For nearly as long as our society has obsessed over pop culture and celebrity gossip, we’ve been speculating on changes to stars’ appearances, no matter how small. Marilyn Monroe got the “did she or didn’t she” treatment regarding changes to her chin and nose, and today, countless celebrities’ bodies are scrutinized by paparazzi, editors, and superfans on social media, analyzing for any tweaks that may have been made.
In recent years, however, something has changed—celebrities are coming forward to acknowledge their procedures. Most notably, a wide range of female stars have been sharing that not only have they previously undergone breast augmentation surgery, but they’ve since opted to remove their implants, including Chrissy Teigen, Victoria Beckham, Tori Spelling, and Yolanda Hadid. It’s refreshing, especially considering the strong role that celebrities play in affecting cultural beauty standards. But the question is Why now? Here, we break down three major movements that are inspiring stars to divulge their explant surgeries—and what that means for the future of breast augmentation.
The aesthetic and style trend cycle
If you or a family member ever had Buns of Steel on VHS, you’re familiar with the look of the ’80s: leg warmers and neon leotards filled out by lean figures. When the next decade hit, however, the bodies of the busty stars of Baywatch became the new standard. But as style junkies have noticed, the late ’80s and early ’90s are back in a big way—including the desire for smaller and more athletic-looking breasts.
“In the past three to five years, clothes have changed so much, [and] an athletic look is more in now than it’s been,” says Nashville-based board-certified plastic surgeon Dr. Melinda Haws. “I’m making more B cups than I ever have in my entire career—and I’ve been in practice for more than 20 years.” In regard to athleticism in particular, Glee star Heather Morris cited pain when working out as one of her primary reasons for her breast implant removal. Other stars, including Chrissy Teigen, wanted to be able to wear dresses in their true size.
Dr. Haws adds that both physicians and patients have also gotten better at communicating, which has led to an evolution in breast enhancement. Previously, when patients would request fuller breasts, many surgeons would default to breast implant surgery. “An implant makes you bigger, not necessarily fuller—but often, what a lot of women weren’t articulating is that they just wanted a breast lift,” says Dr. Haws. In fact, Ayesha Curry revealed in an issue of Working Mother that what she had actually wanted during her breast enhancement was a lift, but what she got—and removed—was breast implants in an uncomfortably large size.
Breast lift, also known as mastopexy, has become more popular in recent years, which has likely added to the explant trend. It’s also worth noting that breast lifts are frequently performed in tandem with breast implant removal, as Chrissy Teigen revealed. “The goal [with explant surgery] is to repair what the implant has done and leave the woman with a breast that is approaching what she started with,” explains Beverly Hills, California, board-certified plastic surgeon Dr. Kelly Killeen. “I usually repair the muscle, if the muscle’s been lifted, and then I do some fancy footwork internally, to try to get a rounder, narrower breast.” Should more work be required —which is especially the case when an en bloc capsulectomy has been performed; more on this later—Dr. Killeen will do some fat grafting or a breast lift. “Things change with time, and they can look better even just with plain old boring removal,” she adds.
Dr. Haws agrees, remarking that while many patients believe getting big implants will permanently deform their breasts, this is not usually the case. “It’s really fascinating, how elastic the breast is,” she says. “Provided that you haven’t had significant weight changes or pregnancies with prolonged breastfeeding, they often go back to where they were pre-implant.” When working with patients who are removing their old saline implants (which were especially popular in the ’90s and early ’00s), Dr. Haws will often deflate them ahead of time. “When they let their breasts contract up, 90% of the time, they are astounded by how much better and how much more breast tissue they have than they thought,” she says.
Body positivity and celebration of individuality
While unsolicited criticism of women’s bodies has always persisted in the media, it never seemed as overt as it did in the early 2000s. The typical body goals of that era: thin bodies with super-flat stomachs (that you could flaunt in super-low-rise jeans, of course), and big boobs (think Christina Aguilera in her “Dirrty” phase). The advent of digital journalism and social media only accelerated the popularity and normativity of these body types.
“Fame has really become a full-blown, addictive response to clicks and likes, which has taken the place of a more elongated fame trajectory,” explains Dr. Donna Rockwell, a celebrity psychologist and fame expert. “Fame comes fast, and no one’s prepared for it.” And while we all know many get plastic surgery for themselves, regardless of societal input, we also know that plenty get work done to be more appealing to others, stars included. Supermodel Gisele Bündchen shared just that with People: “I was always praised for my body, and I felt like people had expectations from me that I couldn’t deliver,” said Bündchen, who chose to get implants to balance her appearance after breastfeeding. She also shared in her memoir that she immediately regretted the procedure. In an interview with Glamour UK, Chrissy Teigen also disclosed that her implant surgery was driven by her modeling career, particularly for swim campaigns: “I thought, ‘If I’m going to be posing, laid on my back, I want them to be perky!’”
