Outcomes of Implant Removal and Capsulectomy for Breast Implant Illness in 248 Patients

Jacob Y. Katsnelson, MD; Joseph R. Spaniol, MD; Joshua C. Buinewicz, BA; Frederick V. Ramsey, PhD; Brian R. Buinewicz, MD, FACS


Plast Reconstr Surg Glob Open. 2021;9(9):e3813 

In This Article

Abstract and Introduction


Background: Breast implant illness (BII) is a term popularized by social media to describe systemic symptoms that patients ascribe to their breast implants. Though the concept of implants as an underlying cause for a systemic illness remains controversial, few studies have delineated the implant characteristics, capsular histology, and outcomes of patients who undergo explantation for BII.

Methods: We retrospectively reviewed the demographics, presenting symptoms, outcomes, capsular histology, and culture results of all women who presented to the senior author with symptoms attributed to BII and underwent breast implant removal with capsulectomy from August 2016 to February 2020. Chi-square and logistic regression analyses were performed to evaluate association between implant type, composition, and findings of inflammation on capsule pathology.

Results: Among 248 patients, 111 (23%) capsules demonstrated inflammatory changes on permanent pathology. Capsular inflammation was independently associated with silicone versus saline (right odds ratio [OR] = 2.18 [1.16–4.11], P = 0.016, left OR = 2.35 [1.08–5.12], P = 0.03) and textured versus smooth implants (right OR = 2.18 [1.16–4.11], P = 0.016, left OR = 2.25 [1.17–4.31], P = 0.01). Silicone material was present in the capsules of 12 patients (4.8%). Fourteen patients had positive cultures. There was one pneumothorax (0.4%), three hematomas requiring evacuation (1%), and two DVTs (0.8%). Of 228 patients, 206 (90.4%) reported high satisfaction with the outcome of the procedure.

Conclusions: In a large cohort of BII patients, we found that capsular inflammation is significantly associated with silicone and textured implants. Implant removal with capsulectomy can be safely performed in patients with BII with a low complication rate and high patient satisfaction.


Breast implant illness (BII) is a novel description for a constellation of symptoms potentially driven by a poorly characterized immune or biochemical response to breast implants.[1,2] The name for this disease process has been coined by women who believe they have become ill from their implants rather than by a medical professional society. Awareness of BII is increasingly fueled by the power of social media, with one recent study reporting an online group that reached nearly 110,000 members.[3,4] BII symptoms are frequently nonspecific, vary in severity, and can affect nearly all organ systems, characteristics which have been noted to overlap with many somatization disorders.[5–7] Despite growing concern among the general public regarding BII, breast augmentation is on the rise, with nearly 330,000 procedures performed in 2018 (a 15% increase from 2014), and national data show ongoing trends favoring implant-based breast reconstruction.[8,9] The leading professional societies in plastic surgery have hosted several panels to discuss BII, and continue to offer forums to facilitate dialog among patients, patient advocates, and surgeons.[10–12]

There is a paucity of knowledge about the possible pathophysiology of BII, and many prior studies of implants and systemic disease have occurred in nonsurgical fields with controversial conclusions.[2,6,13–18] Treatment recommendations for this patient group can vary widely, with nearly all surgeons advocating frank and even-handed discussion with patients in light of strong evidence supporting the safety of implants,[14,19] but disagreeing whether surgical treatment including explantation and capsulectomy should be offered for symptoms of uncertain etiology.[2,4,20] We sought to better characterize the presenting symptomatology, postoperative outcomes, patient satisfaction, and capsular findings of a population of patients who self-identified as having BII and proceeded to undergo removal of their implants combined with excision of the associated implant capsule.