Breast Implant Illness: What Is Known, and When Explant Surgery Helps

Breast implant illness (BII) is the term patients use for a cluster of whole-body symptoms — fatigue, brain fog, joint and muscle pain, rashes, hair thinning, anxiety — that they believe are caused by their breast implants. It is not currently an official medical diagnosis, there is no test that confirms it, and no honest surgeon can promise that removing the implants will cure it. What can be said clearly is that the symptoms are real to the women describing them, that wanting your implants out is a sufficient reason to have them removed, and that a proper medical work-up belongs alongside the surgical plan rather than instead of it.

Dr. Paulo Michels is a Brazilian board-certified plastic surgeon with more than 18 years in breast surgery, a member of ISAPS, ASPS and the Brazilian Society of Plastic Surgery, and the recipient of the Gold Medal for Best Body Contouring at the World Plastic Surgery Olympiads 2025. He performs breast implant removal (explant surgery) at Elyzee Hospital in Abu Dhabi for patients from Dubai and across the UAE. This article sets out what is known about BII, what is not, and where surgery genuinely fits.

What do patients mean by breast implant illness?

BII is a term generated by patients, not a chapter in a textbook. The women who use it usually describe some combination drawn from a long and deliberately non-specific list:

• persistent fatigue that sleep does not repair
• difficulty concentrating and short-term memory lapses — the symptom almost everyone calls brain fog
• aching joints and muscles
• rashes, dry skin or new sensitivities
• hair thinning
• anxiety, low mood or disturbed sleep
• dry eyes and dry mouth
• a general sense of being unwell without an obvious source

Two features come up again and again in consultation. The first is that the symptoms are diffuse: they belong to no single organ, which is exactly why they are difficult to investigate. The second is that the woman has already connected them to a timeline — they began, or clearly worsened, after her implants were placed. That timeline is what brings her to a plastic surgeon rather than to a physician.

Why is BII not an official medical diagnosis?

Because a diagnosis needs a definition, and a definition needs something measurable. At present there is no blood marker, imaging finding or pathology result that identifies BII, and the symptom list overlaps almost entirely with several common and treatable conditions: thyroid disease, iron or vitamin D deficiency, anaemia, autoimmune conditions, perimenopause, sleep disorders and depression. Research into whether implants provoke a systemic response in susceptible women continues, and it has not yet produced a test.

Not an official diagnosis is not the same as not real. What it means in practice is narrower and more useful: a surgeon cannot confirm BII, cannot exclude it, and cannot use it to predict how you will feel after surgery. It also means that if something else is causing your symptoms, taking the implants out will not treat that other thing — and the only way to find out is to look.

What should the work-up include before explant surgery?

Two assessments run in parallel, and neither replaces the other.

The surgical assessment. Your reason for removal and what you want the breasts to look like afterwards; examination of breast tissue, skin quality and nipple position relative to the fold; your implant records where available — manufacturer, model, serial number, surface and date of placement; and imaging. Ultrasound is routine, with MRI added when rupture is suspected or the implants are old. Imaging is not a formality: it shows whether an implant has ruptured, whether there is fluid around it, and how thick or calcified the capsule is, and those findings decide whether the capsule comes out and how.

The medical assessment. In parallel, a physician should look for the treatable causes that produce the same symptom list — thyroid function, full blood count, iron and vitamin D status, inflammatory markers, an autoimmune screen where the history suggests one, and an honest review of sleep, mood and stress. This is not scepticism dressed up as caution. It exists so that surgery is not asked to solve a problem it cannot solve, and so that a condition with a real treatment is not missed while attention is on the implants.

Can explant surgery make the symptoms go away?

Many women report improvement after explantation. That is consistently described, it is taken seriously, and it is one reason removal is reasonable to offer to a patient who wants it. But improvement is not guaranteed, it is not uniform, and nothing measured beforehand predicts it. Some patients feel better within weeks. Some improve gradually over months. Some notice no change at all, which is usually the point at which another cause is found and treated in its own right.

