What Problems Can Occur with Breast Implants?
Most women with breast implants never have a serious problem, and long-term studies show satisfaction remains high.
However, implants are medical devices that stay in the body for many years, and complications do happen. The commonest are capsular contracture and rupture, which between them account for most repeat operations. Much rarer, but more serious, is BIA-ALCL, a lymphoma linked mainly to textured implants. Breast implant illness sits somewhere in between: the symptoms women describe are real, but their cause is still debated.
Ms McEvoy has written separately about why breast enlargement remains popular, how long implants last and when removal makes sense.
This is the second article in a series of four:
What Problems Can Occur With Breast Implants?
Should I Have My Breast Implants Removed?
This article explains each potential problem, how common it is, how it shows itself and what can be done about it. If you are weighing up removal, our companion article Should I Have My Breast Implants Removed? covers that decision, and How Long Do Breast Implants Last? looks at implant lifespan in detail.
How common are problems with breast implants?
Fairly common over the long term, but usually treatable. In the large manufacturer follow-up studies, roughly one in five women needed a further operation within eight to ten years of their first. Not all of these were for complications: a wish to change size is one of the commonest reasons. Most problems affect the breast itself rather than general health, and most can be corrected surgically.
What is capsular contracture?
Capsular contracture is the commonest complication of breast implants, and the single commonest reason for repeat surgery. Every implant is surrounded by a capsule. This is the body's normal response to anything placed inside it: within a few weeks of surgery, a thin lining of collagen-rich scar tissue forms around the implant, walling it off from the surrounding breast tissue. It is not a complication. A healthy capsule is thin, soft and almost transparent, and it helps hold the implant in position.
The capsule matters because so much else happens there. It is where contracture develops, it usually contains the gel if a silicone implant ruptures, and it is where BIA-ALCL arises. It is also what surgeons are referring to when they talk about capsulectomy: removing some or all of this lining when an implant comes out.
In most women the capsule stays thin and unnoticeable for life. In contracture, it thickens and tightens, squeezing the implant.
Its causes are not fully understood, but low-grade bacterial colonisation of the implant surface (biofilm), or bleeding at the time of surgery or radiotherapy all appear to play a part.
Surgeons grade it using the Baker scale:
Grade I: soft, looks and feels natural.
Grade II: a little firm but looks normal.
Grade III: firm and visibly distorted, often rounder or higher-riding.
Grade IV: hard, distorted and painful.
Grades I and II need no treatment. Grades III and IV usually do, either by replacing the implant and removing the capsule (capsulectomy), or by removing the implant altogether. Contracture can recur after replacement, so for women on their second or third episode, removal often becomes the more appealing long-term answer.
What happens if a breast implant ruptures?
It depends on the filling. A ruptured saline implant deflates over a few days and the change is obvious. The saline is absorbed harmlessly. A ruptured silicone implant is different: it is often "silent", with no change in look or feel, and is found only on a scan.
Silicone ruptures fall into two types:
Intracapsular: the implant shell has split but the gel stays inside the capsule. This is the more common type and often causes no symptoms.
Extracapsular: gel has escaped beyond the capsule into the breast tissue, sometimes forming small lumps (siliconomas) or travelling to the lymph nodes in the armpit.
How often does it happen? In the ten-year follow-up of Allergan's round silicone implants, MRI showed rupture in about 8% of implants. The figure for the company's shaped implants was similar, at about 10% of implants. Rupture risk rises with each year an implant is in place.
When symptoms do occur, they include a change in size or shape, softening, new lumps, tenderness or a change in how the breast moves. Ultrasound is a sensible first test; MRI is the most accurate. A confirmed rupture is not an emergency, but most surgeons advise removal or replacement, particularly if gel has escaped beyond the capsule.
Can silicone gel leak from an intact implant?
Yes, in small amounts. Silicone molecules can slowly diffuse through an intact shell, a process known as "gel bleed". Modern implants have barrier layers in the shell and more cohesive gels, which greatly reduce it, but it has not been eliminated.
In most women the small amount that escapes is contained within the capsule and causes no harm. Occasionally silicone reaches the lymph nodes in the armpit, where it can cause enlarged nodes or small lumps. These are usually harmless, but any new lump in the breast or armpit should be examined, as it may need a scan to rule out other causes. Gel bleed has also been suggested as one contributor to capsular contracture.
What is breast implant illness?
Breast implant illness (BII) is a term women use for a range of whole-body symptoms they attribute to their implants. The commonest are fatigue, "brain fog", joint and muscle pain, anxiety, headaches, hair loss and poor sleep. It is not a formal medical diagnosis, there is no test for it, and large studies have not shown that implants cause autoimmune or connective tissue disease.
That does not mean the symptoms are imagined. The US Food and Drug Administration (FDA) has received thousands of reports describing them, and in 2020 it formally acknowledged that some women experience these symptoms and that some improve after removal. The position is that the symptoms are real, but the cause remains unproven.
