Plastic Surgery; Women's Health

Breast implant illness: Diagnosing and treating its many complex symptoms

Plastic Surgery; Women's Health

breast implants
Breast implant illness describes a wide range of symptoms from fatigue to chronic joint and muscle pain that a small number of women experience after getting breast implants.

More than 193,000 women received breast implants in 2020. While that was down from 287,000 in 2019, largely due to COVID-19 restrictions, breast augmentation remains one of the most common plastic surgery procedures performed in the U.S.

The risk of complications due to breast implants is only about 1%, with the most common being breast pain, changes in nipple and breast sensation, scar tissue formation, and rupture and deflation.

However, a small number of women experience a compilation of symptoms that has come to be known as breast implant illness, or BII. Though we are still learning about BII, and it is not a formal diagnosis, the symptoms are real.

While more than 100 symptoms have been associated with BII, some of the most common include:

  • Anxiety or depression
  • Brain fog
  • Chronic fatigue
  • Dry mouth and dry eyes
  • Gastrointestinal problems
  • Hair loss
  • Headaches
  • Joint or muscle pain
  • Rashes and skin problems
  • Weight changes

Breast implant illness has become more widely known in the last couple decades as patients have increasingly shared their stories on social media. In April 2022, retired race car driver Danica Patrick posted on Instagram about her struggles with BII and her decision to have her breast implants removed.

It can be comforting to find a community of people with similar symptoms as you; unfortunately, sometimes these channels help spread misinformation or unnecessary fear.

Many patients with BII symptoms can find relief without having to remove their breast implants. Often, the cause of symptoms is an underlying condition that affects the immune system or hormone production.

If you develop unexplained symptoms that you suspect may stem from your breast implants, talk with a breast specialist or plastic surgeon. We will listen to you and connect you with specialists who can help you feel more like yourself again.

Determining the cause of your symptoms

Young woman feeling ill
More than 100 symptoms have been associated with breast implant illness, including headaches, fatigue, and gastrointestinal problems.

Symptoms can occur with any type of breast implants and can start immediately after implantation or years later.

Because so many BII symptoms are associated with other conditions, it’s important to rule out causes unrelated to the breast implants. For example, many similar symptoms are associated with autoimmune conditions such as lupus, rheumatoid arthritis, scleroderma, and Lyme disease. Hypothyroidism, menopause, and fibromyalgia also can cause symptoms similar to those of BII.

Our goals in diagnosis are to determine the cause of your symptoms and to make a plan to resolve those issues at the source. In some women, the implants themselves prove to be the issue, such as if the implant or tissues surrounding it stiffen, or if the implant ruptures. For many more, an underlying condition is the culprit.

Diagnosis starts with a conversation about what triggers your symptoms and the extent to which they interfere with your quality of life. From there, we may refer you to a specialist in areas such as:

  • Rheumatology, for musculoskeletal or immune system concerns.
  • Endocrinology, for thyroid or hormone issues, which can cause symptoms such as fatigue or weight changes.
  • Dermatology, for scleroderma, rashes, or stiff/tight skin.
  • Neurology, for behavioral or emotional challenges such as brain fog, anxiety, or depression.

If the specialists find an underlying condition, unrelated to your breast implants, treatment for that condition should relieve or eliminate your symptoms. If no underlying conditions are found, we’ll discuss potential next steps, such as removing your implants.

Deciding whether to remove your breast implants

Choosing to remove your breast implants is just as big a decision as it was to get them. If you’re unhappy with the size or shape of your implants, or if you’ve developed a complication such as capsular contracture – the formation of hard, stiff scar tissue around the implant – the decision to remove them may reduce your symptoms.

But if you are satisfied with your appearance and your symptoms are systemic, rather than directly associated with the breasts, the decision can be more difficult. Even if BII symptoms resolve after implant removal, adjusting to changes in your appearance can be challenging.

Your plastic surgeon will discuss all your options with you to help you make the best decision.

Clearing up common myths related to BII

There are many websites and social media groups dedicated to breast implant illness. And it’s not unusual for patients to tell me they read or saw something that worries them in one of these communities. I’d like to address a couple of the more common concerns I hear.

Sagging skin after implant removal: There are a lot of people who post photos of themselves after having their implants removed. These photos are usually of women who had very large – 400cc or 500cc – implants removed, leaving excessive, sagging skin behind. Images like these can cause unnecessary anxiety.

Transferring fat to the breast from elsewhere in the body can help restore some volume after implant removal. Though your breasts likely will not be as full as they were with implants, this process can provide a pleasing appearance and a less dramatic transition.

“Only one right” way to remove implants: There are a several methods to safely remove breast implants:

  • Removing the implants and leaving the scar tissue, or capsule, that surrounds your implant.
  • Removing the implant and entire capsule without cutting into the capsule, known as an en-bloc capsulectomy.
  • Cutting into the capsule, removing the implant, and then removing all or most of the capsule.

However, many social communities say that only specific procedures – notably en-bloc capsulectomy – will eliminate BII symptoms. This is untrue, and there are situations in which that procedure could cause more problems. For example, if the capsule is stuck to the chest wall, taking it all out could cause a pneumothorax, or air to leak into the space between the lungs and chest wall. In this case, we can take out most of the capsule and cauterize the patch that’s against the ribcage.

A study published in December 2021 found that the type of capsulectomy performed did not affect the reduction of breast implant illness symptoms, so, if your doctor tells you that they may not be able to perform an en-bloc capsulectomy, don’t despair. We will talk with you about all your options, and we will recommend the safest technique.

Current research and action related to BII

Research is under way to determine the degree to which certain symptoms are directly caused by breast implants. One such effort is a BII task force within The Aesthetic Society. This team conducts research and follows new breast implant patients for more than 10 years.

It’s frustrating to feel unwell without a specific diagnosis – especially after you’ve been through one or more major breast surgeries. Our breast plastic surgery and specialist teams work together, and we are uniquely qualified to help you get answers and start feeling better.

If you experience symptoms or complications that you suspect are due to a breast implant, call 214-645-8300 or request an appointment online.

A breakthrough in breast reconstruction at UTSW

When Renee Mallonee found out she was BRCA2 positive and her lifetime risk of breast cancer was high, she took the news very seriously. After 15 years of screenings and tests every six months, in 2020 she turned to UT Southwestern and became the first patient in the United States to receive a single port robotic nipple-sparing mastectomy.