Health concerns like “breast implant illness” are only one part of the story. The trend suggests a new interplay between American social status, fashion, and breast size.
Emily Alford, National Geographic, July 13, 2026
In February 2026, former reality television star Brandi Glanville allowed a tabloid news show to film her breast implant removal surgery, commonly known as explantation or explant surgery. “I just wanted to be healthy,” she said, noting that she had been suffering from fatigue, joint pain, lumps beneath her skin, and a host of other symptoms. After the surgery, her doctor noted that one of her 20-year-old implants was leaking and the other had ruptured.
“It is torn. It is ripped. And this is actually much worse than I had expected,” he noted, explaining that he had to change gloves mid-surgery because of the silicone leak.
Glanville is just one of many high-profile celebrities—including Alyssa Milano, Michelle Visage, and Chrissy Teigen—who have recently discussed their decision to have an explant, a reflection of the procedure’s growing popularity. In the United States, it has seen rapid growth since 2020, when data from the American Society of Plastic Surgeons (ASPS) noted a 14.9 percent decrease in breast augmentation surgery, along with a 34.4 percent increase in breast implant removal surgery. The explantation trend increased another 9 percent in 2023, and has remained consistent since.
According to the ASPS, some patients seek breast implant removal because it’s necessary to treat capsular contracture (when scar tissue hardens and contracts around the implant), implant rupture, back pain, or autoimmune reactions. Others seek removal for aesthetic reasons. Reports of ruptures and illness have been associated with breast augmentation since implants became commercially available in the 1960s. In the early 1990s, a class action lawsuit against Dow Corning, a leading manufacturer of silicone implants, resulted in a $2.35 billion settlement, though the company never admitted liability. In the wake of earlier lawsuits and in the midst of the class action suit against Dow, the Food and Drug Administration (FDA) placed a formal restriction on silicone implants in 1992. The implants could still be used for reconstruction, however, or correcting “congenital deformities,” such as differences in size. In 2006, the ban was formally lifted for patients over 22 years old.
Despite the ban and reported complications from implants—including breast implant illness, which remains an unofficial medical diagnosis but is listed on the FDA website as a possible side effect—breast implants have remained one of the most popular cosmetic operations in the U.S. Health issues associated with breast implants are part of the trend toward explantation, but the data tell only half the story As a cultural fascination with wellness emerges in the age of the Instagram body, the recent surge in explantation also speaks to a new interplay between American social status and fashion, which has long been reflected in the size of the American breast.
Changing body styles
Achieving the ideal breast size and shape has been crucial for centuries for those pursuing fashion trends—and body modification, including breast augmentation, often follows the fashion, explains Victoria Pitts-Taylor, author of Surgery Junkies: Wellness and Pathology in Cosmetic Culture and chair of the Feminist, Gender, and Sexuality Studies department at Wesleyan University. “Body modification is like fashion, in that it changes,” she says. “Body styles move in waves and cycles. Provocative-looking styles present the female body as an object to be consumed.”
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In 1922, Chicago physician Max Thorek published one of the first American accounts of breast reduction with a successful nipple reattachment. [….] By the 1930s, treatment for “gigantomastia” was touted as a cure for what Maxwell Maltz, a best-selling author and renowned cosmetic surgeon of the day, termed the “distinct disadvantage, socially or economically,” for a woman with breasts deemed too large.
Breasts deemed too small, however, were a more complicated problem. In the late 1890s, some surgeons experimented with paraffin injections for breast augmentation. But paraffin often migrated and became misshapen. Early attempts at augmentation through fat transfer in the 1920s and ’30s also often yielded lumpy, uneven results. Some patients showed initial satisfaction with sponges surgically inserted into the breasts, but those tended to harden over time as breast tissue fused with the sponges, making them difficult to remove.
After World War II, the pendulum of American fashion swung to “blonde bombshells,” embodied by megastars like Marilyn Monroe and Jayne Mansfield. [….]
A surgical cure for that distress arrived in the form of silicone, a synthetic material derived from sand that comes in gel, rubber, or liquid form. It was originally developed by Corning Glass Works and Dow Chemical Company to make products like engine lubricant resistant to high temperatures—but by the mid-1950s, doctors were experimenting with silicone for prostheses to replace damaged urethras or to drain fluid during operations. While it’s unclear exactly how and when silicone began being used for breast enlargement, in 1965, a dancer at a San Francisco nightclub made headlines for her large breasts, filled with nearly a pint of silicone by a house doctor.
The practice became an underground cottage industry; it was unregulated, expensive, and dangerous. Though the 1960s ushered in an era of beauty standards focusing on smaller proportions, like those of mod fashion icon Twiggy, and introduced significant pushback on uncomfortable undergarments like the bullet bra of the previous decade, prominent breasts were still the subject of cultural fascination.
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While silicone injections were never approved by the FDA, many magazines hyping injections as a miracle cure for everything from wrinkles to breast augmentation chalked the lack of official backing up to conservatism on the agency’s part, interviewing doctors who focused on the benefits. But as reports of deaths and health complications rose, it became impossible to ignore the dangers.
Heralded as a safer alternative, the first silicone breast implants were developed by Dow Corning as a more structurally sound counterpart to the painful sponge implants of the early 1960s. By 1970, an article in Cosmopolitan assured readers that “surgically augmented breasts have a better contour than the real thing.” The device was a moneymaker for Dow Corning. By the early 1990s, the company had sold more than half a million.
