Short answer
Breast implant illness (BII) is a term people use for a range of symptoms, such as tiredness, joint pain and “brain fog”, that they link to their breast implants. It is not a single defined disease, there is no test for it, and regulators say it is still not known whether implants cause these symptoms. Many people who have their implants removed report feeling better, but the studies behind this lack proper comparison groups, so how much improvement is due to removal itself remains uncertain.
Key points
- The most commonly reported symptoms are fatigue, joint and muscle pain, anxiety and problems with memory or concentration.
- Reports involve silicone and saline implants, smooth and textured.
- The UK and US regulators say a causal link has not been shown.
- Most studies report symptom improvement after implant removal, but without control groups.
- Current evidence does not show that removing the whole capsule in one piece is needed for symptoms to improve.
What people describe
The Medicines and Healthcare products Regulatory Agency (MHRA, the UK device regulator) describes BII as a term people use for health problems they associate with their implants. Reports include “brain fog”, fatigue, anxiety and joint pain, and some people report autoimmune conditions (where the immune system attacks the body’s own tissues). The reports cover silicone and saline implants with both smooth and textured surfaces.1
The US Food and Drug Administration (FDA) received 10,318 reports of systemic (whole-body) symptoms in people with breast implants between January 2008 and June 2024. The most frequent were fatigue (41.1%), joint problems (30.9%), anxiety (22.9%), autoimmune disease (22.6%) and “fog” (22.5%).2 These are voluntary reports, and the FDA notes that the incidence, prevalence or cause of an event cannot be determined from this reporting system alone.2
Is it a recognised condition?
Not as a single diagnosis. The MHRA says there is no single disease that could explain the symptoms, that it does not currently know whether there is a link between implants and the reported problems, and that there is no definitive evidence or known biological process showing that implants cause them.1 The FDA describes the symptoms as poorly understood and under investigation.3
That is different from saying the symptoms are not real. People’s symptoms are genuine; the open question is whether the implants cause them. A joint safety advisory from international aesthetic surgery societies calls the condition a diagnosis of exclusion, meaning other medical causes should be looked for and ruled out first.6
What the research shows
A 2025 systematic review and meta-analysis (a study pooling the results of earlier studies) included 33 studies and 6,048 women. Fatigue (58.3%), joint pain (51%) and muscle pain (44%) were the commonest symptoms, which began on average 6.4 years after implantation.4 The authors concluded that BII is a real, multifactorial condition and suggested possible roles for inflammation and bacterial biofilms (thin layers of bacteria on the implant surface).4
That conclusion needs care. Only 7 of the 33 studies were prospective (following patients forward in time), results varied hugely between studies, and the review notes that no definitive causal link between implants and systemic disease has been established.4 Overall, the evidence on whether implants cause these symptoms is Insufficient.
Does removing the implants help?
Many people report improvement, but the strength of that finding is limited. In the 2025 review, 81.9% of patients reported symptom improvement after removal (explantation).4 In FDA reports that recorded what happened after removal, 687 of 785 described improvement and 98 described no change or worsening.2 The MHRA also notes that some people report feeling better after removal.1
The difficulty is the lack of controlled studies: without a comparison group, improvement can reflect expectation, natural change over time or treatment of other conditions as well as the removal itself.4 The evidence that removal helps is best described as Limited.
Does the capsule need to come out too?
The capsule is the scar tissue the body forms around an implant. Removal can leave it, take part of it (partial capsulectomy), take all of it (total capsulectomy), or take implant and capsule out together in one piece (often called “en bloc”).
