Breast Implant Illness: A Patient's Guide
Breast implant illness (BII) is a term used by patients and physicians to describe a range of systemic symptoms that some individuals with breast implants attribute to their implants. These symptoms -- which can include fatigue, joint pain, cognitive difficulties, and others -- have been reported by a meaningful subset of implant recipients. For the patients who experience them, these symptoms are real, sometimes debilitating, and deeply concerning.
The medical community's understanding of BII continues to evolve. While breast implants remain among the most extensively studied medical devices in history, questions about whether and how implants might cause systemic symptoms in some individuals are the subject of ongoing research. This guide presents what the current peer-reviewed literature says -- and does not say -- about BII, with the goal of helping patients make informed decisions.
Dr. Emily Borsting is a board-certified plastic surgeon in Bend, Oregon, who specializes in breast surgery and takes BII concerns seriously. Her approach is grounded in published evidence, honest conversation, and respect for each patient's experience. She does not dismiss symptoms, nor does she overstate what the science currently supports.
What Is Breast Implant Illness?
BII is not a formal medical diagnosis with established diagnostic criteria. Rather, it is a patient-identified term that describes a collection of symptoms that some individuals with breast implants believe are related to their implants. The symptoms are varied and can overlap with those of many other medical conditions.
A 2024 systematic review published in the Aesthetic Surgery Journal examined 31 studies encompassing 39,505 implant patients. Among the 28 studies that reported symptom prevalence, 31.3% of patients reported symptoms related to BII. The review noted that more patients experiencing BII-related symptoms had received implants for cosmetic reasons (94.0%) than for reconstruction (5.96%).
A 2025 comprehensive systematic review published in Aesthetic Plastic Surgery further characterized the condition, noting the wide range of reported symptoms and the challenges inherent in studying a condition without standardized diagnostic criteria.
It is important to acknowledge that the lack of a formal diagnosis does not mean that patients' symptoms are not real. It means that the medical community is still working to understand the mechanism, identify which patients are at risk, and establish evidence-based management approaches.
Commonly Reported Symptoms
Patients who identify with BII report a diverse array of symptoms. A 2025 systematic review and meta-analysis published in Aesthetic Plastic Surgery analyzed 33 studies encompassing 6,048 women and identified the most frequently reported symptoms:
Fatigue (reported by 58.3% of BII patients in the meta-analysis)
Joint pain (51%)
Muscle pain (44%)
Cognitive difficulties ("brain fog")
Hair loss
Skin rashes
Chronic headaches
Sleep disturbances
Anxiety and depression
Dry eyes and dry mouth
Gastrointestinal issues
The same meta-analysis found that symptoms appeared, on average, 6.4 years after implant placement. The prevalence of co-occurring conditions was notable: 20.7% had autoimmune conditions, 16.5% had psychiatric illness, and 12% had fibromyalgia.
A separate systematic review and meta-analysis published in Plastic and Reconstructive Surgery Global Open in 2025 further defined the symptom profile of BII patients, emphasizing the importance of standardized reporting to advance understanding.
These symptom patterns are important to recognize, but they are also nonspecific -- meaning they can be caused by many conditions unrelated to breast implants. This overlap is one of the central challenges in studying and diagnosing BII.
What the Research Says -- and Does Not Say
The Autoimmune Question
One of the most debated aspects of BII is whether breast implants increase the risk of autoimmune or connective tissue diseases.
A 2022 systematic review and meta-analysis published in Women and Health analyzed the cumulative evidence on silicone breast implants and connective tissue diseases. The review concluded that the current body of evidence does not support a significant association between breast implants and connective tissue diseases, consistent with conclusions reached by multiple prior reviews and regulatory bodies.
However, this does not close the door on the question entirely. A 2025 meta-analysis published in the Journal of Plastic, Reconstructive and Aesthetic Surgery explored BII and its comorbid conditions, finding that while a definitive causal link between implants and autoimmune disease has not been established, there are subgroups of patients who may have a heightened sensitivity to silicone or other implant components.
