Breast Implant Illness (BII) and Breast Implant Removal Questions and Answers with Dr. Lisa Cassileth

BY. LISA B. CASSILETH MD, FACS

Breast implant removal cases have been steadily on the rise in the United States. Thousands of women across the country have been vocalizing their concerns regarding breast implant illness (BII) symptoms and their desire for answers and breast explant treatment. Dr. Lisa Cassileth, founder of the famous Beverly Hills practice, Cassileth Plastic Surgery, treats hundreds of patients annually seeking treatment for their capsular contracture, breast implant illness, implant rupture, and other breast implant related issues. She is a breast expert with over 16 years in practice and is the inventor of many break-through techniques in breast surgery including one-stage breast reconstruction, breast implant removal, internal breast lifts, and breast fat-grafting.


We have compiled a list of the most commonly asked patient questions regarding breast implant removal, breast implant illness, and explant surgery for Dr. Cassileth to answer below.

Q. How do you know when your implants are making you sick?

“Sometimes, it can be obvious, such as hardening of the scar tissue around the implant as in capsular contracture, which typically occurs within six months of the augmentation. But usually, you don’t exactly know if your breast implants are making you sick. Typically, you begin to have medical issues, and you wonder why. The symptoms are usually nonspecific, such as fatigue, brain fog, food intolerances, weight gain, or joint pain, all related to chronic inflammation. Timing can sometimes help. If the symptoms began after the implant was placed, typically within six months, it makes me wonder about the implant placement being related to the new symptoms. “

Q. When should breast implants be removed?

“Breast implants should be removed if you have had them for longer than 15 years, they are past their warranty, or you are experiencing symptoms of a rupture, sudden pain, breast implant illness (BII) or capsular contracture. If you have symptoms if breast implant illness, you should sit down with a doctor who understands it and discuss whether it may be worth it to remove your implants or not. You don’t want to remove implants for no reason, nor do you want to keep implants in that may be damaging to your health.”

Q. What are the symptoms of silicone toxicity?

“Silicone is composed of several different typically non-toxic chemicals. All breast implant shells are composed of a non-reactive silicone shell is inert. Inside, most modern implants are full of cohesive silicone, which stays and place and does not appear to cause inflammation, and does not travel through the body. However, the older implants were a more liquid silicone gel and can cause inflammation and granulation tissue in some patients. If your implants are 15 years or older, composed of liquid silicone, or you have a rupture where silicone has leaked into or outside the capsule, then symptoms could include capsular contracture, breast implant related illness (BII), and lumps from free silicone including enlarged lymph nodes.”

Q. Can you collect all of the particles of silicone that have possibly spread?

“You cannot remove all the microscopic particles of silicone that have spread into one’s body. It is smart to minimize the amount of silicone that is left behind as much as possible while following correct medical guidelines. During our breast implant removal procedures, we remove the entire capsule and all the silicone within it. Silicone that is around or outside the capsule is visible and is also removed. However, we do not excise lymph nodes, as removal of the nodes may cause lymphedema (arm swelling), and does not remove all silicone in the lymph system. Silicone lymphadenopathy is a rare and if the lymph nodes are inflamed and enlarged, lymph node dissection is performed by our breast surgeons at Bedford Breast Center only when indicated.”

Q. I have a ruptured implant; how long should I wait to get my implants removed?

“Patients with a silicone implant rupture should have their implants removed within 6 months of finding the leak. If your implants have ruptured it can be detected by ultrasound, mammogram or MRI. MRI tends to be the most sensitive, but it costs the most; ultrasound and mammogram are easier to get and more affordable, but may miss the leak.”

Q. What can I expect after breast implant removal?

“Individual results vary in patients who have BII and capsular contracture. For BII, patients often will experience what I call the “light-switch” effect and have reported instantly feeling better. Half of these patients who experience such sudden improvements at our practice have tested positive for biofilms from microbiology and PCR. As we collect more data over time, we have come to believe that it is actually bacteria living on the implant surface, called biofilm, that causes most of the BII. And biofilms are not all created equal. Ones that produce inflammatory mediators, such as P. acnes, appear to be the worst offenders. Even in patient that don’t grow biofilms, many of them report overall feeling that their symptoms are more manageable. They feel that they can get their life back and are more active, feel more confident, and have peace of mind by taking control of their health. And for capsular contracture, of course eradication of the capsule provides instant relief.”

Q. What are signs it is time to get my breast implants removed?

“Tell-tale signs it is time to get your breast implants removed include any degree of capsular contracture, changes in breast shape, pulling and/or pain, one breast sits higher than the other, tightness, or tenderness. if you are experiencing any of the above reasons you may want to consider removing them, as a lifetime of implants, especially if you start to have health issues, is a commitment.”

Q. What are signs of an implant rupture?

“When implants rupture from pressure it is generally a painful, popping feeling. I hear this most from patients who have breast implant ruptures from mammograms. In most cases, though, it’s silent, caused by age and wear on the implant shell. Rupture can also cause capsular contracture, as the body finally “sees” the silicone gel inside the implant and then has an inflammatory reaction. Saline implant rupture usually is more noticeable because implants start to deflate over time. The saline isn’t dangerous, but your breast sagging will be!”

Are you thinking about explant surgery for removal of your silicone or saline implants? To learn more about breast implant removal and your options for treatment of BII contact our front desk concierge to schedule a consultation with breast specialist Dr. Lisa Cassileth at (310) 278-8200 or by requesting an appointment online.