| Approach | What the evidence says |
|---|---|
| Implant removal with partial capsulectomy | Similar symptom improvement to total approaches in a prospective study5 |
| Total or total intact (“en bloc”) capsulectomy | No statistically significant extra benefit for symptoms; larger operation that may carry higher risks and need a longer incision56 |
| When full capsule removal is clearly indicated | Cancer in the capsule; also considered for capsular contracture or ruptured silicone implants6 |
A prospective study of 150 women found similar symptom improvement after intact total, total or partial capsulectomy, with no statistical difference, and an average 68% reduction in symptoms at six months among women with self-reported BII.5 The authors concluded their data did not support a requirement for “en bloc” removal, though they described the comparisons as exploratory.5 The societies’ advisory adds that there is no good evidence capsulectomy is needed for symptom improvement without another reason for it, and that “en bloc” should be a term reserved for cancer.6
If you have symptoms
The MHRA advises anyone with lumps, swelling, change in breast shape or health problems they think are linked to their implants to see their GP or implant surgeon first.1 Because fatigue and joint pain have many possible causes, other medical causes should be looked for before attributing them to the implants.6 The 2025 review recommended screening for autoimmune and mental health conditions as part of individual assessment.4
In the UK, problems with implants can be reported through the MHRA Yellow Card scheme, ideally with the manufacturer, model, batch number, surface texture and date of insertion.1 If removal is considered, the choice between keeping, partly removing or fully removing the capsule, and its risks, is part of informed consent.6
When to seek medical advice
See your GP or implant surgeon if you notice a lump, swelling or change in the shape of a breast with an implant, or health problems you think may be linked to your implants.1 New swelling more than a year after surgery should be checked, as it can rarely be a sign of BIA-ALCL, a lymphoma linked to implants.37
Common questions
Is there a blood test for breast implant illness?
No, there is no test that confirms it, because it is not a single defined disease.1 Tests are used to look for other conditions that could explain the symptoms.6
Are silicone implants worse than saline ones for this?
Not clearly: symptom reports involve both silicone and saline implants, smooth and textured.1
How soon after removal do people feel better?
In the prospective study, improvement was already measurable at three to six weeks and was assessed again at six months.5 Not everyone improves, and some report no change.2
Should I tell my surgeon about symptoms before having implants?
Yes. Reviewers of the evidence recommend individual assessment, including screening for autoimmune and mental health conditions, as part of informed consent.4
Bottom line
Breast implant illness describes real symptoms whose cause is not yet established. Removal is followed by improvement for many people, but the evidence is uncontrolled, and full “en bloc” capsule removal has not been shown to be necessary for symptoms. Other causes deserve investigation first.
Related reading
- Breast augmentation guide
- What is BIA-ALCL?
- What is capsular contracture?
- How long do breast implants last?
Sources
- Medicines and Healthcare products Regulatory Agency. Symptoms sometimes referred to as breast implant illness. GOV.UK; updated 2023. https://www.gov.uk/guidance/symptoms-sometimes-referred-to-as-breast-implant-illness. Accessed 5 November 2026.
- US Food and Drug Administration. Medical device reports for systemic symptoms in women with breast implants. FDA; 2025. https://www.fda.gov/medical-devices/breast-implants/medical-device-reports-systemic-symptoms-women-breast-implants. Accessed 5 November 2026.
- US Food and Drug Administration. Risks and complications of breast implants. FDA; 2023. https://www.fda.gov/medical-devices/breast-implants/risks-and-complications-breast-implants. Accessed 5 November 2026.
- Ferreira S, Barros AS, Marques M. Breast implant illness: symptoms, outcomes with explantation and potential etiologies. A systematic review and meta-analysis. Aesthetic Plastic Surgery; 2025;49(23):6600–6620. doi:10.1007/s00266-025-05142-x. https://link.springer.com/article/10.1007/s00266-025-05142-x
- Glicksman C, McGuire P, Kadin M, et al. Impact of capsulectomy type on post-explantation systemic symptom improvement: findings from the ASERF Systemic Symptoms in Women-Biospecimen Analysis Study: Part 1. Aesthetic Surgery Journal; 2022;42(7):809–819. doi:10.1093/asj/sjab417. https://academic.oup.com/asj/article/42/7/809/6463587
- International Society of Aesthetic Plastic Surgery, The Aesthetic Society, Aesthetic Surgery Education and Research Foundation. Joint patient safety advisory: breast implant removal and capsulectomy. ISAPS; 2023. https://www.isaps.org/media/djtnnugi/230509-joint-patient-safety-advisory-breast-implant-removal-and-capsulectomy.pdf. Accessed 5 November 2026.
- Medicines and Healthcare products Regulatory Agency. Breast implant associated anaplastic large cell lymphoma (BIA-ALCL). GOV.UK; updated 2025. https://www.gov.uk/guidance/breast-implants-and-anaplastic-large-cell-lymphoma-alcl. Accessed 5 November 2026.
Article history
- — First published.