Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney
Breast Implant Illness is one of the most contested topics in modern breast surgery. On one side, women report a constellation of symptoms they attribute to their implants, often improving after explant. On the other side, the medical literature has been slow to accept BII as a discrete diagnosis because the symptom list is broad, the proposed mechanism is uncertain, and rigorous controlled studies are difficult to design. Both sides hold honest positions, and the truth sits in the middle. The symptoms are real. The mechanism is still being worked out. The explant data is genuinely promising. And the conversation has moved well beyond the dismissive “it’s all in your head” framing of a decade ago.
This guide covers what’s currently understood about BII in 2026: the recognised symptom patterns, what we know about who’s affected, the role of explant surgery, and how the conversation should look between a patient and a Specialist Plastic Surgeon if BII is on the table. I’m Dr Scott J Turner, a Specialist Plastic Surgeon (FRACS) consulting at our Bondi Junction and Manly clinics. If you’ve had breast augmentation and you’re worried about BII, the most important thing you can do is have the conversation with a surgeon who takes it seriously.
What is Breast Implant Illness?
Breast Implant Illness refers to a constellation of systemic symptoms that some women experience after breast implant surgery, which they attribute to the implants themselves. The symptoms vary substantially between patients, but commonly reported features include fatigue, brain fog, joint and muscle pain, hair changes, skin rashes, gastrointestinal issues, and what patients often describe as a general sense of being unwell.
The current state of the evidence: BII is not yet recognised as a discrete medical diagnosis with a specific cause and a specific test. It’s recognised in the broader medical community as a phenomenon that deserves serious attention, and bodies including the FDA in the United States and the Therapeutic Goods Administration (TGA) in Australia now reference BII directly in their patient information about breast implants.
This is a meaningful shift from where the conversation was even five years ago. The recognition that something real is happening to a subset of patients, even if we don’t yet have a unified explanation, is the foundation for taking BII seriously in clinical practice.
Recognised Symptom Patterns
The symptoms most commonly reported in BII research and patient surveys cluster into a few broad categories. Patients rarely have all of these symptoms. Most have a personal cluster of perhaps 5-10 that affect them most.
Constitutional symptoms are the most commonly reported. These include persistent fatigue (often described as different from ordinary tiredness), brain fog and cognitive dysfunction, sleep disturbance, and a generalised sense of being unwell.
Musculoskeletal symptoms include joint pain (arthralgia), muscle pain (myalgia), and morning stiffness. These can resemble early inflammatory arthritis, which is one reason BII patients sometimes initially receive other diagnoses.
Skin and hair changes include unexplained rashes, hair thinning or loss, and dry skin or skin sensitivity changes.
Neurological and psychological symptoms include headaches (sometimes described as new-onset migraines), anxiety and depression that feels disproportionate to life circumstances, mood changes, and concentration difficulties.
Other reported symptoms include gastrointestinal issues, dry eyes and visual changes, new food sensitivities, hormonal disturbances, and recurrent infections.
The non-specific nature of this symptom list is part of why BII has been clinically difficult to characterise. Each individual symptom has many possible causes. What makes BII distinctive is the cluster pattern, the temporal relationship to implant surgery (sometimes immediate, often delayed by years), and the reported improvement after explant.
What We Know About Causes
The honest answer is that we don’t fully know. Several hypotheses have been proposed, and the picture is likely multifactorial rather than a single mechanism.
Immune response to the implant. Some patients may have an inflammatory or immune response to the implant materials or to the capsule that forms around the implant. This is consistent with the autoimmune/inflammatory syndrome induced by adjuvants (ASIA) framework that some researchers have proposed. The ASIA hypothesis remains contested in the literature.
Biofilm and bacterial considerations. Low-grade bacterial colonisation of the implant surface (biofilm) has been investigated as a potential contributor in some patients, though the evidence here is still developing.
