Breast Implant Illness (BII): Symptoms, Assessment and Implant Removal

• What BII is
• Symptoms
• Possible causes
• How common is it?
• How it is assessed
• BII vs other implant problems
• Does removal help?
• Surgical options
• Recovery
• Medicare and cost
• Common questions

What is breast implant illness?

Breast implant illness is a term that came from patients, not from doctors. It describes a wide range of symptoms that some women with breast implants experience and believe are caused by them. Researchers and regulators increasingly use the more neutral term systemic symptoms associated with breast implants (SSBI).

Three things are true at once. First, there is no blood test, scan or biopsy that proves BII exists in a particular person. Second, no cause has been proven. Third, the women reporting these symptoms are unwell, and many improve after their implants are removed. The lack of a test is a gap in medical knowledge. It is not evidence that nothing is happening.

The Therapeutic Goods Administration (TGA) recognises BII on its breast implant hub, and researchers in Australia and overseas are studying it.

Symptoms women report

No single symptom defines BII, and many of the symptoms are common in the general population. The list most often reported includes fatigue, brain fog, memory problems, joint and muscle pain, rashes, hair loss, headaches, anxiety and low mood, disturbed sleep, dry eyes and mouth, and a racing heart. The table groups them with the other common conditions that can cause the same picture. This is why testing for other causes matters so much.

Symptom group	Examples reported	Other common causes to rule out
Energy and thinking	Fatigue, brain fog, poor memory and concentration	Iron or vitamin B12 deficiency, thyroid disease, sleep apnoea, depression
Joints and muscles	Joint pain, muscle aches, stiffness	Autoimmune arthritis, fibromyalgia, vitamin D deficiency
Skin and hair	Rashes, hair thinning, dry skin	Thyroid disease, iron deficiency, hormonal change, eczema or dermatitis
Mood and sleep	Anxiety, low mood, poor sleep	Depression and anxiety disorders, perimenopause, life stress
Other body systems	Headaches, palpitations, gut upset, dry eyes or mouth	Migraine, thyroid disease, coeliac disease, Sjögren’s syndrome
Breast itself	Pain, tightness, change in shape, swelling	Capsular contracture, rupture, seroma. Late swelling needs checking for BIA-ALCL

Swelling of one breast years after surgery is different. It is not a typical BII symptom and should be checked promptly with an ultrasound, because it can be a sign of fluid around the implant. Read BIA-ALCL: breast implant-associated lymphoma.

What might cause it?

Several ideas are being studied. None is proven, and it is possible that different women have different causes, or that some symptoms are unrelated to the implants.

• An immune or inflammatory reaction to the implant shell or to small amounts of silicone that can pass through an intact shell (gel bleed).
• Low-grade bacterial contamination (biofilm) on the implant surface, which may keep the capsule inflamed.
• The capsule itself, the scar tissue the body forms around every implant.
• Individual susceptibility, such as a personal or family history of allergy or autoimmune disease.

BII has been reported with silicone and saline implants, smooth and textured. There is no known pattern that predicts who will be affected.

How common is it?

No one knows, because there is no agreed definition or test to count cases. What is known is that more Australian women are having their implants taken out. Data from the Australian Breast Device Registry show that removal without replacement rose from 0.4% of cosmetic implant operations in 2016 to 7% in 2022 (ABC News, 2024). Concern about BII is one reason, but not the only one.

How Dr Kumar assesses implant concerns

Because there is no single test, assessment has two aims. The first is to check the implants and the breasts. The second is to make sure another treatable condition has not been missed. This is not a way of dismissing your symptoms. If something else is causing them, removing your implants will not fix it, and you would have had an operation you did not need.

1. Your implant history. When and why the implants were placed, the type (your implant card, operation report or the Australian Breast Device Registry can help), and any later surgery.
2. Your symptoms. When they started, how they have changed, and how they affect daily life.
3. Examination of the breasts, the capsules, the armpits and the lymph nodes.
4. Imaging. An ultrasound, and sometimes an MRI, to look for rupture, fluid or capsular problems.
5. Tests with your GP for common look-alike conditions: for example a blood count, iron studies, vitamin B12, thyroid function and inflammatory markers, and autoimmune tests or a specialist referral if these are suggested.
6. An honest discussion of what surgery can and cannot be expected to do, so that any decision is yours and well informed.

You do not need a diagnosis to have your implants removed. It is your body, and removal is a legitimate choice. The assessment simply makes sure you go into it with accurate expectations.

Breast implant illness compared with other implant problems

BII is often confused with three other conditions that have clear tests and clear treatments. Knowing the difference helps you ask the right questions.

Condition	What it is	Typical signs	How it is confirmed
Breast implant illness	A group of whole-body symptoms attributed to implants	Fatigue, brain fog, joint pain, rashes, hair loss	No test. Diagnosis by excluding other causes
BIA-ALCL	A rare lymphoma in the fluid or capsule around an implant, mostly textured	Late swelling of one breast, sometimes a lump	Ultrasound, and laboratory testing of fluid (CD30)
Implant rupture	A tear in the implant shell	Often none. Sometimes a change in shape, pain or lumps	Ultrasound or MRI
Capsular contracture	Tightening of the scar capsule around the implant	Firmness, pain, a high or distorted breast	Examination

Does removing implants help?

