Breast surgery
Breast Implant Illness
Breast implant illness (BII) describes a range of systemic symptoms that some women develop after breast implant surgery. Dr. Cassileth evaluates and treats patients who suspect their implants are the cause.
Technique
How it's done.
Breast implant illness often presents as fatigue that sleep does not relieve, joint pain, and slowed thinking. Laboratory results are often normal, so many patients are told nothing is wrong. If you recognize these symptoms, Dr. Cassileth can evaluate whether your implants are involved.
A real evaluation. Dr. Cassileth reviews your history, your symptoms, and when they began relative to your implants. Symptoms that started within months of placement raise her suspicion. She also wants to rule out other causes, so your own physicians stay part of the conversation.
Implant and capsule removal. The treatment for breast implant illness is breast implant removal. Dr. Cassileth removes the implant together with the entire capsule, the layer of scar tissue your body forms around it. When indicated, Dr. Cassileth performs en bloc capsulectomy, which removes the implant and capsule as one intact unit.
Testing what comes out. Your capsule and implant surface are sent for standard microbiology and for PCR testing, which can identify bacteria a routine culture misses.
A plan for your shape. Removal alone can leave breasts looking deflated. Dr. Cassileth can reshape them in the same operation with a breast lift or fat transfer, so you leave without implants and still look like yourself.
What to expect. Many women feel better after implant removal3. In the FDA’s review of patient reports, 687 of the 785 that described what happened after removal noted improvement, which is nearly nine in ten1. Individual results vary, and Dr. Cassileth discusses what you can expect at your consultation.
Breast Implant Illness Symptoms
Breast implant illness symptoms are frustrating precisely because they are so ordinary. Each one has a dozen possible explanations. Together, and timed to your implants, they tell a different story.
The FDA has reviewed more than 10,000 reports from women with breast implants1. These were the symptoms of breast implant illness reported most often:
- Fatigue (41.1%)
- Joint problems (30.9%)
- Anxiety (22.9%)
- Autoimmune disease (22.6%)
- Brain fog (22.5%)
- Hair loss (19.6%)
- A general feeling of illness (18.7%)
- Depression (16.9%)
- Rash (16.7%)
- Weight changes (16.5%)
Dr. Cassileth’s patients also report food intolerances and digestive problems. These symptoms are not limited to one type of implant. According to the FDA, breast implant illness symptoms have been reported with both saline and silicone implants2.
There is currently no test for breast implant illness. BII is not a formal medical diagnosis, and no blood test or scan can confirm it1. Instead, doctors identify it by the pattern and timing of your symptoms and by a workup that rules out other conditions.
What Causes Breast Implant Illness?
No one has yet proven what causes breast implant illness, or how far the symptoms relate to the implants themselves1. However, an unknown cause does not mean that your symptoms are imagined.
Saline and silicone breast implants are both approved medical devices. Even so, they can rupture, leak, or become contaminated over time, and some women appear to react to the implant itself. Among her own patients, Dr. Cassileth sees the most evidence for two explanations.
Breast Implant Illness From Silicone Implant Leakage
As implants age, the shell can rupture. In most cases, the silicone stays contained within the capsule2. However, it can also travel through the lymphatic system into the surrounding breast tissue, muscle, and lymph nodes.
Silicone is nonreactive in most people. In sensitive individuals, though, it can cause inflammation, granulomas, and calcifications.
To correct this, Dr. Cassileth removes the implant, the capsule, the free silicone, and the surrounding tissue, leaving as few silicone particles behind as possible. Silicone that has reached the lymph nodes in your armpit is the exception. She does not recommend removing those nodes unless they are causing symptoms, because doing so risks lasting arm swelling.
Breast Implant Illness from Biofilm
A biofilm is a thin colony of bacteria living on the implant's surface. It is not an infection in the usual sense, because it causes no fever and no abscess. Even so, the bacteria can drive inflammation and place a constant burden on your immune system.
These bacteria live on the skin and in the breast ducts, and they multiply during breastfeeding. As a result, contamination can happen when the implant is placed or years later.
Biofilms are also hard to grow in a standard culture, which makes them hard to diagnose. For that reason, Dr. Cassileth recommends PCR testing of the capsule and implant surface for every patient, alongside the usual microbiology. When biofilm is behind breast implant illness, both the capsule and the implant need to be removed.
FAQ
Common questions.
What is breast implant illness?
Breast implant illness (BII) is a term for a range of systemic symptoms, such as fatigue, joint pain, and brain fog, that some women develop after breast implant surgery. It is not yet a formal medical diagnosis. However, the FDA recognizes the reported symptoms and continues to study their cause.
Is breast implant illness real?
Yes. The symptoms of breast implant illness are real, and thousands of women have reported them to the FDA1. Only the cause remains unproven. Dr. Cassileth has treated implant illness for years and describes it as rare but real. Many of her patients report feeling better after their implants and capsules are removed.
How common is breast implant illness?
The exact rate is unknown. The FDA received 10,318 reports of systemic symptoms in women with breast implants between 2008 and mid-20241. However, voluntary reports cannot show how common breast implant illness is. Most women with implants never develop it, but if you have symptoms, they warrant a proper evaluation.
Is there a test for breast implant illness?
No. There is currently no breast implant illness test, and no blood test or scan can confirm it1. Instead, doctors identify it by reviewing your symptoms and their timing and by ruling out other conditions. After removal, Dr. Cassileth tests the capsule and implant surface for bacteria using microbiology and PCR.
Do breast implant illness symptoms go away after explant?
For many women, yes. Among 785 FDA reports that described the outcome of implant removal, 687 noted improvement in breast implant illness symptoms, which is nearly nine in ten1. Some patients feel better within days, while others improve gradually over months. Individual results vary, so Dr. Cassileth discusses what you can expect beforehand.
Does insurance cover implant removal for breast implant illness?
Insurance coverage for breast implant illness depends on your plan. Implant removal for documented complications, such as rupture or capsular contracture, may qualify for partial coverage. Elective removal, however, is typically paid out of pocket. Our Patient Advocacy team verifies your benefits and gives you a written estimate before you commit to surgery.
Related reading
From the journal.
Sources
Cited research.
- 1U.S. Food and Drug Administration. Medical Device Reports for Systemic Symptoms in Women with Breast Implants. fda.gov · Content current as of February 6, 2025.
- 2U.S. Food and Drug Administration. Risks and Complications of Breast Implants. fda.gov · Content current as of December 15, 2023.
- 3Serena TJ, Habib P, Derosa A. Breast Implant Illness: A Cohort Study. Cureus. 2023;15(4):e38056. PMC10208020 · doi:10.7759/cureus.38056
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