What happened
On September 8, 2026, KevinMD published a piece by a retired cosmetic surgeon on the “explant” trend, the growing number of women having breast implants taken out without replacement. It quoted two figures that frame the debate: 306,196 breast augmentations in the United States in 2024 according to the American Society of Plastic Surgeons, and the boxed warning the FDA attached to every breast implant in October 2021, which states that implants are not lifetime devices, that complications increase the longer they stay in, and that they have been associated with a rare lymphoma and with a cluster of systemic symptoms now called breast implant illness. The UK reached the same point from the other direction. In February 2026 the House of Commons Women and Equalities Committee published its cosmetic procedures report and recommended that every implant and every explant be recorded in the national implant registry by the end of 2026, that the government fund long-term research into breast implant illness, and that a cooling-off period of at least two weeks separate consultation from surgery.
Two new meta-analyses landed in the same year. I am writing about this because a growing share of the women who message me about implants ask a version of the same question: should mine come out?
The common misconception
The belief runs in two directions and both are wrong. The first is that implants last forever, so a woman who feels fine at year twelve has no reason to think about them. The second is that any woman with fatigue, joint pain, or brain fog and a pair of implants has breast implant illness, and that removing the implants will cure her. The evidence supports neither. Implants age, and a long-standing implant deserves a check even in a woman with no symptoms. And the symptom cluster called breast implant illness is real but overlaps heavily with conditions that have nothing to do with silicone, so removal is not a diagnostic test, and it should not be sold as a cure before the other causes have been looked for.
The clinical reality
Implants are devices with a service life, and the FDA now says so on the box. The 2021 labeling requires a boxed warning stating that implants are not lifetime devices and that the chance of complications rises with time in the body. The screening recommendation that came with it is specific: for silicone implants, an ultrasound or MRI five to six years after surgery, then every two to three years, even with no symptoms. The ten-year data behind that advice come from the manufacturers’ own core studies. In the Sientra core study of 1,788 patients, the ten-year rupture rate by patient was 8.6 percent, severe capsular contracture 13.5 percent, and reoperation 31.5 percent, with more than half of the reoperations done for cosmetic reasons such as a size change rather than for a complication. A woman with twelve-year-old implants who has never had a scan is not in danger, but she is overdue for information.
The symptom cluster is real, and its overlap with other diagnoses is the problem. A 2025 meta-analysis in Plastic and Reconstructive Surgery Global Open pooled 36 studies and 10,519 patients and found that fatigue, muscle pain, and cognitive complaints were roughly three times as common in women with implants as without them. Nobody serious now dismisses the symptoms. But a 2025 meta-analysis from the Mayo Clinic covering 7,045 implant patients found that among the women presenting with breast implant illness symptoms, 51 percent had another diagnosis that explained them: thyroid disease, an autoimmune condition, a psychiatric diagnosis, sleep disorders. In the largest symptom review, covering 6,048 women, 20.7 percent had a diagnosed autoimmune condition, 16.5 percent a psychiatric illness, and 12 percent fibromyalgia. Removing implants from a woman whose fatigue comes from an untreated thyroid does not treat the thyroid.
Explantation helps most symptomatic women, and the improvement is usually partial. This is where the two 2025 and 2026 meta-analyses agree and where marketing tends to overstate. Across 33 studies and 6,048 women, 81.9 percent reported symptom improvement after removal; the average implant had been in place 12.3 years and symptoms had started at year 6.4. A March 2026 systematic review and meta-analysis in JPRAS Open separated the groups more carefully and found that women with the classic breast implant illness cluster did not, on average, achieve complete resolution after explantation and capsulectomy; the improvement was moderate, and it was not related to how long the implants had been in, to capsular contracture, or to rupture. Women whose problems were structural, such as granulomas from a ruptured implant, did far better. Improvement, yes. Cure, not reliably. A surgeon who promises the second is promising something the data do not contain.
