Patient-Reported Symptom Changes Following Breast Implant Explantation with Total Capsulectomy: A Prospective Case Series of 50 Patients

Background: Breast implant illness (BII) is a constellation of non-specific systemic and local symptoms—including fatigue, joint pain, cognitive dysfunction, and autoimmune-like manifestations—attributed to silicone breast implants. Although BII remains a controversial clinical entity, accumulating evidence suggests symptom improvement following implant removal; however, causal mechanisms and optimal surgical strategies remain uncertain. Objective: The objective was to evaluate the prevalence of BII symptoms and the effect of explantation with en bloc total capsulectomy on symptom resolution in affected women. Methods: A prospective case series of 50 women who underwent explantation with total capsulectomy between 2023 and 2025 was conducted (Level IV evidence). The BII Questionnaire of the American Society for Aesthetic Plastic Surgery (ASAPS) was administered to assess preoperative and one-year postoperative symptom burden. Perioperative data—including implant characteristics, capsular findings, and imaging results—were analyzed. Symptom changes were assessed using descriptive statistics and nonparametric tests. Results: The mean age at explantation was 43 years, with a mean age at implantation of 31 years. Implants were predominantly placed in the retropectoral plane (80%). Intraoperative rupture was identified in 34 patients (68%). At one-year follow-up, a statistically significant reduction in symptom burden was observed, with an 81.7% decrease in mean symptom frequency (preoperative mean: 10.79 vs. postoperative: 1.97; p < 0.001). The most pronounced improvements were noted in chronic fatigue, cognitive impairment, and delayed wound healing. No surgical complications were recorded, and aesthetic outcomes were satisfactory among patients who underwent single-stage mastopexy. Conclusions: Explantation with en bloc total capsulectomy is associated with substantial symptom improvement in women presenting with BII. Although the precise pathophysiology of BII remains elusive, these findings support a patient-centered approach incorporating thorough preoperative evaluation and shared decision-making. Future research should prioritize the development of standardized diagnostic criteria, biomarker validation, and patient subgroup stratification to optimize clinical management and further advance the understanding of BII. Limitations: The absence of a control group precludes causal inference. Objective clinical and immunological assessments were not performed. Patient-reported symptoms were not corroborated by formal clinical evaluation. Most patients were self-referred, introducing referral and expectation bias. The sample size was small.