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


From January 2016 through September 2020, 200 self-reported female patients with symptoms consistent with BII underwent bilateral implant removal and total capsulectomies, with specimens sent for pathology examination and cultures (Figure 5). The patients' characteristics are summarized in Table 2. The average age was 45.5 years (range 29–73 years) and the average BMI was 26.3 (range 19–36.8). The majority of the patients (80%) had a smooth implant removed. For all patients, 59% of the implants were placed in the subpectoral plane and 41% of the implants were placed in the subglandular plane. The average follow-up time post-surgery was 5 months (range 3–46 months). Only 2 patients had postoperative complications (1.0%). One patient had wound dehiscence, and the other patient had a hematoma. Both patients recovered unremarkably.

Figure 5.

A 34-year-old female patient presenting with BII mastodynia unilaterally on the left breast underwent total capsulectomy to remove the silicone gel implant and capsule as one entity.

All patients (n = 200) were diagnosed with capsular contracture with the majority being Baker-Gordon Grade III (75.5%) followed by Grade IV (14.5%) in at least one breast. In addition, a high percentage of patients presented with hyperthyroidism or hypothyroidism prior to removal of the implants (34.7%; Table 2).

Some form of mastodynia was noted by 100% of the patients (n = 200; Table 3). At least two other BII symptoms were reported by 98% of patients, most commonly fatigue (82.5%), loss of concentration during activities (81.5%), joint pain (57.5%), muscle pain (51.5%), rash or other skin disorder (37.5%), ocular complaint (23.5%), memory loss (18.0%), and autoimmune diagnosis (10.5%).

After surgery 96% of patients reported a significant decrease in their symptoms, whereas 90.5% of patients reported a complete disappearance of symptoms after implant removal and capsulectomy. The 4% of patients (n = 8) who reported no improvement initially after surgery had negative histopathology, negative cultures, and no periprosthetic fluid.

In pathologic examination of the specimens removed, 68.5% (137/200) of patients had at least 1 positive bacterial culture (Table 4). The most common organisms found were Propionibacterium acnes (49.6%) followed by Staphylococcus epidermidis (26.2%), Propionibacterium granulosum (16.8%), alpha-hemolytic streptococcus species (8.7%), and bacillus species excluding bacillus anthrax (2.5%). There was 1 positive bacterial culture of Mycobacterium Chelonae (0.7%), Mycobacterium fortuitum (0.7%), and Mycobacterium Avium-intracellulare (0.7%) and 2 positive fungi cultures of Candida albicans (1.5%) and Aspergillus fumigatus (1.5%). Extracted specimens from 14 patients grew more than 1 organism (10.2%), including 3 organisms found in 3 patients (2.2%). All patients with fungal or mycobacterial infections were sent to infectious disease specialists, and patients with other positive culture were treated with culture-specific antibiotics. All culture-positive patients reported improvement after treatment. There were no cases of breast implant associated anaplastic large cell lymphoma (BIA-ALCL), although 12 specimens were sent to cytology containing periprosthetic fluid.

Furthermore, there was no significant difference among patients in percentage of positive cultures in the implant when placed in the subglandular plane (55%, P = 0.23) and subpectoral plane (34.5%, P = 0.25). Also, there was no significant difference among patients in percentage of positive cultures bacterial cultures in textured implants (37.5%, P = 0.44) and smooth implants (43.9%, P = 0.11).