Key points
- Breast implant illness (BII) refers to a variety of systemic symptoms experienced by people with implants, and because no diagnostic procedures or recommendations have been established, it is a highly controversial topic [1].
- A 2025 meta-analysis analyzed 33 studies covering 6,048 women, and the most common symptoms were fatigue (58.3%), joint pain (51%), and muscle pain (44%) [3].
- In the same analysis, 81.9% reported that their symptoms improved after implant removal, but the cause and mechanism are still unclear [3].
- Some argue that silicone is the cause, while others consider this unlikely because silicone is biologically inert, and the role of bacterial biofilm has also been raised [4, 5].
- There is no consensus on whether the entire capsule should be removed when implants are taken out, and it has been pointed out that removing it may increase adverse reactions and compromise the final shape [6].
What is breast implant illness?
A possible link between implants and systemic disease has been reported since the 1960s [2]. There have been studies both supporting and refuting it, but the question has not been resolved, and it is now referred to as breast implant illness [2]. A 2019 review explained that with growing patient advocacy and communication through social media, more people have been visiting plastic surgeons about this issue [2].
A 2021 review summarized that because no diagnostic procedures or recommendations have been established, breast implant illness is one of the most controversial topics in reconstructive breast surgery [1]. It also stated that amid concerns about implant-associated lymphoma and breast implant illness, several countries, including Korea, have introduced national registries to oversee the safety and quality of implant surgery [1].
A 2025 meta-analysis likewise described breast implant illness as a controversial condition characterized by a wide range of systemic symptoms reported by people with implants, and stated that immune responses, microbial colonization, and psychological factors have been proposed as hypotheses [3].
What symptoms are reported?
A 2025 systematic review and meta-analysis included 33 of 4,612 publications and analyzed 6,048 women with an average age of 46.0 years [3]. Symptoms were recorded as appearing 6.4 years after implant placement, and implant removal as taking place 12.3 years after placement [3].
The most common symptoms were fatigue (58.3%), joint pain (51%), and muscle pain (44%) [3]. A 2022 review also named difficulty concentrating, hair loss, weight changes, depression, dry eyes and mouth, and rashes among the reported symptoms [4].
In the same meta-analysis, the prevalence of psychiatric conditions, autoimmune diseases, and fibromyalgia was 16.5%, 20.7%, and 12%, respectively, and a positive antinuclear antibody test (a blood marker often checked for autoimmune disease) was estimated at 24% [3]. Implant rupture was found in 21.4% and capsular contracture in 44.4% [3].
What views are there on the cause?
Views on the cause differ from one publication to another. One 2022 review applied criteria for judging causation and concluded that there is a causal relationship between silicone implants and breast implant illness, considering that implants cause a characteristic systemic reaction in some women [5].
On the other hand, another 2022 review considered that silicone is a biologically inert material and is therefore unlikely to be the cause of these symptoms [4]. As grounds, it cited reports of an increased risk of autoimmune disease with other implanted devices, such as orthopedic implants, and suggested that bacterial biofilm and the body's response to it may be involved [4].
The same review summarized that epidemiological studies over the past 10 years had provided evidence supporting an association between implants and autoimmune diseases such as Sjögren's syndrome, rheumatoid arthritis, systemic sclerosis, chronic fatigue syndrome, and Raynaud's syndrome [4]. The 2025 meta-analysis regarded breast implant illness as a multifactorial condition involving immune dysregulation, chronic inflammation, and microbial biofilm, and positive microbial tests were found in 35.2% and capsular inflammation in 58.4% [3].
As this shows, interpretations of the cause are still divided, and ongoing research needs to be followed.
Do symptoms improve if the implants are removed?
In the 2025 meta-analysis, 81.9% reported that their symptoms improved after implant removal [3]. A 2022 review also summarized that implant removal relieved symptoms in 50% or more of patients [4]. However, not everyone improves, and it is necessary to evaluate whether the symptoms are caused by the implants or by another condition.
The 2022 review stressed the need to better understand the actual disease process (pathophysiology) and to develop treatments other than implant removal [4]. The 2025 meta-analysis considered it important to carry out individualized assessment, screening for autoimmune disease and mental health conditions, informed consent based on thorough explanation, and adherence to surgical principles that reduce complications, such as antimicrobial irrigation [3].
What to consider in implant removal surgery
A 2021 publication explained that it can be difficult to create a pleasing breast shape after implant removal, especially when the entire capsule is removed [6]. It pointed out that opinion has not fully converged on whether removing the capsule is necessary for various breast problems, and that removal can increase adverse reactions and the burden of recovery and compromise the final shape [6].
This publication presented a step-by-step decision framework for how to handle the capsule and the breast [6]. Other procedures are sometimes considered at the same time to shape the breast after removal, so it is a good idea to discuss in advance whether to have the implants removed only or to combine removal with other procedures.
What to check during your consultation
If you suspect breast implant illness, the starting point is to keep a record of your symptoms and have other possible causes evaluated as well. It is a good idea to check the following during your examination.
- The types of symptoms you have now and when they started
- Whether tests for autoimmune disease or other causes are needed
- The type of implant, when you had surgery, and whether there is rupture or capsular contracture
- How the capsule will be handled during removal and the expected change in shape
- The chance that symptoms may remain even after removal
Frequently asked questions
- Is breast implant illness an officially recognized disease?
- No diagnostic procedures or recommendations have been established yet, and it remains a highly controversial topic [1]. A 2025 meta-analysis regarded it as a real condition involving multiple factors, but there is also a view that silicone is unlikely to be the cause [3, 4]. It is most accurate to understand it as a subject of ongoing research.
- Will my symptoms go away if I have my implants removed?
- In a 2025 meta-analysis, 81.9% reported that their symptoms improved after implant removal [3]. However, not everyone improves, so other causes need to be evaluated as well. It is also a good idea to discuss the removal method and the shape of your breasts afterward in advance [6].
- What symptoms might suggest it?
- Among the reported symptoms, fatigue, joint pain, and muscle pain were the most common [3]. Difficulty concentrating, hair loss, dryness, and rashes have also been reported [4]. However, these symptoms can also occur with other conditions, so the cause needs to be investigated broadly through an examination.
References
- Pelc Z, Skórzewska M, Kurylcio A, et al. Current Challenges in Breast Implantation. Medicina (Kaunas). 2021.PubMed 34833432DOI
- Magnusson MR, Cooter RD, Rakhorst H, et al. Breast Implant Illness: A Way Forward. Plast Reconstr Surg. 2019.PubMed 30817559DOI
- Ferreira S, Barros AS, Marques M. Breast Implant Illness: Symptoms, Outcomes with Explantation and Potential Etiologies-A Systematic Review and Meta-analysis. Aesthetic Plast Surg. 2025.PubMed 40788544DOI
- Suh LJ, Khan I, Kelley-Patteson C, et al. Breast Implant-Associated Immunological Disorders. J Immunol Res. 2022.PubMed 35571560DOI
- Cohen Tervaert JW, Mohazab N, Redmond D, et al. Breast implant illness: scientific evidence of its existence. Expert Rev Clin Immunol. 2022.PubMed 34882509DOI
- Calobrace MB, Mays C. An Algorithm for the Management of Explantation Surgery. Clin Plast Surg. 2021.PubMed 33220896DOI
This article is an English translation of general health information that DOY JUN Plastic Surgery compiled in Korean from the summaries (abstracts) of papers in international academic journals. Treatment methods and results vary depending on each person's condition, so please consult a specialist for an accurate diagnosis and treatment plan.