The capsule matters for the lymphoma, not for the symptoms, and “en bloc” is a technique, not a treatment. The capsule is the thin layer of scar the body forms around any implant, and much of the explant marketing revolves around removing it whole. For the symptom cluster, the best prospective data say the capsule technique makes no difference: the ASERF study followed 150 patients for a year after explantation and found systemic symptom improvement in the breast implant illness group regardless of the type of capsulectomy performed. A 2025 systematic review of metal residues in implants and capsules found no consistent link to symptoms and concluded that heavy metal toxicity does not justify total capsulectomy. My own reading is the same: when there is a problem, the problem is the implant, and once it is out, whether the capsule leaves in one piece or several changes nothing for the symptoms. The capsule matters in one situation. Breast implant-associated anaplastic large cell lymphoma arises in the fluid or the capsule around textured implants, and there the capsule is the disease: a Memorial Sloan Kettering series of 18 cases treated with bilateral implant removal and complete capsulectomy reported no recurrences. So where there is a late fluid collection, a mass, or a textured implant with any concern, the capsule comes out completely and goes to pathology. Otherwise I remove what is abnormal and do not chase a thin, healthy capsule off the chest wall for a benefit no study has shown.
What comes after removal is a reconstruction question, and it needs to be planned before the first incision. An augmented breast that loses its implant does not return to its previous self. The skin envelope has stretched, the tissue has thinned under years of pressure, and the nipple may sit lower than it did. In a woman with good skin and a small implant, removal alone gives an acceptable result. In most others the honest options are removal with a breast lift in the same session, removal with fat transfer to restore some volume, or a staged plan. I show patients photographs of what a deflated breast looks like before they decide, because the regret I see is rarely about the symptoms and usually about the shape. The considerations are the mirror image of the ones I describe on the page about choosing implant size.
My position is that a woman who wants her implants out is entitled to have them out, and that the workup serves the diagnosis, not the permission. I do not require a blood panel or a scan before I remove implants; the operation is hers to choose, for symptoms, for comfort, or simply because she no longer wants them. The workup matters when the question is different: will my symptoms go away? For that question I want blood work including thyroid and autoimmune screening, an ultrasound or MRI of the implants, and a clear picture of what else has been looked for, because that is what lets me give an honest answer. If the scan shows a rupture or a contracted capsule, the answer is simple and the implants come out with the capsule. If the workup finds another cause, I say so, refer for it, and still operate if she wants me to, with expectations set accordingly. What I will not do is tell a woman that removal will make her feel better when the evidence says it may or may not.
The practical takeaway for patients
If you have decided you want your implants out, you do not need to justify the decision; send photographs standing, front and both sides, and the age and type of your implants if you know them, and I will tell you whether removal alone, removal with a lift, or removal with fat transfer fits your breast. If your implants are more than six years old and you have never had a scan, have an ultrasound regardless of what you decide. If you have symptoms and want to know what removal is likely to do for them, list them with dates, tell me what your own doctor has already tested, and send the scan report; that is the information that lets me answer honestly rather than optimistically. Ask any surgeon three questions: what will you do with the capsule and why, what will my breasts look like afterward, and what percentage of women like me improve. The honest answer to the third begins with the word “most” and not with “all”. The guide to choosing a surgeon covers the rest.
Honest limits
The studies pooled here are heterogeneous, most are retrospective, and the JPRAS Open authors say plainly that their results should be read with caution. No blood test diagnoses breast implant illness. No trial has randomized symptomatic women to removal versus observation, and none will. I cannot tell any individual woman in advance whether her fatigue will lift after surgery. Women with a diagnosed autoimmune disease should see their rheumatologist before and after surgery, not instead of it. Removal is a legitimate choice even with intact implants and a clean scan. What is not legitimate is selling it as the cure for symptoms that have another cause, and that is the version of this operation I refuse to perform.
If you are weighing removal, send your implant details, your most recent scan report, and photographs to +90 544 772 0772 on WhatsApp. The surgical team reviews photographs the same day and I reply with a written view on what I would and would not recommend. You can also check whether you are ready for any operation with the surgery readiness check.
Dr. Mustafa Aydınol is a plastic, reconstructive and aesthetic surgeon in Istanbul and a member of ISAPS.