The 2025 Ferreira meta-analysis reported that antinuclear antibody (ANA) positivity prevalence among BII patients was approximately 24%, and capsular inflammation was present in 58.4% of cases. Implant rupture was found in 21.4% and capsular contracture in 44.4% of BII patients studied.
FDA Perspective
The U.S. Food and Drug Administration has acknowledged patients' reports of systemic symptoms associated with breast implants and has taken several actions, including:
Requiring breast implant manufacturers to conduct long-term postapproval studies
Mandating a boxed warning on breast implants that includes information about BII
Requiring a patient decision checklist before implant surgery
Recommending a comprehensive informed consent process that addresses BII
A long-term FDA postapproval study of 99,993 patients, published in the Annals of Surgery, provided extensive safety data on breast implants. The FDA continues to monitor emerging evidence and has stated that while breast implants are not lifetime devices, they do not recommend prophylactic removal of implants in asymptomatic patients.
The Challenge of Causation
The central scientific challenge with BII is establishing causation. The symptoms associated with BII are common in the general population, and many of the conditions that overlap with BII (autoimmune disorders, fibromyalgia, chronic fatigue) occur independently of breast implants. Without controlled studies that compare implant patients to appropriately matched non-implant patients, it is difficult to determine whether implants are causing symptoms, exacerbating pre-existing conditions, or coinciding with symptoms that would have occurred regardless.
A 2022 systematic review by Rohrich and colleagues published in Plastic and Reconstructive Surgery emphasized this challenge, noting that while some patients clearly improve after explantation, the lack of controlled, prospective studies limits the ability to draw definitive conclusions about causation. The authors called for carefully designed, large-scale outcomes studies.
Explantation: What the Evidence Shows
For patients experiencing symptoms they attribute to BII, implant removal (explantation) -- often with capsulectomy (removal of the scar tissue capsule surrounding the implant) -- is the primary surgical treatment.
Symptom Improvement After Explantation
The 2025 Ferreira meta-analysis found that 81.9% of patients reported symptom improvement following explantation. This is an encouraging finding, though it should be interpreted with important caveats:
Most studies in the review were retrospective and relied on patient self-reporting.
There were no control groups (patients with similar symptoms who did not undergo explantation).
The placebo effect of surgery is well documented and cannot be excluded.
Some patients experienced partial but not complete resolution of symptoms.
Current reviews consistently emphasize that symptom improvement after explantation is encouraging but not definitive proof of causation. The available studies remain heterogeneous, many rely on retrospective self-reporting, and higher-quality prospective research is still needed.
Types of Explantation
Simple explantation. Removal of the implant only, leaving the capsule in place.
Total capsulectomy. Removal of the implant and the entire capsule.
En bloc capsulectomy. Removal of the implant and capsule together as a single unit, without opening the capsule. This is the approach most commonly requested by BII patients.
The 2024 Kabir systematic review found that 53% of patients undergoing explantation for BII had total capsulectomy. There is currently no high-level evidence demonstrating that one technique is superior to another in terms of symptom resolution, though many patients and some surgeons prefer en bloc capsulectomy when anatomically feasible.
If You Are Experiencing Symptoms
If you have breast implants and are experiencing unexplained systemic symptoms, the following steps are important:
1. See your primary care physician. Many BII symptoms overlap with common medical conditions. A thorough medical evaluation -- including blood work, thyroid function, autoimmune panels, and other relevant testing -- is essential to rule out or identify treatable conditions.
2. Document your symptoms. Keep a log of symptoms, their onset, duration, and severity. This information is valuable for any physician you consult.
3. Consult a board-certified plastic surgeon. If your symptoms persist after a thorough medical workup and you suspect they may be related to your implants, a consultation with a plastic surgeon experienced in explantation is appropriate.
4. Understand the evidence. The decision to undergo explantation is significant. Understanding what the research does and does not support can help you make a truly informed decision.
5. Consider the psychological dimension. Living with unexplained symptoms is stressful, and the decision to pursue explantation involves emotional, financial, and aesthetic considerations. Support from a mental health professional can be valuable during this process.
