Assessing Long-term Outcomes in Breast Implant Illness

The Missing Link? A Systematic Review

Rod J. Rohrich, M.D.; Justin L. Bellamy, M.D.; Brendan Alleyne, M.D.


Plast Reconstr Surg. 2022;149(4):638e-645e. 

In This Article


Despite decades of breast implant use worldwide, breast implant illness remains an elusive and poorly understood condition that plagues patients and practitioners alike. Current deficiencies in our understanding of breast implant illness long-term outcomes are our Achilles heel, as they leave a multitude of unanswered questions, including how do we identify the subset of patients who benefit from explantation, and how should the capsule be managed? The discussion surrounding capsule management is particularly contentious and has significant implications on surgical management strategies; some surgeons advocate for the importance of en bloc capsulectomy in breast implant illness, despite it being unstudied and with significant potential for morbidity. The issues of which patients improve with surgical intervention and to what extent aggressive capsulectomy is required remain in question. Unfortunately, to date, the existing data concerning breast implant illness suffer from significant design flaws and a paucity of outcome data that threaten both internal and external study validity.

Over the last 30 years, breast implant illness has shown us it is here to stay. In today's atmosphere, the absolute safety of silicone implants continues to be scrutinized, and being able to deliver informed care remains essential. At present, we are limited in our ability to establish sound and evidence-based management strategies for breast implant illness. For this reason, a plea is made to all our societies, foundations, and high-volume centers to develop and fund standardized prospective studies that use a large cohort of patients from multiple institutions with specific breast implant illness inclusion criteria, an appropriate control population, sufficient follow-up (>12 months), utilizing standardized patient-reported outcomes measures, and with careful documentation of capsule management, such that future investigations may accurately elucidate best management strategies. Only then can we establish an evidence-based and sound treatment approach for this perplexing condition.