Implant surface and material factors. Concerns about specific implant types and surface textures led to the regulatory action against macrotextured implants linked to BIA-ALCL. Whether texture or surface plays a separate role in BII is less well established but has been proposed.
Individual susceptibility. Some patients may have genetic, immunological, or other individual factors that make them more susceptible to symptoms after implant surgery. This would help explain why most patients have no systemic symptoms after augmentation, while a smaller subset develop the BII symptom pattern.
What’s important to be clear about: many of the historical claims about BII causes haven’t held up to scrutiny. Speculation about specific external factors should be weighed cautiously and shouldn’t drive clinical decisions on its own.
The Role of Explant Surgery
Explant surgery (removing the breast implants) is the intervention that has shown the most consistent improvement in BII symptoms across the available studies. Reported rates of symptom improvement after explant range widely between studies but consistently show meaningful improvement in a substantial proportion of patients.
Two technical approaches are commonly discussed:
Implant removal with partial capsulectomy removes the implant and a portion of the surrounding capsule, leaving capsule tissue that’s adherent to underlying structures or that doesn’t show signs of pathology.
En-bloc capsulectomy removes the implant and the entire surrounding capsule as a single intact specimen. This approach is the standard of care when there’s confirmed silicone implant rupture, where keeping the capsule intact prevents silicone material from leaking into surrounding tissue.
For BII specifically, the picture is more nuanced. Earlier suggestions that en-bloc capsulectomy produced superior symptom improvement compared to less extensive capsule removal haven’t been clearly supported in subsequent studies. Both approaches have shown symptom improvement in BII patients. The choice between them depends on individual factors including capsule thickness, evidence of capsular pathology, implant integrity, and patient preference. This is a conversation to have with your surgeon, not a decision to make based on what’s recommended in patient forums.
For more on the recovery process after explant, see recovery after breast implant removal procedure.
When BII Symptoms Aren’t BII
A meaningful proportion of patients who present with concerns about BII actually have a different explanation for their symptoms, including identifiable breast implant complications and unrelated medical conditions.
Capsular contracture is the formation of thickened, sometimes painful scar tissue around the implant. It can cause breast pain, distortion, and discomfort that may be misattributed to systemic illness. Capsular contracture has well-defined treatment pathways.
Implant rupture (particularly silent rupture of silicone implants) can cause local symptoms and may produce systemic responses in some patients. Silent rupture is detectable on MRI and is one reason ongoing imaging surveillance is recommended for women with silicone gel implants.
BIA-ALCL is a rare cancer linked specifically to certain textured implants, particularly macrotextured devices that are no longer available in Australia. BIA-ALCL typically presents with delayed seroma formation around the implant, not the systemic symptom pattern of BII.
Unrelated medical conditions with overlapping symptom profiles include autoimmune diseases (such as rheumatoid arthritis or lupus), thyroid dysfunction, fibromyalgia, chronic fatigue syndrome, perimenopause and menopause symptoms, and depression with somatic features. A thorough medical workup before attributing symptoms to BII is important. Some patients with persistent unexplained symptoms benefit from assessment by a rheumatologist, endocrinologist, or other specialist before considering explant surgery.
What to Do If You’re Concerned About BII
If you have implants and you’re experiencing symptoms you’re worried about, the practical next steps look like this:
Start with your GP. A general medical workup including blood tests for inflammatory markers, thyroid function, hormonal status, vitamin levels, and screening for autoimmune conditions can identify alternative explanations and provides a baseline for ongoing monitoring.
Get appropriate breast imaging. MRI is the most reliable test for detecting silent rupture in silicone gel implants. Ultrasound can identify capsular issues and seromas. Mammogram screening should continue at the recommended interval.
Then book a consultation with a Specialist Plastic Surgeon (FRACS) experienced in implant assessment and potential explant. The consultation should include a discussion of your symptom timeline, a physical examination, a review of your imaging, and a frank conversation about treatment options including explant if that’s what you decide is right.
