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Breast Implant Illness (BII) describes a constellation of non-specific systemic symptoms reported by women with breast implants. As implant removal is increasingly sought by patients reporting BII, prospective data using standardized assessment tools remain limited. This study evaluated changes in self-reported systemic and psychological symptoms following implant and capsule removal.

This prospective multicenter cohort study enrolled 50 women: 20 symptomatic BII patients (Group 1), 20 asymptomatic implant carriers (Group 2), and 10 healthy controls without implants (Group 3). Patients undergoing implant removal completed the Hospital Anxiety and Depression Scale (HADS), the Generic Assessment of Side Effects (GASE-P), and the BREAST-Q© Animation Deformity Scale pre- and 3 months postoperatively.

Mean HADS total score in BII patients decreased from 22.8 pre- to 11.8 postoperatively (48% reduction). The most pronounced improvement was observed in anxiety scores (HADS-A: 10.4 to 5.8), while depressive symptoms showed a more modest reduction (HADS-D: 7.2 to 6.0). Within the BII cohort, implant removal was associated with a marked reduction in overall systemic symptom burden: the mean GASE-P total score decreased from 35.0 preoperatively to 11.7 postoperatively (67% reduction). Postoperative scores approached those observed in healthy controls (Group 3, mean 6.3), while patients undergoing explantation in group 2 demonstrated a more moderate reduction (27.1 to 13.9; 49%). In the BII group, the most pronounced improvements were observed in fatigue (−74%), muscle pain (−88%), and joint pain (−40%). BREAST-Q Animation Scores improved in both explantation groups, with a more pronounced improvement observed in patients undergoing surgery for capsular contracture (mean increase 38%), compared to those with BII symptoms (9%).

In this prospective cohort, patients with self-reported BII demonstrated marked reductions in systemic symptom burden and anxiety following implant removal. Improvements exceeded those observed in patients undergoing implant removal for other indications. Ongoing integration of biological analyses within the present prospective study framework may help clarify underlying mechanisms.

To report a rare presentation of sarcoidosis manifesting as late peri-implant seroma, clinically and radiologically mimicking breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). We aim to highlight the critical diagnostic challenge posed by non-malignant systemic inflammatory conditions in this setting, and to emphasise the importance of thorough multidisciplinary evaluation to avoid misdiagnosis, unnecessary oncological treatment and patient morbidity.

We report the case of a 42-year-old woman who presented with bilateral breast swelling seven years after submuscular textured implant augmentation. Clinical suspicion was for BIA-ALCL. Ultrasound-guided fine needle aspiration (FNA) of the peri-prosthetic fluid was performed for cytology and flow cytometry. Cross-sectional imaging with PET-CT was undertaken to assess for systemic disease. The patient proceeded to have bilateral en bloc capsulectomy and implant removal due to persistent concerns for disseminated BIA-ALCL. Subsequent histopathological and immunohistochemical analyses were performed on capsular tissue and mediastinal lymph node biopsies done.

FNA cytology demonstrates no atypical lymphoid cells, and flow cytometry was negative for CD30 expression. PET-CT revealed significant FDG avidity within both implant capsules, mediastinal lymph nodes, liver and spleen, raising concerns for disseminated BIA-ALCL. Intraoperative findings were unremarkable macroscopically. Capsular histology showed chronic inflammatory changes without evidence of lymphoma, and immunohistochemistry remained CD30-negative. The mediastinal lymph node biopsies demonstrated non-caseating granulomas consistent with sarcoidosis, with no malignancy identified. The patient was started on medical therapy for sarcoidosis.

This case highlights the diagnostic complexity of late-onset peri-implant seroma in patients with textured breast implants. While BIA-ALCL must remain as the primary differential diagnosis, sarcoidosis represents a rare but important mimic, particularly when PET-CT demonstrates widespread FDG uptake. Imaging findings alone lack specificity, and definitive diagnosis requires cytological and histopathological confirmation. A structured multi-disciplinary approach is essential to avoid misdiagnosis and unnecessary oncologic treatment.