In 2016, when Britney Pollock was 26, she decided to get breast implants: 400 cubic cm of silicone, inserted under her pectoral muscles.

She “felt awesome” after the procedure, says Pollock, now 34 and a teacher based in California. “It just felt good to look good.”

Around 2019, things began changing. “I started getting randomly sick and I couldn’t figure out why,” she says.

Joint and muscle pain had her waking up every morning feeling like she’d “been hit by a bus”. She had brain fog, migraines, strange rashes, problems with her vision and “electrical shooting pains in my body and especially my breasts”, she says. These “weird, random symptoms” came and went: one day she’d be out and about; the next, she’d have to call in sick from work or cancel plans with friends.

Pollock sought help from several specialists. Eventually, a rheumatologist at the University of California Los Angeles told her that, based on her ailments and the timeline of their progression, she might have an autoimmune disease triggered or exacerbated by her implants. While removing the implants might not completely cure her, the doctor explained, it could alleviate her symptoms or prevent them from getting worse.

Pollock had her implants removed in September 2023. Since then, many of her symptoms have grown milder or disappeared. “Generally, I feel a bit better, and mentally, it feels better they’re not inside me anymore, doing possible damage,” she says.

Pollock is among an unknown number of people experiencing what many have unofficially termed “breast implant illness” (BII). The term has gained traction on social media but is not a formal medical diagnosis, and therefore still unfamiliar to many doctors.

What is breast implant illness?

BII refers to autoimmune dysfunction characterized by “chronic, low level inflammation that somehow is caused by breast implants”, says Dr Brian Buinewicz, a plastic surgeon working in Pennsylvania and New Jersey. Buinewicz co-authored a 2021 study on BII citing generalized pain, fatigue, brain fog, migraines, anxiety, arthritis, vision changes, rashes, gastrointestinal issues and depression among the most common symptoms mentioned by a cohort of 248 participants.

The highest risk of inflammation seemed posed by textured silicone implants, but the study found people with all types of implant could experience symptoms of BII and find relief upon removal.

Autoimmune dysfunction affects many of the body’s organ systems, which is why such a diverse range of symptoms can result, Buinewicz says.

Why are breast implants making some people sick?

We don’t know for sure why breast implants may cause health issues. There are several theories.

Buinewicz, who performs around 25 explant – or implant removal – surgeries every month, suggests that the problems may relate to silicone, as both saline and silicone gel implants have a shell made of polysiloxane silicone rubber. Silicone is currently considered non-toxic and biologically inert, meaning it shouldn’t initiate a reaction from living tissue. It is widely used in both medical and everyday applications, like cookware. Yet doctors are now wondering if it could trigger inflammation, especially in patients who have some form of pre-existing allergy or sensitivity.

Buinewicz’s 2021 study also raised the possibility that low-grade bacterial infections related to implants could be linked to BII, but further research is needed.

Researchers in 2023 argued that people who express high levels of a gene called RAC2 may be more prone to severe inflammatory responses to foreign objects in the body, like pacemakers or breast implants.

In Facebook groups for people with BII, some fear that heavy metals like platinum, trace amounts of which can be present in breast implants, may be provoking the toxic effects they feel; or that their bodies are simply rejecting foreign materials, the way skin pushes out a splinter. Some report discovering that their implants were leaking, or that they had severe capsular contracture, a hardening of scar tissue around an implant that can sometimes trigger inflammatory conditions.

In October 2021, the FDA tightened safety regulations for breast implants, requiring clearer communication about potential “systemic symptoms” – meaning that in order to offer breast implants at all, healthcare providers must explain to prospective patients that implants could pose a risk to multiple organs and bodily systems, not just “localized” problems like breast swelling or nipple pain.

Do we know for sure that breast implants are causing autoimmune symptoms?

Are implants truly causing the reported symptoms or could other factors explain them? Autoimmune diseases are often mysterious in origin, and BII in particular is a “relatively new entity” that has “really come to the fore in social media platforms” by way of shared anecdote, notes Dr Andrea Pusic, chief of plastic and reconstructive surgery at Brigham and Women’s hospital in Boston and a professor of surgery at Harvard Medical School.

That doesn’t mean BII is not real, but doctors will probably consider more familiar and easily treatable causes before the possible role of implants.

“We believe these women, but there is a lot that is unknown in terms of causality of the symptoms,” says Pusic. “Many other things can cause some of the symptoms that women are attributing to their breast implants,” including anxiety, depression, menopause and thyroid issues.

“The vast majority of women that either receive implants or reconstruction for cosmetic purposes do not experience symptoms,” says Pusic. “That doesn’t mean we’ve answered the question” of whether implants can cause autoimmune responses, “but it’s reassuring information for women that are considering breast implant reconstruction as a part of their cancer treatment,” she says.

Pusic co-designed Breast-Q, a tool that measures patient outcomes of breast surgery. She and her team will soon update it to include an implant illness scale that will help doctors better measure the incidence of patient-reported autoimmune symptoms after breast surgery.

Could breast implant illness be linked to mental health?

The mind-body connection – the link between our emotions and physical health – is a well-established concept in integrated medicine. Since breast augmentation often relates to body image and societal pressures around appearance, it’s reasonable to consider whether BII could have physical components influenced by these emotional and psychological factors.

Dr Tameca Harris-Jackson is a Florida-based clinical social worker and therapist who works closely with members of marginalized groups, including women, trans individuals and people of color. Medical professionals tend to downplay the pain of marginalized individuals, she says. They often dismiss concerns related to cosmetic procedures such as breast implants even more readily, seeing them as elective. Brushing off these quality of life concerns can disempower patients and extend health issues.

But it is possible for physical and psychosomatic symptoms to coexist and exacerbate each other. Harris-Jackson recommends that people who feel they may have symptoms of BII construct timelines of their mental and physical health before and after the procedure, including details like post-procedure anxiety because of unmet expectations for how they would feel or how surgery could affect their relationships. This will give patients and doctors a clearer sense of how such factors might correlate to their symptoms.

Does removing implants resolve breast implant illness symptoms?

Research on BII is incomplete and ongoing. However, some studies indicate that removing breast implants and capsular scar tissue surrounding implants can provide patients with some relief. Buinewicz’s 2021 study found that implant and capsular tissue removal was safe, and resulted in high patient satisfaction. A 2000 study showed a temporary reduction in musculoskeletal pain, improved vitality, mental health and body satisfaction after explant. And a 2022 study from the Netherlands followed 152 women who had their implants removed on clinical grounds and found 43% experienced significant symptom improvement.

Anecdotally, patients like Pollock and the television personality Michelle Visage, who released a 2021 documentary about BII and her explant surgery, say they feel better after having their implants removed.

But explants are not always a quick fix, and symptoms may persist even after removal. Pollock continues to experience vision issues, which she attributes to the autoimmune response triggered by her implants. Keri Hall, 40, who runs a Facebook group for explant patients, says it took three or four years before she felt “consistently more normal”. Still, Hall’s thyroid health and cholesterol levels improved shortly after the explant – finally convincing her skeptical family doctor that the implants had been contributing to her health issues all along.