What a good consultation will not include: pressure to decide quickly, dismissal of your symptoms, or a specific procedure (such as en-bloc capsulectomy) being recommended before a full assessment. If a consultation feels like either of those things, seek a second opinion.
The Australian Breast Device Registry
Australia maintains the Australian Breast Device Registry (ABDR), which tracks breast implant surgeries, complications, and outcomes nationally. If you’ve had implant surgery in Australia in recent years, your data may be in the registry. The ABDR is one of the mechanisms by which patterns of implant-related issues including BIA-ALCL and emerging concerns about BII can be identified and tracked over time.
If you’re considering explant surgery and want your case to contribute to the evolving evidence base, ask your surgeon whether your procedure will be entered into the ABDR.
Frequently Asked Questions
Is BII a recognised medical condition in Australia? BII is not currently a discrete diagnosis with specific diagnostic criteria, but the phenomenon is recognised in patient information from the TGA and in clinical practice. The conversation has moved on significantly from earlier dismissive framing, and Specialist Plastic Surgeons now routinely discuss BII with patients considering breast augmentation and patients reporting symptoms after surgery.
Should I get my implants removed if I have any of these symptoms? Not necessarily. The first step is a thorough medical workup to identify or rule out alternative explanations for your symptoms. Many patients with symptoms initially attributed to BII have a different underlying cause that responds to other treatment. If alternative causes are ruled out and symptoms continue to affect quality of life, explant is a reasonable consideration discussed with a Specialist Plastic Surgeon experienced in this area.
Does it matter what kind of implants I have? Macrotextured implants linked to BIA-ALCL are no longer available in Australia. For BII specifically, the role of implant type is less clear. Smooth and microtextured silicone gel implants remain in widespread use and are not currently identified as carrying significantly different BII risk than other implant types. Your surgeon can confirm what type of implants you have based on your surgical records.
Will my symptoms definitely improve after explant? The available evidence suggests a substantial proportion of patients experience meaningful symptom improvement after explant, but improvement is not universal and varies between patients. The honest answer at consultation is that we can’t predict with certainty how an individual patient will respond. Some patients see significant improvement within weeks. Others see partial improvement over months. A smaller proportion don’t see meaningful change. This uncertainty is part of an honest informed-consent conversation.
Do I need an en-bloc capsulectomy or is partial capsulectomy enough? The clinical evidence doesn’t clearly support en-bloc as superior to less extensive capsulectomy for BII symptom improvement. The technique used should be tailored to your specific situation: capsule thickness, implant integrity, and other clinical factors. Patient communities sometimes advocate strongly for en-bloc, but the choice should be a clinical decision discussed with your surgeon based on what your individual case requires.
How much does explant surgery cost in Australia? Costs vary depending on whether your case has a Medicare item number that applies (which would be relevant for confirmed implant-related complications such as significant capsular contracture or rupture), the specific procedure required, the hospital, and the surgeon. For purely elective explant for BII concerns where no other indication applies, Medicare typically doesn’t contribute. Specific costs are discussed at consultation.
Book a Consultation
If you’re considering explant surgery for BII concerns, or you want to discuss your symptoms with a Specialist Plastic Surgeon (FRACS) who takes the topic seriously, you can book a consultation at our Bondi Junction or Manly clinics. Dr Turner also consults with patients at Brisbane, Canberra, and Newcastle.
A note on what a BII consultation involves. Since July 2023, AHPRA guidelines require a GP referral for cosmetic consultations. For explant surgery being considered for medical reasons (including BII concerns), the GP referral is also valuable because it includes your medical history and any workup that’s been done so far. The consultation process for explant follows the same two-consultation framework as other procedures, with a psychological evaluation and cooling-off period before surgery is scheduled. These steps support a careful decision rather than slowing you down unnecessarily.
Contact our clinic or call 1300 437 758 to book.