Many patients report improvement after their implants are removed. The published evidence supports that, with an important limit: most studies are observational and have no comparison group, so the size of the effect is uncertain.

• A 2022 Dutch prospective study followed 109 women who had silicone implants removed. Symptom and quality-of-life scores improved significantly in those who had symptoms, but most still had some symptoms afterwards. The extent of capsule removal did not make a measurable difference.
• An Australian study led by Sydney plastic surgeon Professor Anand Deva assessed 226 women with suspected BII. Of the 77 who had their implants removed, 85% reported a significant reduction in the number and severity of their symptoms at six months (reported by ABC News, 2024).

What this means for you: improvement is common, but it cannot be promised, and it may be partial. Symptoms that have another cause will not improve.

Surgical options

The operation is planned around what is found, not a fixed policy. The main choices are how much of the capsule to remove, and whether to reshape the breast at the same time or later. Removed capsule tissue is sent to the laboratory for testing.

Option	What it involves	When it is considered
Implant removal only	The implant is taken out and the capsule is left	Thin, soft, healthy capsule and no concerns on imaging
Removal with partial or total capsulectomy	The implant and some or all of the capsule are removed	Thickened, hardened or calcified capsule, or symptoms from the capsule
Total intact capsulectomy (often called “en bloc”)	The implant and the whole capsule are removed together, with the capsule unopened	Suspected or confirmed BIA-ALCL, a mass, or ruptured silicone inside the capsule
Removal with a breast lift	Loose skin is tightened and the nipple raised	Stretched skin or low nipples. May be done at the same time or delayed
Later fat grafting	Your own fat is used to restore some volume	Once healing is complete, for those who want more fullness without implants

You do not need an “en bloc” operation to have your implants removed. The term comes from cancer surgery, and it is only accurate, and only needed, when BIA-ALCL or another cancer is suspected. It is widely marketed online as the only safe way to remove implants, but there is no good evidence that it improves breast implant illness symptoms more than removal with the right capsule management. Read why “en bloc” is the wrong word.

After removal the breasts are usually smaller and often lower than they were with implants, because the skin and tissue have been stretched. Dr Kumar will show you what to expect on examination. More detail on the operation is on the explant surgery and implant removal or revision pages.

Recovery, week by week

Recovery depends on how much capsule is removed and whether a lift is done at the same time. This is a typical course.

When	What to expect
Day of surgery	Usually a day case, at Westmead Private Hospital or Somerset Private Hospital, Kingswood. A drain is nearly always placed, and a support bra or compression garment is fitted.
Weeks 1 to 2	Time off work. Soreness, swelling and tightness across the chest. Walk daily, and avoid lifting or reaching overhead. First review with Dr Kumar and his nurses at about one week.
Weeks 2 to 6	Most patients return to work from about two weeks, then gradually resume most everyday activities over the next four weeks, depending on how physical they are. No heavy lifting or straining. Wear the garment for six weeks.
Weeks 6 to 12	Build back up to full activity and exercise. Most people are cleared for everything by 12 weeks. Review at six and 12 weeks.
3 to 12 months	The breasts settle into their final shape and the scars fade. Reviews at six and 12 months. Symptom changes are tracked over this time.

Stopping all nicotine for six weeks before and after surgery lowers the risk of wound problems.

Medicare, health insurance and cost

This is the part most often misunderstood, and it is worth knowing before you plan.

• Medicare item 45551 covers removal of an implant with excision of at least half the capsule, without a new implant. The capsule must go to the laboratory. It is intended where there is a medical reason for the capsulectomy, such as capsular contracture, a mass in the capsule, or BIA-ALCL or another cancer.
• Item 45548 covers removal of an implant as a procedure on its own.
• Symptoms attributed to implants, on their own, do not meet the indications for item 45551. Which item, if any, applies is decided by what is found clinically.
• Where a Medicare item applies, private health insurance may help with hospital costs, depending on your cover.

The consultation fee is $400, with a Medicare rebate of about $88, and a GP referral is required. Surgical fees depend on the operation you need and are set out after your consultation in a written, itemised quote.

Should implants be removed as a precaution?

No. The TGA does not advise removing implants in women who have no symptoms or concerns. If your implants are causing no problems, the sensible approach is to know how your breasts normally look and feel, check them regularly, and see your GP or surgeon if anything changes.

Reporting your symptoms

If you believe your implants have caused symptoms, you can report this to the TGA as an adverse event. Reports help the TGA and researchers understand BII better. If your implants were inserted in Australia since 2015, the Australian Breast Device Registry may also hold a record of them.

Where Dr Kumar consults and operates

Dr Kumar consults in Westmead, Penrith and Orange. Implant removal is usually performed as a day case at Westmead Private Hospital or Somerset Private Hospital in Kingswood.

Common questions