“There is such pressure to look the way that middle America believes one should look, such that commercialism can reap its greatest profits in making everybody—particularly women and girls—vulnerable to not ‘being enough,’” says Dr. Rockwell. “It makes them feel that they’re not worthwhile based on the most basic part of their humanity, so there is this addiction to staying hot in order to feel a sense of worth.”
But happily, those tides have been turning, especially in the past decade. “We’ve experienced a lot of history rather quickly in the context of women’s rights in this country,” opines Dr. Rockwell. “The #MeToo movement really reoriented the dialogue around the way a woman interprets her own uniqueness and reclaims her authentic self.” Body positivity and the willingness to be more vulnerable without shame have made it feel more comfortable to be our true selves—and this also means that now “we can believe ourselves when we know something doesn’t feel right,” says Dr. Rockwell. This is reflected in the remarks of some stars who’ve previously had breast augmentations—like Adrienne Bailon, Pamela Anderson, and Mena Suvari—who have confessed that the procedure negatively affected their self-esteem and made them feel less like themselves, leading them to remove their implants, restoring both their bodies and their confidence levels.
And for many women, these cultural shifts have caused changes in their mindsets, reframing the ideas of aging and changing bodies. In 2018, Melissa Gilbert told People that she realized she had been placing an enormous amount of pressure on herself to stay youthful. She decided to remove her implants so she could “age gracefully and appropriately and let my body and my face become whatever they are going to become,” adding, “I just had to sit back and reevaluate and find my way, and I’m actually really glad that I did.”
Wellness culture and breast implant illness
Eating nutrient-dense foods, detoxifying our beauty routines, practicing mindfulness—being more in tune with our bodies and the attention to self-care are wonderful aspects of wellness culture. But one could also make the case that society has never been more unwell. A key example of this is that anxiety is on the rise in people of all ages, in large part due to social media. Since humans first evolved, our brains’ amygdalas have played an important role in the analysis of threats. While our ancestors may have had to worry about sabre-toothed tigers, today’s threats are more psychological, such as the concern over toxins in our skin care and aesthetics treatments. Anxiety and intrusive thoughts like “What is ‘wrong’ with me?”—whether something is actually wrong or not—cause your brain to search for answers, for better or for worse.
One such example of this is the rise of breast implant illness (BII), a relatively new condition with a variety of symptoms affecting everything from gut health to mental wellness, including persistent body pain and chronic fatigue. However, it’s worth noting that this is a controversial disease: No clinical testing has yet been able to prove its existence. Dr. Haws is involved in an ongoing study on BII, the first paper of which was recently published in the Aesthetic Society Journal. The study examined three groups of women: those with BII symptoms requesting implant removal, those without symptoms getting explants, and women getting breast enhancement sans implant. Regardless of the way the participants’ implants were removed, the majority of them experienced significant and lasting improvement in their symptoms. “But there’s no lab value, which is something we’ve been trying to find with the study,” says Dr. Haws. “We haven’t found hard, objective data that you can measure to say, ‘This makes it breast implant illness.’”
As women have looked for causes of their mysterious symptoms—and been turned away by providers who don’t acknowledge them or the potential existence of BII—they’ve forged online communities like The Heal Is Real and Breast Implant Illness and Healing by Nicole for connection and affirmation. In spaces like these, women can share their personal experiences and advice, including surgery types and providers.
For some time now, Dr. John Paul Tutela, a board-certified plastic surgeon in Livingston, New Jersey, has been one of the BII community’s top providers in the NYC area. Shortly after completing his medical training, a patient came in and shared a list of symptoms she’d been experiencing, an online community she’d found, and her self-diagnosis of BII. “I was surprised that I first heard of it from a patient, as opposed to my training,” explains Dr. Tutela, who, after researching the condition, discovered that many women were experiencing symptoms. The patient explicitly requested an en bloc capsulectomy, with which Dr. Tutela complied. “She had a great outcome visually and with her symptoms—many of them resolved starting right after surgery,” he says. Explants make up approximately 5 percent of his practice.
The BII community feels strongly that en bloc capsulectomy is the best choice for explant surgery. During this procedure, a surgeon removes the entirety of the capsule, or scar tissue formed around an implant, in one piece with the implant. “They say that you should remove the implant and the capsule and a rim of healthy tissue in order to keep the toxins in,” says Dr. Killeen. However, as seen in Dr. Haws’ study, the method of implant removal is not necessarily a determining factor in how women with BII feel post-op. En bloc capsulectomy is also a riskier procedure with higher side effects, and it can result in more cosmetic damage to the breast. “We see people every day with breasts that are horribly deformed after having that kind of removal,” says Dr. Killeen, adding that this experience is even more emotionally devastating when patients experience suboptimal improvement in their symptoms.
