For years, breast augmentation held the pinnacle spot as the most popular cosmetic surgery procedure. Then, things changed. Concerns over Breast Implant Illness (BII) and risks tied to textured implants—some linked to rare cancers—sparked a wave of bad press and doubts. Five years later, where do we stand? Are implants back in favor? We’re taking a closer look at the shift and what’s next for this ever-evolving procedure.
Featured Experts
- Patricia McGuire, MD is board-certified plastic surgeon in St. Louis
- David Turer, MD is board-certified plastic surgeon in Pittsburgh
- Mark Jewell, MD is a board-certified plastic surgeon in Eugene, OR
- Robert Singer, MD is a board-certified plastic surgeon in La Jolla, CA
Trend Shift
The 2020s saw more patients opting to remove their implants. St. Louis plastic surgeon Patricia McGuire, MD who has done extensive research on breast implants, particularly around BII, says many removals now come down to personal preference. “Last year, the number of implant placements and removals were equal,” she explains. “The patients I see for removal are ready to move on. Their bodies have changed from aging, childbirth and weight changes.”
While she still encounters some patients with BII symptoms, Dr. McGuire notes that these cases have become less common. “Patients are very educated now and open to discussing their options, including implant removal without capsulectomy if they have no other indications for capsule removal. Almost all patients are aware of systemic symptoms potentially related to implants, which wasn’t the case five years ago.”
Social Influence
Plastic surgeons recognize that BII symptoms are real and valid concerns for many patients. However, it’s intriguing that reported cases of BII appear more common in countries such as the United States, Canada and Australia, despite their use globally. Dr. McGuire says this might be influenced by social media, noting that “64 percent of patients in our study identified social media as their primary source of medical information.” In contrast, patients in regions like Asia, where BII reports are less frequent, tend to rely more on direct consultations with physicians for information.
Rise of Revisions
With more patients opting to remove their implants, the demand for revision surgeries has also grown. Pittsburgh plastic surgeon David Turer, MD has observed this trend at his practice. “I see both. Some surgeons are very active in this space and are doing a lot of unnecessary surgery,” he says.
One of the most debated breast procedures is en bloc capsulectomy, a technique to remove the implant and surrounding scar tissue capsule as a single unit. Though it is time-intensive, Dr. Turer clarifies that it’s not always essential. “En bloc is such nonsense,” he says. “The Aesthetic Society, along with the American Society of Plastic Surgeons (ASPS), put out a joint consensus statement to define this terminology. By definition, en bloc refers to a cancer operation.”
Safety Check
Dr. McGuire explains that new safety protocols are also helping patients make more informed decisions. “The FDA-mandated checklist now reviews common and rare risks, such as BIA-ALCL for textured implants and BIA-SCC,” she says.
Eugene, OR plastic surgeon Mark Jewell, MD stresses the importance of understanding the risks before surgery. “Patients should be informed about the possibility of BII before the operation,” he says. “Choosing implants based on individual needs is crucial. The current generation of breast implants is excellent.”
Registering implants on the Aesthetic One app also aids in advancing care. La Jolla, CA plastic surgeon Robert Singer, MD notes the value of data collection: “I think as we get more data from the registry, we’ll be able to improve best practices,” he says.
What’s Next?
Experts see implants evolving, with Dr. McGuire noting a trend toward smaller sizes combined with fat. “Fashions are changing. Smaller implants, which have less effect on tissues over time, are a welcome change,” she says. She also anticipates more options becoming available in the U.S., including polyurethane and lightweight B-lite implants, but this could take years to get FDA approval. “Smooth implants and Betadine irrigation have decreased biofilm and capsular contracture,” adds Dr. Singer. Other highlights, Dr. Jewell shares, include advancements like absorbable scaffolds and fat coatings that reduce contracture. As Dr. Singer says, implants are still popular. “Do I think there will be a decrease in breast implant procedures? I doubt it.”
Did You Know?
Breast implants were first introduced in 1962 by plastic surgeons Thomas Cronin and Frank Gerow. By 2025, implants will have been around for more than 60 years with decades of advancements in safety, look and feel.
Expanded Lineup
With Motiva joining the U.S. market after FDA approval late last year, patients now have more choices than ever. Motiva, well-known in Europe, brings its SmoothSilk implant technology, adding to the variety offered by manufacturers like Allergan (Natrelle), Mentor (MemoryGel) and Sientra. “I was an investigator in the Motiva study; the data shows a good safety profile and high patient satisfaction,” shares Dr. McGuire.
