A TERM STILL BEING STUDIED
What Is Breast Implant Illness?
Breast implant illness, often shortened to BII, is a term patients and clinicians use for a range of systemic symptoms reported after breast implants. It is not a formal medical diagnosis, there is no specific diagnostic test or recognized set of criteria, and the cause of or relationship between these symptoms and implants remains unclear. [1]
BII is different from local implant concerns such as rupture, capsular contracture, infection, or malposition. It is also distinct from breast implant-associated anaplastic large cell lymphoma, or BIA-ALCL. Each concern has its own evaluation and treatment decisions.
LISTEN FIRST
Why Women Ask About Breast Implant Illness
Patients report varied symptoms that deserve to be heard carefully without deciding the cause—or the surgical answer—in advance. Some patients report improvement after implant removal, while others do not. Current evidence cannot predict an individual response or establish that implants caused the symptoms.
- Fatigue or changes in energy
- Memory or concentration concerns sometimes called brain fog
- Joint or muscle pain
- Rash, hair, or other skin-related changes
- Sleep, anxiety, depression, or other systemic concerns
These symptoms can have many possible explanations. Consultation creates space to review the implant-related surgical questions while remaining honest about what surgery can and cannot establish.
A THOUGHTFUL NEXT STEP
How Are BII Concerns Evaluated?
No single test confirms BII. Consultation begins with what you have noticed, when it began, your implant and surgical history, breast concerns, health information, and what you hope to understand or change.
Dr. Howarth can examine your breasts, review available implant information, operative records, or imaging when relevant, and discuss whether additional imaging or evaluation may be useful for the specific concern. Her role is to assess the surgical questions and explain the limits of what surgery can establish or accomplish—not to diagnose the cause of systemic symptoms from a checklist.
Persistent swelling, a mass, or pain around an implant warrants medical evaluation because those findings may require a pathway distinct from BII. A patient does not need to decide which condition she has before contacting the practice.
When Surgery May Not Be the Right Choice
The purpose of consultation is to identify the most appropriate next step—not to presume that an operation is needed. Dr. Howarth may recommend waiting, further evaluation, a different setting or approach, nonsurgical care, or no surgery when that is the more appropriate recommendation.
PERSONAL DECISIONS. THOUGHTFUL CARE.
Privacy During Breast Surgery Consultation and Care
Questions about breast surgery can feel personal. When you contact us, you can tell us whether you prefer a call or text. Your consultation with Dr. Howarth is a thoughtful conversation about your anatomy, concerns, and goals.
SURGEON-LED GUIDANCE
Choosing a Surgeon for Breast Implant Illness Concerns: Why Dr. Howarth
Ashley Howarth, MD, FACS, is a board-certified plastic surgeon in Scottsdale, an Instructor in Plastic Surgery at Mayo Clinic, and a Fellow of the American College of Surgeons. Her background includes nine years of formal surgical training in general, plastic, and reconstructive surgery.
Good surgical judgment includes listening carefully without using surgery to prove a diagnosis. It also requires separating the implant, capsule, breast shape, imaging, prior operations, and systemic uncertainty into different questions.
Dr. Howarth explains what implant-related surgery may accomplish, what it cannot promise, and how the breast may change after removal or revision. Depending on the findings and goals, the appropriate path may be continued consideration, removal, revision, a separate shape procedure, another evaluation, or no immediate surgery.
PLASTIC SURGERY
OF SURGEONS
SCOTTSDALE · MODERN OFFICE SETTING
FROM CONSULTATION TO CONFIDENCE
Breast Implant Illness Consultation and Patient Care Coordination
Your patient care coordinator helps with scheduling, estimates, financing, forms, travel, and follow-up logistics. Dr. Howarth and her clinical team answer medical questions and make all clinical recommendations.
A thoughtful beginning.
Your coordinator can arrange consultation and explain which implant details, records, photographs, or imaging may be useful. Missing records should not prevent you from reaching out.
Clear information before you decide.
After Dr. Howarth recommends a plan, your coordinator can review the written estimate, financing information, scheduling requirements, forms, next steps, and practical questions.
Practical details, clearly organized.
Once required visits are known, your coordinator can help organize Scottsdale travel and follow-up timing. The clinical team provides individualized medical guidance.
