What Is Breast Implant Illness?
Breast implant illness (BII) refers to a wide range of symptoms, including joint and muscle pain, chronic fatigue, and memory and concentration problems, that can develop in people who have any type of breast implants.
The number of people reporting symptoms of BII seems to be growing, but doctors and researchers are still trying to understand what causes BII and how best to treat it. Some experts believe BII symptoms may be caused by an autoimmune or inflammatory reaction to breast implants.
Here’s what doctors and researchers do know about BII:
BII symptoms can occur in people with any type of breast implant, including silicone gel-filled, saline-filled, smooth surface, textured surface, round, or teardrop-shaped.
BII symptoms can develop whether implants have ruptured or stayed intact.
BII symptoms can appear any time after implant surgery — some people start to develop breast implant illness symptoms immediately, while others develop them years later.
Breast implant illness symptoms and signs
Breast implant illness (BII) affects everyone differently. Symptoms and signs of breast implant illness can include:
chronic fatigue
joint and muscle pain
memory and concentration problems
breathing problems
sleep disturbance
rashes and other skin problems
dry mouth and dry eyes
anxiety
depression
headaches
hair loss
gastrointestinal problems
In many, but not all cases, surgery to remove the breast implants improves or completely resolves the breast implant illness symptoms.
BII isn't currently an official medical diagnosis because it’s still not well understood.
This can make it more difficult for people with BII symptoms to get appropriate treatment. For example, there are no medical tests that are widely used to identify if someone has BII, no treatment guidelines published by major medical societies, and no specific codes to bill insurance companies for BII treatment.
“BII is a cluster of symptoms that don’t fit into any other classic disease diagnosis,” says Diana Zuckerman, PhD, president of the National Center for Health Research and a researcher who studies breast implant safety issues. “We believe that it eventually will be recognized as a medical condition, but that process will take time.”
A growing number of doctors are recognizing BII as a real problem and trying to find the best approaches for helping patients that have BII symptoms.
"A high percentage of people are fine with breast implants, but there is a real minority that is susceptible to BII,” says Jessica Erdmann-Sager, MD, FACS, associate surgeon in the Division of Plastic and Reconstructive Surgery at Brigham and Women’s Hospital and assistant professor of surgery at Harvard Medical School. “When you put a breast implant in their body, it’s a trigger that sets off what is most likely an autoimmune or inflammatory response.”
In recent years, the U.S. Food and Drug Administration (FDA), the major plastic surgery societies, and other health authorities have been devoting more attention to BII than they had in the past. In 2021, the FDA began requiring breast implant manufacturers to include information about the risk of symptoms that affect the whole body in a warning on breast implant packaging and in a patient decision checklist that is included in patient information booklets. The FDA refers to symptoms that affect the whole body, rather than just a single organ or body part, as systemic symptoms. The FDA said it's restricting the sale and distribution of breast implants only to health providers that review the checklist as part of the informed consent process before surgery, but it’s unclear how this is being enforced.
How common is breast implant illness?
It’s unclear how many people with breast implants develop BII. More people are reporting BII symptoms to their doctors and to the FDA in the last few years. Social media groups and media coverage have helped to raise awareness of the condition. While there aren’t any large studies on the percentage of people with breast implants that develop BII symptoms, some of the online communities related to breast implant illness have tens of thousands of members.
Breast implant illness tests and diagnosis
Currently, there are no commonly used diagnostic tests or diagnostic criteria specifically for BII.
Plastic surgeons who specialize in treating BII say it’s common for people who seek treatment to have multiple symptoms that are interfering with their ability to function.
“Usually, my clients with BII find me after exhausting all other medical avenues and going through exhaustive medical testing,” says Robert Whitfield, MD, FACS, a plastic surgeon in Austin, Texas who treats people with BII.
Plastic surgeons may need to review medical records and order tests to rule out other diseases, conditions, or medication side effects that might be causing the symptoms. They may see if symptoms improve with treatment for other conditions.
BII symptoms can be the same as or similar to symptoms that are associated with:
autoimmune conditions
connective tissue disorders
Chronic fatigue syndrome
thyroid problems
Lyme disease
perimenopause or menopause
side effects of some breast cancer treatments, such as hormonal therapy and chemotherapy
In some cases, a person might have a combination of BII symptoms and symptoms from other conditions.
Treating breast implant illness
Many plastic surgeons with experience treating BII say that removing the implants is the most effective treatment for improving symptoms in the long term. In some cases, the plastic surgeon may remove all or part of the surrounding scar tissue capsule as well.
A study published in Nature Scientific Reports in 2022, and several other studies, have shown that people who reported they had BII often had a significant improvement in their BII symptoms after surgery to remove their breast implants. Doctors and scientists don’t yet know exactly why BII symptoms frequently improve after implant removal.
Plastic surgeons usually don’t recommend replacing implants with new ones if you have BII symptoms. There is a risk that you might develop BII symptoms again. After having your implants removed, depending on your individual situation and preferences, you might decide to go flat or to have breast reconstruction with flaps (autologous reconstruction), fat grafting, or both.
If you’re considering surgery to address BII symptoms, be sure to ask your plastic surgeon about the risks and benefits of the various surgical treatment approaches.
Removing your breast implants may not necessarily improve or resolve your BII symptoms.
Also, ask if your surgeon recommends sending samples from the scar tissue capsule and any fluid removed during the surgery to a lab for pathology and culture testing.
Emerging research on breast implant illness
Researchers in several countries have been conducting studies on how to effectively treat BII and whether there are risk factors that could make a person more likely to develop BII. However, they still have a lot to learn.
“It’s hard to study a link between breast implants and BII symptoms, but we’re trying to learn learn more,” says Michael DeLong, MD, assistant professor-in-residence in the Division of Plastic Surgery at UCLA David Geffen School of Medicine, and a researcher who studies breast implant safety issues.
DeLong notes that there are several challenges facing BII researchers. For instance, it’s difficult to conclusively identify patients who have BII (and those who do not) to enroll in studies since there aren’t officially recognized diagnostic criteria and since the symptoms associated with BII are relatively common in the general population.
One promising area of research is showing that bacterial biofilm that forms on the surface of the breast implant may play a role in the development of BII symptoms.
What all this may mean for you
If you’re considering replacing your breast implants or getting breast implants for the first time, talk with your plastic surgeon and other doctors about all the benefits and risks, including the risk of BII.
If you think you have BII, you may want to seek out a plastic surgeon who is certified by the American Board of Plastic Surgery (ABPS) has experience treating people with the condition or at the very least one who takes your concerns seriously and isn’t dismissive about your symptoms. Keep in mind that the surgeon who placed your implants isn’t necessarily the one you should choose to remove them.
In most cases, private health insurance plans cover surgery to remove breast implants in women who have had a mastectomy and breast reconstruction. Since there is no official diagnosis code for BII, plastic surgeons typically list symptoms such as pain, implant rupture, and shortness of breath to show the health insurance company that the surgery is medically necessary. You may need to pay out of pocket for implant removal if your plastic surgeon doesn’t accept your health plan, is considered out of network, or if your implants were placed for cosmetic augmentation rather than for breast reconstruction.
Read more about BII in our Special Report: Breast Implant Illness and BIA-ALCL.
Learn about other risks and complications after breast reconstruction with implants.
This information made possible in part through the generous support of www.BreastCenter.com.
— Last updated on February 1, 2025 at 7:01 PM