Sources
- KevinMD. Breast implant removal leaves patients paying 3 times. Opinion piece by a retired cosmetic surgeon; cites ASPS 2024 figure of 306,196 breast augmentations and the 2021 FDA boxed warning. KevinMD, September 8, 2026. Link
- House of Commons Women and Equalities Committee. Cosmetic procedures. Eleventh Report of Session 2024 to 26; recommends mandatory registry recording of implant and explant procedures by end of 2026, longitudinal research into breast implant illness, and a two-week cooling-off period. UK Parliament, February 18, 2026. Link
- US Food and Drug Administration. Breast implant labeling recommendations: boxed warning, patient decision checklist, and rupture screening at 5 to 6 years then every 2 to 3 years. October 2021, summarized by FORCE. Link
- Cuenca-Pardo J, Ramos-Gallardo GO, Lira-Álvarez M, et al. Breast implant explantation and capsulectomy in symptomatic patients. Is there any improvement with the procedure? Systematic review and meta-analysis. Moderate, incomplete improvement in the BII/SSBI group; significant improvement for structural causes. JPRAS Open, 2026. DOI
- Ferreira S, Barros AS, Marques M. Breast Implant Illness: Symptoms, Outcomes with Explantation and Potential Etiologies. Systematic review and meta-analysis, 33 studies, 6,048 women, 81.9 percent symptom improvement after explantation, mean implant age 12.3 years. Aesthetic Plastic Surgery, 2025. DOI
- Trabilsy M, Haider SA, Borna S, et al. Exploring breast implant illness and its comorbid conditions: A systematic review and meta-analysis. 48 studies, 7,045 patients; 51 percent of symptomatic patients had another explanatory diagnosis. Journal of Plastic, Reconstructive and Aesthetic Surgery, 2025. DOI
- Bouhadana G, Boucher C, Saleh E, Gornitsky J, Borsuk DE. Defining Breast Implant Illness: A Systematic Review and Meta-analysis of Patient-reported Symptoms. 36 studies, 10,519 patients; fatigue RR 3.15, muscle pain RR 2.96, cognitive dysfunction RR 2.87. Plastic and Reconstructive Surgery Global Open, 2025. DOI
- Kabir R, Stanton E, Sorenson TJ, et al. Breast Implant Illness as a Clinical Entity: A Systematic Review of the Literature. 31 studies, 39,505 implant patients; 72.4 percent of symptomatic patients chose explantation, 53 percent had total capsulectomy. Aesthetic Surgery Journal, 2024. DOI
- Stevens WG, Calobrace MB, Alizadeh K, et al. Ten-year Core Study Data for Sientra’s FDA-Approved Round and Shaped Breast Implants with Cohesive Silicone Gel. 1,788 patients, 3,506 implants; rupture 8.6 percent, Baker III/IV contracture 13.5 percent, reoperation 31.5 percent. Plastic and Reconstructive Surgery, 2018. DOI
- Glicksman C, McGuire P, Kadin M, et al. Longevity of Post-Explantation Systemic Symptom Improvement and Potential Etiologies: Findings From the ASERF Systemic Symptoms in Women-Biospecimen Analysis Study: Part 4. Prospective, 150 patients in three cohorts; 88 percent at least partial improvement at one year, regardless of capsulectomy type. Aesthetic Surgery Journal, 2023. DOI
- Smith JE, Taritsa IC, Stigliano M, et al. Heavy Metals in Breast Implants and Implications for Breast Implant Illness: A Systematic Review of the Literature. 7 studies; no consistent link between metal levels and symptoms, heavy metal toxicity not a justification for total capsulectomy. Aesthetic Plastic Surgery, 2025. DOI
- Vorstenbosch J, Ghione P, Plitas G, et al. Surgical Management and Long-Term Outcomes of BIA-ALCL: A Multidisciplinary Approach. 18 cases, all macrotextured implants, median exposure 11 years; bilateral implant removal with complete capsulectomy, no recurrences at median 43 months. Annals of Surgical Oncology, 2023. DOI
