Breast implant illness (BII) and BIA-ALCL

What is breast implant illness?

Breast implant illness (BII) is a term used by patients and doctors to describe a range of symptoms that some women experience and relate to their breast implants. It is not yet a formal medical diagnosis, and there is no specific test for it. Health authorities acknowledge that some women report these symptoms and that many feel better after implant removal, while research continues into the cause.

Reported symptoms

Symptoms reported vary widely and include:

• fatigue and poor sleep;
• joint and muscle pain;
• "brain fog", difficulty concentrating and memory problems;
• anxiety and low mood;
• hair loss, dry skin and rashes;
• headaches;
• digestive problems;
• a feeling of being unwell or having flu-like symptoms.

These symptoms are non-specific and can have many other causes, such as thyroid disease, autoimmune conditions, anaemia, menopause or depression. It is important to see your doctor to look for other treatable causes before assuming the implants are responsible.

What does the evidence say?

Research has not established a clear causal link between implants and BII, and studies have produced mixed results. Nevertheless, many women who have their implants removed report an improvement in symptoms, although not all do, and the reasons for improvement are still being studied. Regulators in the UK, the US and Europe recommend that women with implants are informed about BII before surgery and that their symptoms are taken seriously.

A practical approach: see your doctor to rule out other causes, keep a record of your symptoms, and discuss implant removal with an experienced plastic surgeon if your symptoms persist and you wish to consider it.

BIA-ALCL: a rare lymphoma

BIA-ALCL (breast implant-associated anaplastic large cell lymphoma) is a rare type of lymphoma – a cancer of the immune system, not of the breast tissue. It develops in the fluid or capsule around the implant and has been associated mainly with textured-surface implants. It is very rare, and the risk depends on the type of texture.

The typical sign is late swelling of one breast caused by fluid around the implant, usually years after surgery. Less often, there is a lump in the breast or armpit. Diagnosis is made by ultrasound and testing a sample of the fluid. When found early and confined to the capsule, BIA-ALCL is usually treated by removing the implant and the entire capsule (en bloc capsulectomy); some cases need additional treatment.

Regulators do not recommend removing textured implants in women without symptoms. If you have textured implants, be aware of the symptoms and see a doctor promptly if one breast becomes swollen.

Very rare cases of other cancers (such as squamous cell carcinoma) in the capsule have also been reported; they are also investigated if there is late swelling or a mass.

Implant removal (explant) options

• Implant removal with total capsulectomy: the implant and the whole capsule are removed, often in separate pieces.
• En bloc capsulectomy: the implant and capsule are removed together, in one piece. It is the standard approach for BIA-ALCL and in cases of rupture, and is requested by some women with BII; it is not always technically possible or necessary, for example when the capsule is very thin or adheres to the ribs.
• Removal with a breast lift: after removal, the breast may look empty or sag. A breast lift reshapes it, either at the same time or a few months later.
• Removal with fat transfer: fat transfer can partly restore volume naturally.
• Exchange: some women choose new implants of a different type; see implant replacement.

The removed capsule can be sent for laboratory analysis, and the implant can be inspected for rupture.

What to expect after explant

Recovery usually involves one night in hospital, drains in some cases, a supportive bra for several weeks and a return to desk work after one to two weeks. The breasts will look smaller and may sag; skin can retract over several months. Symptoms that improve may do so gradually. If you have had implants for many years and the skin is thin, a staged approach – removal first, then a lift later – sometimes gives the best result. Our page on breast lift without implants describes how shape can be restored.

How New City Clinic can help

If you are considering implant removal, send photos, your implant information and any imaging reports via WhatsApp for a free online assessment. Our surgeons will explain removal, en bloc capsulectomy, lift and fat transfer options and give a written plan. Learn more on newcityclinic.com about implant revision and removal and implant safety and aftercare, or read the guide to implant replacement and removal in Turkey. Suspected BIA-ALCL is managed together with the oncology team.