Breast Implant Illness and Explant Surgery: What Delaware Patients Need to Know

What Is Breast Implant Illness?

Breast implant illness (BII) is a collection of systemic symptoms that some patients attribute to their breast implants. It is not yet a formal medical diagnosis, but it is a real and increasingly recognized phenomenon, one that the American Society of Plastic Surgeons and the Aesthetic Society are actively studying through a multi-year, long-term patient registry.

Patients with BII report a wide range of symptoms, which may include:

• Chronic fatigue
• Brain fog, memory issues, difficulty concentrating
• Joint and muscle pain
• Hair loss
• Skin rashes and dry skin
• Anxiety and mood changes
• Sleep disturbance
• Recurrent infections
• Gastrointestinal symptoms
• Hormonal irregularities

The symptoms are real. What is still being researched is the exact mechanism, whether it is an immune response, a low-grade chronic inflammatory reaction, microbial biofilm on the implant surface, or another process entirely. It is also unclear why some patients develop symptoms and others with the same implants do not.

Who Is at Risk?

There is no perfect predictor, but trends in the patient population suggest:

• BII can occur with both silicone and saline implants
• It can occur with smooth or textured implants
• Symptoms can appear soon after augmentation or many years later
• A personal or family history of autoimmune conditions may increase risk
• Women with prior allergies, eczema, or chronic inflammation may be more susceptible

If you have implants and you are experiencing unexplained systemic symptoms that your primary care physician and specialists have not been able to attribute to another cause, BII is worth raising with a plastic surgeon.

Before You Consider Explant: Rule Out Other Causes

Many of the symptoms associated with BII overlap with other conditions: thyroid disease, perimenopause, Lyme disease, anemia, sleep apnea, autoimmune disorders, and depression among them. A responsible explant conversation starts with making sure something treatable has not been missed.

A typical pre-explant workup might include:

• A full thyroid panel
• Hormone testing
• Inflammatory markers (CRP, ESR)
• Vitamin D and B12 levels
• Sleep evaluation if indicated
• A review of any new medications

This is not to talk you out of explant. It is to make sure that if you do proceed, you have maximized the chances that your symptoms actually resolve afterward.

What Explant Surgery Involves

Breast explant surgery is the removal of breast implants. Several approaches exist:

Simple implant removal. The implant is removed through a small incision, often the original scar. The capsule (scar tissue your body formed around the implant) is left in place.

En bloc capsulectomy. The implant and the entire surrounding capsule are removed as one intact unit, without rupturing or contaminating the surgical field. This is the approach many BII patients specifically request, and is recommended in certain cases such as ALCL surveillance or textured implant removal.

Total capsulectomy. The implant is removed first and the entire capsule is then meticulously removed, but not necessarily as one piece. Often equivalent to en bloc in terms of completeness.

Explant with lift (mastopexy). Many patients also need a breast lift at the time of explant, especially if the implants were large or in place for many years. The breast tissue and skin will not snap back to its pre-implant shape, and a lift restores a natural contour.

Explant with fat transfer. Fat from another area of the body is added to restore modest volume after implant removal, often combined with a lift.

Will Your Symptoms Improve?

This is the question every BII patient wants answered, and the honest answer is: most patients report improvement, but not all, and not always completely.

Research and patient reports suggest:

• Many patients experience meaningful symptom improvement within weeks to months
• Some improvements are immediate; others build over a year
• Fatigue, brain fog, and joint pain are among the most commonly reported improvements
• Not every symptom resolves, and a small subset of patients see little change

A surgeon who promises 100 percent symptom resolution is overselling. A surgeon who dismisses BII entirely is undereducated. Look for one who takes the symptoms seriously, talks honestly about probabilities, and has experience with explant patients.

What Recovery Looks Like

Explant recovery is typically easier than the original augmentation:

• 1 week of significant downtime
• Return to desk work in 5 to 7 days
• Drains may be used for several days
• Final breast shape settles over 3 to 6 months
• If a lift is included, recovery extends modestly

Most patients are surprised that the physical recovery is straightforward. The emotional adjustment to a new breast shape, often softer, smaller, or different in projection, can take longer and is worth discussing with your surgeon in advance.

How to Choose a Surgeon for Explant

Ask:

• How many explants do you perform per year?
• Do you offer en bloc capsulectomy when requested, and when do you recommend it?
• Will I need a lift, fat transfer, or both for an acceptable cosmetic result?
• What does your follow-up look like for BII patients?
• Can I see before-and-after photos of explant patients with similar anatomy?

Schedule a BII or Explant Consultation in Wilmington

Dr. Gillespie is double board certified and routinely performs explant procedures, including en bloc capsulectomy and explant with lift or fat transfer, at his Wilmington, DE practice. If you are considering removal, whether for symptoms, lifestyle change, or simply because you no longer want implants, schedule a consultation to discuss what is right for your situation.

This article is for general education and does not replace a medical evaluation. Breast implant illness research is ongoing; consult a board-certified plastic surgeon for guidance specific to your situation.