Anecdotally, Dr. Tutela has found that the type of implant removal has made little difference to the appearance of his patients’ breasts and notes that nearly every one of his patients who has undergone the procedure has had a resolution in BII symptoms. Still, even as a popular provider in this community, Dr. Tutela points out that BII is a gray area of medicine. “The symptoms are very vague,” he says. “I always tell my patients that it’s important to also see another physician, to really do a thorough workup of these symptoms.” He even noted that one patient who came in for an explant consultation returned months later to share that, after discontinuing a collagen supplement, found that all of her symptoms went away.
Naturopath Dr. Peter Bongiorno, who has treated multiple patients with BII symptoms, has found that many who experience said symptoms are those with preexisting medical conditions—like explant advocate Yolanda Hadid’s Lyme disease or Drag Race star Michelle Visage’s Hashimoto’s. “Most people don’t show correlations [between implants and symptoms], but every once in a while, you encounter people who are genetically susceptible,” he says. Often, these patients will have had prior issues, such as food sensitivities, gut inflammation, or hormonal imbalances, that can promote inflammatory issues. “Then a breast implant and the immune system’s response takes them over the top,” says Dr. Bongiorno. “It’s probably multifactorial, because if it weren’t, you would see a lot of people [with BII] relative to the number of people who get breast implants—but just because the numbers are low doesn’t mean it’s insignificant or doesn’t exist.”
Those in the BII community speaking up about their symptoms were able to shed light on this concerning issue, “but as good as social media can be, it can also be really terrible,” says Dr. Tutela. “I’ve had patients come in, feeling like they’ve gotten bullied and pressured . . . harsh treatment for somebody who’s just trying to make sense of it all.” Fitness influencer and personal trainer Bec Donlan—who has Hashimoto’s and Sjögren’s syndrome—agrees. Two years ago, she had her implants removed after experiencing nearly the entire spectrum of BII symptoms, but “it was these extremists that actually made me turn a blind eye to BII, as I couldn’t relate to them,” she recalls. “I realized it was more like a cult, preying on everyone’s desperation for answers.”
Donlan, a self-described aesthetics lover, is frustrated by the black-and-white nature of the BII community. “I really believe self-love and body positivity come in many different forms and are so personal . . . that’s the beauty of it,” she says. She remembers being attacked on Instagram after her explant surgery for things as simple as getting her nails done, with members of BII groups calling her out for “adding to her system’s toxic load.” “I was made to feel uncomfortable because I love beauty and to them, that was seen as I don’t love myself enough, which couldn’t have been further from the truth,” says Donlan. (For what it’s worth, Donlan still gets aesthetic treatments—though none that incorporate foreign objects.) Not only does she love herself since her explant surgery, but she now actually feels like herself—and the skin on her breasts have fully bounced back, leaving her very happy with her post-procedure look.
Beyond BII, another frightening concern regarding implants in recent years is BIA-ALCL, or breast implant–associated anaplastic large-cell lymphoma. Thankfully, this form of cancer is very rare, with a low mortality rate, and is predominantly associated with textured implants, some of which have been recalled by the FDA. BIA-ALCL typically presents as one breast suddenly swelling long after surgery, often years later. To evaluate for cancer, your provider would likely drain the fluid and send it to a lab. Catching it early is key—but it typically is, as patients often come in because they’re concerned about their swollen breast. “When it’s caught early, it’s luckily very easy to treat and doesn’t require chemotherapy in most patients,” says Dr. Killeen.
A far more prevalent health concern about breast implants is wear and tear. Though implants are FDA-cleared devices, their longevity is only understood within the body. “It’s something to think about, but it’s not like you have a ticking time bomb in you,” says Dr. Killeen. The most common issue is leaks. According to Dr. Killeen, ruptures most often occur when ripples in an implant rub together; over years, this friction can cause a microtear and subsequent leak. Though she’s seen patients who have had the same implants for 20 years without any issues, she typically recommends a patient gets a replacement at the 10-year mark. “There is maintenance [required] with breast implants,” says Dr. Haws. “Our car tires, our hip joints all wear out—a breast implant is probably not going to last you forever.” Stars including Sharon Osbourne, Pamela Anderson, Stevie Nicks, and Yolanda Hadid all have said they’ve experienced ruptures.
If you’re concerned about the integrity of your implants—though it’s worth noting that implants made in recent years are sturdier devices than those of the past—book an appointment with your provider for ultrasound imaging. “High-definition ultrasound from a skilled practitioner is as good as MRI,” says Dr. Killeen. “In my experience, it’s less expensive and easier to get done, and I’ve had good success getting insurance to cover it for my cosmetic patients.” Dr. Killeen suggests getting an ultrasound with your age-appropriate breast cancer screening or every other year after the first three years, for younger implant patients.
Ultimately, the fact that celebrities—who are seen as role models by many—are being open about their plastic surgery is encouraging, but there’s still a lot of work to be done. One of the goals at RealSelf is to remove the stigma of cosmetic procedures; breast augmentations and removals are elective, which means the choice is yours, and you alone get to decide whether a certain procedure is right for you. We celebrate individuals making informed decisions about what’s best for their bodies, whether that’s living life au naturale or trying the latest surgical enhancements.
