Breast Implant Illness: Treatment Using Total Capsulectomy and Implant Removal

Stephen E. Metzinger, MD, FACS; Christopher Homsy, MD; Magnus J. Chun, BS; Rebecca C. Metzinger, MD


ePlasty. 2022;22(e5) 

In This Article

Abstract and Introduction


Background: Breast implant illness (BII) is extramammary systemic symptoms that are caused by breast implants. The emergence of this controversial topic has spurred patients with breast implants who are experiencing these symptoms to seek implant removal, hoping to feel better. This article presents novel outcomes and suggestions for plastic surgeons in managing BII using total capsulectomy and breast implant removal.

Methods: In this retrospective cohort study conducted between 2016 and 2020, medical records of all patients undergoing breast implant removal were reviewed. Inclusion criteria consisted of all patients with history of breast implant placement presenting with mastodynia and capsular contracture on physical examination. Patients with history of implant-based reconstruction following mastectomy and patients who underwent implant exchange were excluded. All patients underwent bilateral implant removal and total capsulectomies.

Results: A total of 200 patients who fulfilled the inclusion criteria were identified. Average age was 45.5 (range: 29–73) years and average body mass index was 26.28 (range: 19–36.8), with an average follow-up time of 5 months postoperatively. Of patients with a presentation of BII, 96% reported improved or complete resolution of their systemic symptoms after implant removal and total capsulectomy. A positive microbial culture was found in 68.5% of patients, and all culture-positive patients reported improvement post-treatment. The most common organisms found were Propionibacterium acnes (49.6%). There were no associations between implant characteristics and rate of positive microbiology findings.

Conclusions: Our study shows that implant removal with capsulectomy drastically improves BII symptoms. Further large prospective cohort studies are needed to better understand this entity.


Breast implant illness (BII) refers to symptoms that develop after breast reconstruction or augmentation with any type of breast implants (saline-filled, silicone gel–filled, textured surface, smooth surface, round, or teardrop-shaped). Symptoms of BII first appeared in women in the 1980s, and there were large concerns of connective tissue diseases being linked to newly implanted silicone breast implants. These symptoms were especially prevalent in Japanese women during World War II.[1,2] After years of further study, the Food and Drug Administration (FDA) approved modified breast implants to be introduced to the market.[3] Unfortunately, BII is still prevalent today and impacts individuals in many unique ways including but not limited to the symptoms shown in Table 1. Symptoms may appear at any time post-breast implant surgery.

Currently, there is a lack of literature on cohort study outcomes after implant removal surgery for BII patients. A study of 100 patients concluded that 89% of patients who had capsulectomy and implant removal had symptom improvement within 3 months of surgery.[4] These symptoms included cognitive problems, fatigue, burning pain in the breast and chest wall, dry eyes, anxiety, and joint pain. Researchers in the Netherlands studied 80 women with implants and found that symptoms improved in 69% of patients after surgery.[5]

Clearly, breast implant removal improves or completely resolves the BII symptoms. However, BII is not accepted as an official medical diagnosis. It is poorly understood, and there are limited studies because it is a unique condition. BII appears to be a cluster of symptoms that do not align with other classic diagnosis. It can worsen over time and is different in its presentation even for patients with similar implants. As of now, the incidence and prevalence of BII is increasing.

To our knowledge, there is a lack of Level I cohort studies of women with breast implants who subsequently develop BII. In our novel retrospective study, we review the outcomes in managing BII using total capsulectomy and breast implant removal. Additionally, we discuss the details of BII and what patients should do if BII is suspected.