WHAT THE CONSULTATION CLARIFIES
Should I Consider Implant Removal for BII Concerns?
Continue or Observe
Some patients want more time, information, or evaluation before making an implant decision. Contacting the practice does not commit you to surgery.
Remove the Implants
Breast Implant Removal addresses explant surgery, capsule choices, breast shape, scars, recovery, and cost. Removal cannot guarantee symptom improvement.
Revise or Replace
Breast Revision addresses replacement, pocket or position correction, and broader planning when removal without replacement is not the primary goal.
Plan Shape Separately
A lift or Fat Transfer may be discussed selectively after removal. Each adds its own anatomy, risks, scars, recovery, and limitations.
CAPSULE MANAGEMENT
Does Breast Implant Illness Require En Bloc Capsulectomy?
No. Breast implant illness concerns alone do not create an indication for en bloc capsulectomy. Implant removal and capsule removal are separate surgical decisions. Dr. Howarth bases capsule management on the examination, imaging, implant integrity, capsule findings, prior operations, and the additional risk created by dissection.
The Breast Surgery Collaborative Community consensus reserves en bloc for removal of an implant and capsule with a margin of uninvolved tissue when breast implant-associated cancer is suspected or established. In a noncancer operation, the accurate terms are partial capsulectomy, total capsulectomy, or total intact capsulectomy.
In the prospective ASERF study, patients who attributed systemic symptoms to their implants reported improvement after explantation, but improvement did not differ among partial, total, and total-intact capsulectomy groups. Peer-reviewed analyses including Keane and colleagues and Johal and Floyd likewise caution against presenting en bloc removal as a required or superior BII treatment.
Capsular contracture, rupture or silicone contamination, abnormal thickening or calcification, fluid, a mass, or concern for implant-associated malignancy can change the operation. When those findings are absent, more extensive capsule dissection may add local surgical risk without evidence of better BII symptom relief.
THE OPERATION FOLLOWS THE FINDINGS
If Implant Surgery Becomes Part of the Plan
The exact operation determines preparation, setting, anesthesia, capsule management, discharge, and follow-up. Implant-only removal differs from partial or total capsule removal, revision or replacement, and a plan that also includes lift or fat transfer.
The known details are reviewed.
The team confirms the health review, available implant records, planned operation, and individualized preparation instructions.
Surgery follows the agreed plan.
Dr. Howarth follows the implant and capsule plan, including any separately planned breast procedure, based on findings and goals.
Guidance fits the operation.
Written instructions address comfort, activity, incision care, follow-up, and travel according to the surgery performed.
CLEAR LIMITS MATTER
Breast Implant Illness Surgery: Safety and Limitations
Implant removal can accomplish the surgical goal of removing an implant. It cannot prove what caused systemic symptoms or promise that they will improve. Some patients report improvement after removal, while others do not.
The operation and risks depend on the findings and plan. More capsule dissection can add local risk, so total capsule removal is not automatically the safest or most appropriate choice for every patient. Breast shape may also change according to the implant, tissue, skin, capsule, prior surgery, and whether another procedure is planned.
Surgical Considerations Include
- Bleeding, infection, fluid collection, or delayed healing
- Pain, sensation change, scarring, or asymmetry
- Chest-wall or tissue injury during capsule dissection
- Volume loss, laxity, indentation, or contour change
- Need for staged reshaping or another operation
- Recovery differences based on the actual procedure
Surgery Cannot Guarantee
- Proof that implants caused systemic symptoms
- Improvement or resolution of systemic symptoms
- That total capsule removal is required or safer
- A particular breast shape after implant removal
- Freedom from future evaluation or surgery
RECOVERY FOLLOWS THE ACTUAL OPERATION
Recovery After Implant Removal or Revision
Recovery depends on whether the plan involves implant-only removal, capsule surgery, replacement, pocket work, lift, fat transfer, or another correction. Work, driving, exercise, caregiving, travel, and follow-up are individualized.
Early care centers on comfort, gentle movement, incision care, and the support plan provided by the clinical team.
Work, driving, caregiving, and travel return according to the operation, medication use, daily demands, and follow-up findings.
Lifting and exercise resume after healing progresses and the clinical team provides guidance for the actual operation.
Swelling and tissue position keep changing. Breast shape and systemic symptoms must be evaluated rather than assumed from a result.
