless inquiries regarding breast augmentation surgery, including questions and concerns about the possibility of developing BII. While thankfully, none of Dr. Cat's past patients have developed symptoms related to BII, nor has she ever used the recently recalled Allergan breast implants in any of her patients, she is very aware of the growing concern amongst women looking to undergo breast enhancement and those who've already gone through the surgical procedure. Dr. Cat is extremely proactive in disseminating BII awareness on her website and social media platforms and continues to research and investigate FDA and scientific studies as well as individual patient's experiences and those directly impacted by BII.
In our experience, patients who suspect they may be dealing with breast implant illness often describe a gradual onset of symptoms that worsened over months or years. Dr. Cat encourages every patient to track their symptoms carefully and bring a detailed history to their consultation, as this information is critical for determining the best path forward.
Let's Stick Together: Seeking Support and Staying Informed
Due to the still-limited literature and published research, Dr. Cat suggests women who may be experiencing BII connect with BII advocacy and women's health support groups – online or otherwise – to stay informed about the origins of BII from real women who've experienced it. Being plugged in to support groups also allows women to stay abreast of new and ongoing developments from the medical community. As far as breast augmentation surgery, Dr. Cat refers potential patients to these available resources to help women make informed decisions for the longevity of their health, as well as body image. All women need a well-rounded, informative pool of information they can rely on to make these life-changing decisions about their bodies. The link between breast implants and BII proves to be hotly debated amongst plastic surgeons and others in the medical community. Dr. Cat painstakingly strives to be inclusive of all information - scientific-backed information and studies as well as all patients' experiences.
Dr. Cat is committed to providing an open platform where all women's voices can be heard and believes a community that encourages open, candid communication is the best way to take decisive action for ourselves while caring for each other in the process. Strength in numbers can only boost BII awareness while advocating for real solutions.
For more information on BII and to see and hear from real women who've struggled with its unsettling symptoms, please visit @breast_implant_illness on Instagram. Spearheaded by Kim Barden, this growing community page is the Instagram profile to Healing Breast Implant Illness and features invaluable resources, unfiltered photos, and in-depth discussions about women's battles with BII. Reach out on Dr. Cat's IG profiles @beautybydrcat and @surgeon, a loyal community of followers that convene and converse about beauty, wellness, and life.
Frequently Asked Questions About Breast Implant Illness
What are the most common symptoms of breast implant illness?
The most frequently reported symptoms include chronic fatigue, joint and muscle pain, brain fog, hair loss, skin rashes, and recurring headaches. Some patients also experience anxiety, sleep disturbances, and gastrointestinal issues. Symptoms can appear months or even years after implant placement.
Can breast implant illness occur with saline implants?
Yes. Breast implant illness has been reported in patients with both saline and silicone implants. The body's immune response to the implant shell itself, along with potential biofilm formation around the capsule, may contribute to symptoms regardless of the fill material.
How soon do symptoms improve after explant surgery?
Many patients begin noticing improvement within weeks of implant removal, though full resolution can take several months. Factors like how long the implants were in place, overall health, and whether a total capsulectomy was performed can all influence the recovery timeline.