Two practical cautions belong in the same conversation. The first is that surgery has its own recovery: fatigue in the early weeks is expected and is not a verdict on whether the operation helped, so judge nothing before three months. The second is aesthetic. Removing implants changes the shape of the breast, and whether you need a lift or fat transfer at the same time is decided by your tissue, not by your reason for removal. The explant regret described online is very often a needed lift that was declined — a separate decision that deserves the same honesty as the medical one.

Should the capsule be removed in a BII case?

The capsule decision is made on the condition of the capsule, not on the label attached to the symptoms. A thin, soft, healthy capsule does not have to be removed; left alone it shrinks and is reabsorbed. A thick, contracted or calcified capsule is removed, because it would otherwise remain as a firm shell that can trap fluid. A ruptured implant is best taken out with the capsule intact around it so that free silicone is contained. A suspected implant-associated condition requires complete removal of implant and capsule together.

Many patients who suspect BII specifically request a total or en bloc capsulectomy, and the request is discussed openly rather than dismissed. What is explained in return is that en bloc is not automatically the safer choice. When a capsule is paper-thin and stuck to the chest wall, an en bloc dissection can only be achieved by taking healthy tissue with it, with more bleeding and more risk to the muscle, ribs and lining of the chest. In that anatomy a meticulous total capsulectomy reaches the same end point more safely. Whenever a capsule is removed for a clinical reason it is sent for pathology, and the result is reviewed with you at follow-up. The full range of options is set out on the explant surgery page.

How is breast implant illness different from BIA-ALCL?

These are two entirely different conversations that are often confused, so it is worth separating them cleanly.

	Breast implant illness (BII)	BIA-ALCL
What it is	A patient-reported cluster of systemic symptoms	A rare cancer of the immune system arising in the capsule
Diagnosis	No test; not an official diagnosis	Confirmed by analysing the fluid around the implant
Typical picture	Fatigue, brain fog, joint pain, rashes	Late one-sided swelling of one breast, sometimes a lump or firmness
Implant surface	Reported with implants of all types	Associated mainly with certain textured surfaces
Investigation	Medical work-up plus implant imaging	Ultrasound and analysis of the fluid
Treatment	Explant is reasonable if you want it, but is not a promised cure	Removal of the implant with a complete en bloc capsulectomy

BIA-ALCL is rare, and it is not a reason for a woman without symptoms to remove her implants. It is, however, the reason a new swelling of one breast is examined rather than watched. When it is caught early, removal with a complete en bloc capsulectomy is curative in the large majority of cases.

When should I see a doctor rather than wait?

Some findings are observable and should be assessed promptly rather than monitored at home:

• a new or increasing swelling of one breast, particularly years after surgery
• a new lump, firmness or change in the shape of one breast
• skin changes, redness or an ulcer over one breast
• fever alongside pain or swelling in a breast

None of these automatically means something serious. Each of them earns an examination and an ultrasound. If you are already recovering from surgery, spreading redness, wound edges that open, fever, or a breast that becomes suddenly larger or firmer than the other deserve a same-day call, and calf pain or breathlessness is an emergency.

How does Dr. Michels approach the conversation?

Directly, and without either extreme. Patients arriving with BII symptoms are frequently met elsewhere with dismissal on one side or a promised cure on the other, and neither is honest. The position here is simple: your symptoms are taken seriously, your wish to remove your implants is respected as sufficient in itself, the medical work-up runs in parallel so nothing treatable is missed, and the surgical plan — capsule or no capsule, lift or no lift, fat transfer or not — is decided on what the examination and imaging actually show. If you also want to understand the alternative of exchanging rather than removing implants, that is covered in the guide to breast implant revision and replacement.

How are consultations arranged for patients from Dubai?

All consultations and surgery take place at Elyzee Hospital in Abu Dhabi, with JCI-accredited theatres, general anaesthesia given by board-certified anaesthesiologists and ultrasound-guided nerve blocks in every case. Patients travelling from Dubai — roughly an hour by road — and from elsewhere in the UAE have their consultation, imaging, pre-operative tests and follow-up reviews grouped wherever possible, so the plan is built around a small number of journeys rather than many. To discuss your own situation, arrange a consultation and bring your implant records and any previous imaging with you.