BEFORE & AFTER GALLERIES
Private Breast Implant Removal and Revision Before & After Gallery
Breast Implant Removal and Revision before-and-after photographs can feel deeply personal. As both a woman and a surgeon, Ashley Howarth, MD, FACS, understands the trust involved in sharing them. Howarth Plastic Surgery in Scottsdale makes galleries of real patient results available by request through private before-and-after reviews.
Keeping breast implant removal and revision before-and-after galleries off unrestricted public pages helps preserve patient dignity and clinical context while limiting casual viewing, unauthorized reposting, and collection by automated systems or AI agents.
During your private before-and-after review, you can see a range of breast implant removal and revision results and discuss how starting anatomy, surgical choices, healing, and time influenced each outcome. These photographs can support an informed consultation, but individual results vary, and no image can predict your outcome.
PATIENT CASE SUMMARIES
Selected Breast Implant Illness Case Summaries
These deidentified case summaries illustrate how Ashley Howarth, MD, FACS, approaches breast implant illness concerns at Howarth Plastic Surgery in Scottsdale, Arizona. They emphasize symptom history, medical evaluation, informed explant decisions, capsule management, shape planning, and uncertainty about systemic symptom response. To protect patient privacy, some nonclinical identifying details have been generalized or modified. Individual anatomy, procedures, healing, and results vary.
Case 01
Systemic symptoms
Persistent systemic symptoms were evaluated before elective explantation
Patient presentation
The patient reported fatigue, cognitive difficulty, joint discomfort, and other systemic symptoms she associated with implants.
Clinical evaluation
Dr. Howarth reviewed symptom timing, implant history, breast findings, imaging, medical evaluation, alternatives, and expectations.
Procedure performed
Implants were removed after discussion that explantation could not guarantee systemic symptom improvement.
Clinical rationale
The reported symptoms were taken seriously, but they are nonspecific and may have more than one cause.
Follow-up
Follow-up separately documented healing, breast shape, and evolving symptom reports without assuming causation.
Case 02
Capsule management
Breast implant illness concerns required a separate capsulectomy decision
Patient presentation
The patient requested implant removal and complete capsule removal after researching BII.
Clinical evaluation
Dr. Howarth reviewed integrity, symptoms, imaging, capsule, prior operations, anatomy, and dissection risk.
Procedure performed
Implants were removed with capsule treatment limited to the extent supported by findings.
Clinical rationale
Implant removal and capsulectomy are not synonymous; capsule treatment should match pathology, anatomy, and safety.
Follow-up
Care reviewed healing, pathology when obtained, contour, and symptom tracking with other clinicians.
Case 03
Explant and lift
Explantation and expected deflation prompted a concurrent shape discussion
Patient presentation
The patient wanted implants removed and worried about loose skin and low nipple position afterward.
Clinical evaluation
Examination assessed device size, native tissue, elasticity, nipple position, capsule, scars, and lift suitability.
Procedure performed
Implant removal and mastopexy were performed with coordinated capsule and reshaping plans.
Clinical rationale
Explantation removes devices but does not correct stretched skin or breast position.
Follow-up
Follow-up evaluated healing, shape, scars, and symptom course without promising causal response.
Case 04
Staged reconstruction
Thin tissue and uncertain post-explant shape supported staging
Patient presentation
The patient wanted removal but was unsure about a later lift or fat transfer.
Clinical evaluation
Dr. Howarth evaluated native volume, laxity, thickness, donor areas, nipple position, capsule, and immediate-shape uncertainty.
Procedure performed
Implants were removed first, with later reshaping deferred until healing clarified the breast contour.
Clinical rationale
Staging avoided an irreversible shape procedure based on an uncertain immediate appearance.
Follow-up
Follow-up documented healing, contraction, position, symptoms, and second-stage preferences.
Case 05
Informed preference
Normal imaging did not preclude explantation when the informed patient preferred removal
Patient presentation
The patient had systemic concerns but reassuring imaging and no clear local complication.
Clinical evaluation
Dr. Howarth reviewed imaging, examination, history, medical workup, expected changes, risks, capsule options, and uncertainty.
Procedure performed
Elective implant removal was performed without promising symptom resolution or a specific cause.
Clinical rationale
Normal imaging does not settle a preference-sensitive explant decision.
