Breast Implant Illness (BII)

Breast implant illness is not a specific disease but rather a set of symptoms.
Many illnesses share symptoms with breast implant illness, so it’s important to talk to your doctor and your plastic surgeon when looking into BII.
There is no test for BII. As such, doctors determine the likelihood of BII after ruling out other conditions that can be tested for.
There is no guaranteed cure for BII, but some women do experience symptom relief after having their breast implants removed.

What Is Breast Implant Illness?

Breast implant illness (BII) is a group of symptoms that some people experience after getting breast implants. BII is currently not a formal medical diagnosis, but the condition is being tracked and studied. Still, the exact cause of BII is unclear, which makes diagnostic criteria uncertain. The phenomenon has been seen with both saline and silicone implants, and there is no exact timeline between breast augmentation and symptom onset. There are credible reports of patients experiencing symptom relief after having their breast implants removed, but this is not a guaranteed outcome of implant removal.

What Breast Implant Illness Is Not

It’s important to understand that BII is not breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) or breast cancer. BIA-ALCL and other rare implant-associated malignancies are distinct medical conditions with specific diagnostic criteria and testing. New persistent swelling, a mass, or fluid around an implant should be evaluated by a physician to rule out cancer or other serious problems. Never assume that a breast or implant issue is BII, displacement, or something else. Have problems checked by a medical professional.

Breast Implant Illness Symptoms

Breast implant illness symptoms tend to be systemic, which means they impact many areas of your body and not just your breasts. Unfortunately, BII and many other illnesses share a lot of the same symptoms, which makes diagnosing BII medically complicated. The FDA currently recognizes the following symptoms as associated with BII, but the list is by no means exhaustive, as patients have reported more than 50 unique symptoms, including:

  • Fatigue
  • Joint issues
  • Anxiety
  • Brain fog
  • Hair loss
  • Depression
  • Rash
  • Weight changes
  • Muscle pain and headaches
  • Skin changes
  • Sleep problems

Could My Symptoms Be Related to My Breast Implants?

There is no breast implant illness test, so a doctor cannot simply perform a blood test, imaging study, antibody panel, or other diagnostic panel to check for BII. All of these tests may be used to help determine whether you may have BII, however, because BII is identified by exclusion. This means it is considered after ruling out other possibilities. Likewise, finding another health condition does not necessarily mean every symptom must come from that one illness.

Signs It Could Be BII

There are some clues that BII may be causing your symptoms. Although BII is still being studied, some potential hallmarks of the illness include:

  • Symptoms that started after breast implant surgery
  • Symptoms that persist and get worse over time
  • Negative autoimmune testing
  • Facial changes, such as under-eye circles, puffiness, and dull skin
  • Symptoms impacting multiple body systems

Look at the Timing and Pattern of Symptoms

Diagnosing BII is still a bit of a guessing game, but the timing and patterns of your symptoms may provide a clue. Begin documenting and tracking your symptoms as soon as you can, as this may help reveal useful patterns and timelines. It’s helpful if you can answer the following questions when you see your doctor or plastic surgeon:

  • Which symptoms appeared first?
  • Did your symptoms appear before or after your breast augmentation?
  • How long after augmentation did your symptoms start?
  • Did your symptoms develop gradually or suddenly?
  • Are your symptoms persistent or intermittent?
  • Did several seemingly unrelated symptoms start around the same time?
  • Have your symptoms progressively changed or worsened?
  • Did you have any autoimmune, inflammatory, or other health conditions before getting your implants?
  • Did anything change around the time of symptom onset, such as medications, pregnancy, menopause, illness, or surgery?

Bring Your Implant History to the Evaluation

The more information we can gather about your implants and breast augmentation surgery, the better able we are to help you and other patients who may be experiencing BII. The condition is still a bit mysterious, and any and all information we can gather contributes to medicine’s collective knowledge base. Whenever possible, please tell your care provider:

  • When the implants were placed
  • Whether you have had one breast surgery or several
  • The name of your implant manufacturer
  • If you have saline, silicone, or gummy bear implants
  • If your implants have a smooth or textured surface
  • Your implant size and profile
  • If you have a history of implant rupture, capsular contracture, implant displacement, or revision surgery
  • Whether symptoms changed after an implant exchange

If you no longer have your implant card, the surgeon or clinic who performed your augmentation can often provide information about your implants.