Dr. Borsting's Approach to BII
Dr. Borsting approaches BII with the same evidence-based rigor she brings to all aspects of her practice. Her approach includes:
Listening without judgment. Patients' symptoms and concerns are taken seriously. The consultation is a space for honest, thorough conversation.
Thorough evaluation. Dr. Borsting reviews imaging, medical history, and the specifics of the original implant procedure to develop a complete picture.
Honest discussion of the evidence. She presents what the research currently supports, what remains uncertain, and what realistic expectations for explantation outcomes look like.
Individualized surgical planning. If explantation is pursued, the surgical approach -- including the type of capsulectomy and any simultaneous reconstructive or aesthetic procedures -- is tailored to each patient.
Continued care. Follow-up after explantation is important, both to monitor healing and to assess symptom trajectory.
Dr. Borsting does not perform explantation solely because a patient requests it without first ensuring that a thorough evaluation has been completed and that the patient has realistic expectations. Similarly, she does not discourage patients from pursuing explantation when they have made an informed decision.
Frequently Asked Questions
Is breast implant illness a real condition?
The symptoms reported by patients with BII are real and, for many, significantly impact quality of life. However, BII does not have standardized diagnostic criteria, and the medical community is still investigating whether there is a direct causal relationship between breast implants and these symptoms. Major medical organizations, including the FDA, acknowledge patients' reports and continue to study the issue.
Should I have my implants removed if I am not experiencing symptoms?
The FDA and major plastic surgery organizations do not recommend prophylactic removal of breast implants in asymptomatic patients. If your implants are not causing concerns and your routine monitoring (including imaging as recommended) is normal, there is no evidence-based reason to pursue removal. However, breast implants are not lifetime devices, and eventual replacement or removal may be necessary.
How do I know if my symptoms are caused by my implants?
This is one of the most challenging aspects of BII. Because the symptoms overlap with many other conditions, it is essential to undergo a thorough medical evaluation before attributing symptoms to implants. If a comprehensive workup does not identify another cause, and symptoms are consistent with those reported by other BII patients, a consultation with a board-certified plastic surgeon can help you weigh the evidence and options.
What happens to my breasts after explantation?
After implant removal, breast appearance depends on several factors including how long the implants were in place, the original breast tissue, skin elasticity, and whether a capsulectomy was performed. Some patients choose to have a breast lift (mastopexy) at the time of explantation to address changes in breast shape. Others may choose smaller replacement implants or fat grafting. Dr. Borsting discusses all options during the consultation.
Does insurance cover explantation for BII?
Insurance coverage for explantation varies by provider and plan. Some insurers cover the procedure when there is a documented medical indication such as implant rupture or capsular contracture. Coverage for BII specifically is less consistent. Dr. Borsting's practice team can assist with insurance inquiries and provide documentation to support coverage requests.
How long does recovery from explantation take?
Recovery from explantation with capsulectomy is generally comparable to the recovery from the original augmentation procedure. In Dr. Borsting's experience, most patients can expect one to two weeks of limited activity, with full recovery at four to six weeks -- though individual recovery varies based on the extent of the procedure and whether additional procedures are performed simultaneously.
Are some types of implants more associated with BII than others?
Based on the available literature, including large systematic reviews, the current evidence does not definitively link BII to a specific implant type (silicone vs. saline), surface texture (smooth vs. textured), or placement (above vs. below the muscle). Some studies suggest potential associations, but these findings are not consistent across the literature. This remains an active area of research.
Take the Next Step
If you are experiencing symptoms you suspect may be related to your breast implants, you deserve a thorough, evidence-based evaluation -- not dismissal and not overstatement of what the science currently supports. A consultation with Dr. Borsting is an opportunity to have your concerns heard, your medical history reviewed, and your options discussed with honesty and care.
Schedule a consultation or call (541) 316-0627 to speak with the practice team.
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Emily Borsting, MD, is a board-certified plastic surgeon practicing in Bend, Oregon. She is affiliated with St. Charles Health System and Bend Surgery Center. Individual results vary, and all surgical and medical decisions should be made in consultation with qualified physicians. The information in this article is educational and does not constitute medical advice. Patients experiencing symptoms should consult their healthcare providers for individualized evaluation.