Follow-up
Visits assessed healing and contour while symptom changes remained patient-reported observations.
Case 06
Medical evaluation first
Explant surgery was deferred while new symptoms required broader assessment
Patient presentation
The patient attributed recent fatigue, pain, and cognitive symptoms to implants without prior medical evaluation.
Clinical evaluation
Dr. Howarth assessed breasts, devices, imaging, history, and uninvestigated non-breast causes.
Recommendation
Immediate removal was not recommended; appropriate medical assessment was advised first.
Clinical rationale
Direct explantation could delay another diagnosis and create an unsupported expectation of relief.
Follow-up
The patient was invited to return with updated findings for a better-informed decision.
PLANNING WITH CLARITY
Breast Implant Illness Surgery Cost, Financing, and Travel to Scottsdale
Breast Implant Illness Surgery Cost
At Howarth Plastic Surgery in Scottsdale, surgery for concerns attributed to breast implants typically costs $11,000 to $35,000. The range reflects meaningful differences between implant removal, capsulectomy, breast lift, fat transfer, and combined plans. After consultation with Dr. Howarth, you will receive a personalized written estimate for the operation she recommends; not every patient requires the same capsule or contour procedure.
Financing Options
Howarth Plastic Surgery is a cash-pay practice and does not accept or bill insurance. Your patient care coordinator can review financing through PatientFi and CareCredit, subject to third-party approval.
Planning Care in Scottsdale
If you are traveling from elsewhere in Arizona or out of state, out-of-town patient information can help you plan around consultation, surgery, and follow-up. Required appointment dates, how long to remain nearby, and when travel may resume are individualized. An initial consultation may take place virtually, but an in-person examination is required before the operative plan is finalized.
CLEAR ANSWERS
Breast Implant Illness Frequently Asked Questions
BII is a term patients and clinicians use for systemic symptoms reported after breast implants. It is not one defined disease, and the cause of or relationship between the symptoms and implants remains unclear.
No specific test confirms BII. Symptoms, health history, implant information, breast findings, and other relevant evaluation are considered in context rather than used as an online checklist.
Current evidence cannot predict who will improve, establish that implants caused a person’s symptoms, or guarantee that removal or a particular capsule operation will resolve them. Some patients report improvement, while others do not.
No. BIA-ALCL is a distinct lymphoma, and FDA information indicates that risk is higher with textured-surface implants than smooth-surface implants. Persistent swelling, a mass, or pain around an implant warrants medical evaluation but does not by itself establish a diagnosis.
No. Capsule management depends on examination, implant history, imaging or findings when relevant, anatomy, and surgical risk. Total capsulectomy is not automatically required for systemic symptoms.
Bring the information you already have. Implant cards, operative reports, relevant imaging, and a simple symptom timeline may be useful, but missing records should not prevent you from contacting the practice.
Breasts may appear smaller, looser, flatter, differently positioned, asymmetric, or indented after removal. Implant size, skin, tissue, capsule, prior surgery, and any separate reshaping plan influence the change.
At Howarth Plastic Surgery in Scottsdale, surgery for concerns attributed to breast implants typically costs $11,000 to $35,000. The range reflects meaningful differences between implant removal, capsulectomy, breast lift, fat transfer, and combined plans. After consultation with Dr. Howarth, you will receive a personalized written estimate for the operation she recommends; not every patient requires the same capsule or contour procedure.
No. Imaging does not diagnose BII, but it may help evaluate a local implant or breast concern such as suspected rupture, fluid, a mass, or another finding. The appropriate study depends on the specific concern.
No. Implant removal and capsule management are separate decisions. En bloc capsulectomy is reserved for suspected or established breast implant-associated cancer after appropriate workup; it is not a routine treatment for BII. The capsule plan depends on the findings and surgical risk.
Pain, persistent swelling, a mass, firmness, or a change in breast shape may reflect a local implant or breast issue that needs its own evaluation. These findings are not assumed to be BII.
Travel may be possible when consultation, surgery, and follow-up can be coordinated safely. Required visits depend on the evaluation and operation. Begin with the Out-of-Town Patient guide and your coordinator.
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Tell us what you are considering. A member of our patient care team will follow up with consultation availability and next steps.
Megan S.
Patient Coordinator
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Selected Medical References