When Symptoms May Point to Something Other Than Breast Implant Illness

Even if you don’t have BII, you could be experiencing another issue related to your breast implants. While BII creates systemic issues, most breast implant problems are localized to the breasts. Diagnosing BII is often a team effort between your doctor and plastic surgeon, but you should check with your plastic surgeon first if you’re experiencing issues that may point to a breast implant complication, such as:

  • Suddenly swollen breast
  • New breast firmness or hardening
  • New lump or mass
  • Persistent breast pain
  • Significant change in breast shape
  • One breast changing in size
  • Fluid around the implant
  • Suspected implant rupture
  • New implant displacement or malposition

These symptoms are far more likely to indicate capsular contracture, breast pocket problems, or infection than BII.

Should Breast Implants Be Removed for Breast Implant Illness?

While certainly made under medical guidance, the decision as to whether your breast implants should be removed because of BII is a very personal one. Implant removal, called explant surgery, is the current standard of care for suspected BII. Many patients have reported at least partial symptom relief after explant surgery, but others have not. Understand that explant surgery could help you, but there is no guarantee that it will. If you do elect to have your implants removed, there are multiple ways we can go about it.

Implant Removal With or Without Capsulectomy

Implant removal is a straightforward process in which we simply remove your breast implants. This is called explantation. Sometimes we remove just the implant, but at other times we remove the implant and the capsule of scar tissue around it. That procedure is called a capsulectomy. A partial capsulectomy removes only part of the capsule while a total capsulectomy removes the entirety of the scar tissue. The appropriate approach depends on the capsule, implant condition, anatomy, symptoms, previous surgery, and surgical risk.

En Bloc Implant Removal

En bloc implant removal is often confused with an implant removal that includes a total capsulectomy. But the procedures are not the same. Both remove the implant and the complete scar capsule, but an en bloc capsulectomy is the removal of the breast implant and capsule as one intact unit. Implant explantation due to BII does not usually necessitate an en bloc removal.

An en bloc capsulectomy is often reserved for serious breast implant complications, such as implant-associated cancers. Not only is en bloc capsulectomy not always necessary, but it may not be possible. If the capsule is tightly adhered to the ribs, chest wall, or other structures, removing the entire implant and capsule as a single unit isn’t always feasible. Patients often assume that BII always equals an en bloc capsulectomy, but that is not the case.

What Will My Breasts Look Like After Implant Removal?

If you choose to have your breast implants removed, you should expect significant changes to the appearance of your breasts. The appearance of your breasts immediately after explantation is not your final result, and your breast tissue may contract as you heal. This is more likely to yield satisfactory results if your implants are small and you have good skin elasticity.

Depending on implant size, skin quality, breast tissue, age, pregnancy history, and the length of time implants have been present, breasts may have:

  • Loose or stretched skin
  • Reduced upper-breast fullness
  • Sagging
  • Changes in nipple position
  • Asymmetry

Many patients are nervous about what their breasts will look like after explantation, and understandably so. If you wish, we can combine your breast implant removal with other procedures that will help normalize your breasts’ new size and shape. This table explains each procedure and what it does.

OptionWhat it can accomplish
Natural contractionSkin and tissues may tighten somewhat during the months after explantation, particularly with smaller implants and good skin elasticity.
Breast lift (mastopexy)Removes excess skin, reshapes the breast, and raises the nipple/areola when significant sagging remains.
Fat graftingTransfers the patient’s own fat to the breasts to restore some volume and improve contour without another implant.
Lift + fat graftingAddresses both loose skin/sagging and lost volume.
Auto-augmentation mastopexyDuring a lift, existing breast tissue is rearranged to provide more fullness and projection without an implant.

What Should You Do if You Think You Have Breast Implant Illness?

If you think you may have BII, there are steps you can take to make sure that you don’t have another condition and move toward a possible BII diagnosis.

Step 1: Document Your Symptoms

Narrowing your symptoms into a possible case of BII can take some time, so don’t rely on memory alone. When you have a symptom, write down what it is, when it started, and any other relevant information. If the symptom is ongoing, notice any changes like worsening or temporary easing, as well. If you know or have access to it, you should also bring information about the date of your breast augmentation, any revision surgeries, and details about your breast implants to any doctor’s appointments.