The best prospective evidence comes from a US study funded by the Aesthetic Surgery Education and Research Foundation (ASERF). Women who attributed systemic symptoms to their implants were followed for a year after removal. Around 88% reported at least partial improvement, and the improvement was the same whether surgeons removed all of the capsule, part of it, or the implant and capsule in one piece ("en bloc"). The investigators concluded that silicone leakage was unlikely to explain the symptoms.
What might explain that improvement? The researchers raised the possibility that relief from worry, and a "nocebo" effect (where expecting harm produces symptoms), contribute. Many of the listed symptoms are also common in women of the same age without implants. None of this diminishes what women feel. It does mean that:
Removal is a reasonable choice for women who believe their implants are making them unwell, and many feel better afterwards.
Improvement is likely but not guaranteed, and symptoms with another cause, such as thyroid disease, menopause or anaemia, will not resolve. These are worth ruling out first.
Claims online that only "en bloc" removal will work are not supported by the evidence, and more extensive surgery carries more risk.
What is BIA-ALCL?
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare cancer of the immune system that develops in the fluid or capsule around an implant. It is not breast cancer. It is strongly linked to textured implants, and confirmed cases involving only smooth implants are exceptionally rare.
The UK regulator, the MHRA, currently estimates around one confirmed case for every 12,000 breast implants and tissue expanders sold in the UK. The risk varies considerably by implant type: the heavily textured Allergan Biocell range carried the highest risk and was withdrawn from sale worldwide in 2019. Cases typically appear seven to ten years after surgery.
The usual sign is a sudden, persistent swelling of one breast caused by fluid around the implant, appearing years after an uncomplicated operation. Less often it shows as a lump or a hardening of the capsule. Caught early and confined to the capsule, it is usually cured by removing the implant and the entire capsule. Advanced cases may need chemotherapy, and deaths, though very rare, have occurred.
Should I have my implants removed to prevent it? Not if you have no symptoms. Neither the MHRA, the FDA nor UK plastic surgery bodies recommend removal purely as a precaution, because the risks of the operation are judged to outweigh the risk of the disease. Knowing whether your implants are textured, and which brand, helps you and your surgeon weigh this personally.
Since 2022, regulators have also reported a very small number of squamous cell carcinomas (BIA-SCC) and other lymphomas in the capsule. These have occurred with both smooth and textured implants and are rarer still. They do not change routine advice, but they are another reason to report any new swelling, lump or change in shape promptly.
What other problems can occur?
Several less serious problems can affect how implants look and feel:
Malposition: implants can drop too low ("bottoming out"), drift towards the armpit, or, rarely, meet in the middle (symmastia).
Rotation: shaped, teardrop implants can turn, distorting the breast.
Rippling and visible edges: more likely with thin tissue, saline implants and implants placed above the muscle.
Animation deformity: implants under the chest muscle can move or distort the breast when the muscle contracts.
Late seroma: fluid around the implant appearing a year or more after surgery. It always needs investigating, because it can be the first sign of BIA-ALCL.
Infection: most common in the first few weeks, occasionally later.
Changes in sensation: the nipple or breast skin can become more or less sensitive, usually temporarily but sometimes permanently.
Discomfort: larger implants can feel heavy and contribute to neck, shoulder or back ache.
Breast screening: implants can hide a small amount of breast tissue on a mammogram. Women with implants should still attend screening and tell the radiographer, who will take extra views.
When should I seek advice about my implants?
See your GP or surgeon if you notice any of the following, particularly more than a year after surgery:
New swelling of one breast
A lump in the breast or armpit
A change in shape, size or firmness
Pain that is new or worsening
Redness, warmth or fever
Most of these turn out not to be serious, but all deserve an examination and often a scan.
Consider Your Next Step
A consultation is where every good treatment starts. There will be no obligation to proceed. The aim is to provide information and clarity, not pressure to have a operation.
To arrange a consultation with Ms McEvoy please use the links below to telephone or email, or to fill out our contact form click here.
References
US Food and Drug Administration. Breast implants: risks and complications; and Breast Implants: Certain Labeling Recommendations to Improve Patient Communication (guidance, 2020). fda.gov
Coroneos CJ, Selber JC, Offodile AC, Butler CE, Clemens MW. US FDA breast implant postapproval studies: long-term outcomes in 99,993 patients.
Ann Surg. 2019;269(1):30-36.
Spear SL, Baker JL. Classification of capsular contracture after prosthetic breast reconstruction.
Plast Reconstr Surg. 1995;96(5):1119-1123.
Spear SL, Murphy DK; Allergan Silicone Breast Implant U.S. Core Clinical Study Group. Natrelle round silicone breast implants: Core Study results at 10 years.
Plast Reconstr Surg. 2014;133(6):1354-1361.
Maxwell GP, Van Natta BW, Bengtson BP, Murphy DK. Ten-year results from the Natrelle 410 anatomical form-stable silicone breast implant core study.
Aesthet Surg J. 2015;35(2):145-155.
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.
Aesthet Surg J. 2022;42(7):809-819.
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.
Aesthet Surg J. 2023.
Medicines and Healthcare products Regulatory Agency. Breast implants and anaplastic large cell lymphoma (ALCL).
GOV.UK guidance, updated December 2025.