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A growing health crisis
In the three decades following the advent of the silicone breast implant, millions of patients opted for augmentation with it. And from the onset, reports of complications, including autoimmune issues, emerged. [….]
The first large-scale investigation of potential complications with implants came not from the medical community but from a 1978 article in Ms. magazine, which posited, based on only 30 interviews, that breast implants resulted in a 60 percent complication rate. While those numbers are likely inaccurate, the article introduced a new skepticism over breast implants. That year, an FDA advisory panel listed breast implants as moderate-risk Class II devices that did not require clinical trials proving safety before going on the market. A 1988 New York Times article declared, “Silicone Implants Tied to Cancer in Test Rats,” though Frank Young, a commissioner for the FDA, told the Times that “the experts further said that the risk to humans, if it exists at all, would be low.”
As the debate over the safety of breast implants began to make headlines, in 1984, breast implant recipient Maria Stern sued Dow Corning over ruptured implants she claimed had also caused extreme joint pain and chronic fatigue. Stern was awarded nearly two million dollars in compensatory and punitive damages.
What followed was a wave of successful lawsuits against Dow Corning and other silicone manufacturers and a highly public congressional hearing. In February 1992, Dow Corning released a confidential internal memo acknowledging that it had known for decades that silicone gel seeped out of its implants, but the company argued that the seepage did not lead to autoimmune disorders or cancer. Following the closely scrutinized trials and hearings, the FDA banned silicone implants in 1992, a decision that was contentious in the medical community. Despite the complaints and lawsuits, many doctors continued to champion the safety of breast implants, even the newly banned silicone implants.
“From all the research data that’s been presented by competent researchers, there’s no link [between breast implants and autoimmune disorders],” Orlando plastic surgeon James Baker told the New York Times in 1992. However, there were dissenters. In the same article, Miami plastic surgeon Joan Membry explained she had seen side effects from silicone during her residency 20 years prior, noting that she had lost business because of her preference for saline implants.
Despite the ban, silicone implants never really disappeared from the market. According to Diana Zuckerman, president of the National Center for Health Research, the ban was easily circumvented by doctors for whom breast augmentation was an easy and lucrative procedure. “For a while, there was something called a moratorium where the only women who could supposedly get silicone gel breast implants were mastectomy reconstruction patients,” Zuckerman says. “But there was a loophole for women who had any kind of abnormality in their breasts, and it was decided that an abnormality was having one breast be larger than the other. What was supposed to be a major restriction became more of an inconvenience.”
After the 1992 moratorium on silicone implants, saline-filled models replaced the previous generation of breast implants. Though saline implants had been on the market for 20 years, until the moratorium, they were used in just 10 percent of breast augmentations. The implants were considered safer because they leak salt water when ruptured, rather than silicone.
But as the number of patients receiving saline implants increased, so did reports of complications. In 1992, the FDA received 1,200 reports of complications from saline implants, compared with 17,000 from the use of silicone that same year. The next year, the agency warned of long-term side effects of saline implants. In 2000, a study reported by the FDA found that of 901 women with saline breast implants, 21 percent needed additional surgery after three years, 16 percent had dealt with breast pain, and 5 percent experienced leakage. Despite these findings, the FDA approved saline-filled implants from two new manufacturers in the same year.
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But in 2020, the decades-long fervor for large breasts began to change. That year saw a nearly 15 percent decrease in breast augmentations and a new interest in explantation. According to Cleveland-based plastic surgeon Lu-Jean Feng, one of the leading experts on illnesses related to breast implants, social media has popularized information about potential complications from breast implants that doctors have sometimes been remiss in providing.
“In the 21st century, anecdotal information can be shared across a huge population,” Feng says. As an example, she cites the Facebook group founded by Nicole Daruda called Breast Implant Illness Research & Recovery, which she credits with coining the term “breast implant illness” to describe a host of debilitating symptoms associated with silicone breast augmentation since the 1960s, including autoimmune disorders, cancer, fatigue, brain fog, and joint pain. “That name drew the attention of many,” Feng says, pointing out that Daruda’s group initially had 500 patients when it was launched in 2015 and now has almost 80,000 members.
Social media groups like Daruda’s have given patients broader platforms to discuss risks allegedly associated with breast implants and how the procedure has made them feel. Many, including Feng and Zuckerman, believe that conversation is long overdue. Despite testimony from women that implants have made them ill, the health impacts of implants are vastly understudied. Meaningful reviews of potential long-term complications from implants conducted by the manufacturers remain inconclusive, as a significant number of implant recipients dropped out of the studies, which often relied on self-reporting via lengthy questionnaires. Still, the FDA says it has “not detected any association between silicone gel-filled breast implants and connective tissue disease, breast cancer or reproductive problems,” while acknowledging the need for larger and longer studies.
Wellness culture and the explant trend
The same social media that allows patients easy access to information about potential side effects of breast implants has also contributed to a heightened awareness of what types of bodies are in style these days.
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Breasts, too, have fallen under the purview of commercialized wellness. Removing breast implants is marketed as a decision that grants women more control over their own health.
What’s more, breast lifts and fat transfer augmentation are sold as healthier alternatives to breast implants. While the current cultural ideal for breasts may be trending smaller, smaller is not synonymous with natural.
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