Step 2: See Your Doctor

Many BII symptoms, including fatigue, brain fog, joint pain, rashes, hair loss, and similar issues overlap with other, unrelated conditions. It’s important that you don’t just assume your symptoms indicate BII. Many autoimmune diseases, connective-tissue disorders, thyroid problems, chronic fatigue syndrome, perimenopause, Lyme disease, and other conditions share BII symptoms. Although your doctor cannot test for BII, they can test for many of these other conditions. Appropriate medical evaluation is important, even if you strongly suspect BII.

Step 3: Have the Implants and Breasts Evaluated

In addition to seeing your regular doctor and any specialists they refer you to, make an appointment to see a plastic surgeon. They’re the ones best suited to assessing your breasts for:

  • Implant position
  • Capsular contracture
  • Breast asymmetry
  • Signs of rupture or other implant complications
  • Breast or chest-wall abnormalities
  • Whether imaging is appropriate
  • Your previous breast operative history

Step 4: Decide Whether to Pursue Explantation

After ruling out or correcting other issues, you could find yourself left with a very real possibility of BII. If so, you’ll have to consider whether or not you want to remove your breast implants. It’s a difficult choice to make, especially given that we cannot guarantee that your symptoms will resolve or improve after the surgery. They may, and there are many reported cases of post-explantation relief. Unfortunately, the opposite is also true.

When considering an implant removal, make sure you think about the following:

  • Are your symptoms bothersome enough to warrant an additional surgery?
  • Do you have implant pain, rupture, or malposition that makes revision or removal surgery necessary?
  • Do you want your implants permanently removed, or do you prefer to try another size or type?
  • Would you be able to accept your altered breast shape after explant alone?
  • Do you want a lift or fat transfer to reshape your breasts without implants?
  • How much capsule removal is actually indicated?
  • What are the surgical risks in your individual case?

We cannot make this decision for you but are happy to help and guide you in any way we can. The best way to get personalized advice that addresses your specific symptoms and concerns is to schedule a free virtual consultation and chat with our team.

Frequently Asked Questions

Unfortunately, we don’t yet understand what causes breast implant illness. Current theories include bacterial biofilm on the implant or an inflammatory immune response. A definitive cause has not yet been identified.

Because BII is not currently a formally recognized medical diagnosis, we can’t say for sure that BII is or is not ever fatal. We simply don’t have any data to give us a known mortality rate. What we can tell you is that you need to treat symptoms like chest pain, shortness of breath, neurologic symptoms, and other potentially serious problems promptly, no matter their cause.

Again, because BII does not have standardized diagnostic criteria, we just don’t know how common BII is. As of now, doctors estimate that between 1-10% of women with breast implants experience BII. This is really just an educated guess, however, based on the information currently at our disposal. The FDA maintains adverse-event reports, but they cannot be used to calculate incidence or prove causation because reporting systems have major limitations.

Yes. Incidents of BII have been reported with both silicone and saline implants. It’s also of note that even saline implants have a silicone shell, which may or may not be a factor. Again, we simply don’t have enough information to know.

Reports of BII are not limited to a patient’s first set of implants, so an implant exchange could contribute to later BII symptoms. But there are also reports of women experiencing BII with their first set of implants, so it is currently unclear whether implant replacement increases BII risk.

Although scientists have theorized that an autoimmune response may be to blame for BII, no specific autoimmune issue has been identified as the culprit. Researchers continue to study possible immune and inflammatory mechanisms, but the research is complicated by those who have suspected BII along with other, known autoimmune conditions.

Weight change is a reported BII symptom, but there are many, many other potential causes for weight fluctuations. You should see your doctor and have weight changes evaluated within the context of your overall health. Weight changes without other symptoms do not strongly indicate BII.

Rash is a reported BII symptom, but rashes are often associated with various dermatologic, allergic, infectious, and autoimmune causes. As is true of weight gain, a rash without other symptoms is unlikely to indicate BII.

If you believe you are experiencing BII, you should carefully consider whether you want your implants removed and, if so, whether you want them replaced. Replacing them will still expose you to breast implants and may not be the best option if you’re pursuing implant removal for the sole purpose of relieving BII symptoms. This is an important conversation to have with your plastic surgeon.

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