Baylee Saltmarsh knew something was wrong with her new breast implants as soon as the painkillers wore off.
Painful journey: Model-turned-fitness instructor Baylee Saltmarsh suffered from breast implant illness on top of a post-surgery infection that put her in hospital for two months.
She was only 18 and had undergone the surgery because she suspected her athletic build meant she was struggling to get modelling jobs. Feeling insecure and under pressure to conform to the industry's unrealistic expectations, she went to a cosmetic surgeon.
Post-surgery, the pain was intense as her body struggled to accommodate the implants, which were considerably larger than she had wanted.
Within 10 days, infection had set in on both sides, and the day before she turned 19, her body crashing from the infection, she was rushed to hospital for emergency surgery. She spent two months in hospital, and another four months on high-dose antibiotics before finally getting the all-clear.
Then the systemic symptoms began.
"I was falling asleep just putting my shoes on," Baylee, now 26, says.
"I had brain fog, my irritable bowel syndrome got worse, my hair was falling out, and I had unexplained rashes that were so bad I was spending two hours before a photoshoot with a make-up artist who specialised in covering up tattoos.
"Nobody mentioned my implants could be causing it, and I was just being dismissed by doctors, so I thought it was all in my head."
In 2019, two years after her initial surgery, her textured implants were recalled due to links with breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL), a form of cancer related to non-Hodgkin's lymphoma.
Scans showed multiple lumps in her chest wall, and while her biopsies were clear, she was at high risk of developing ALCL. Nevertheless, she couldn't face more surgery to remove them.
The following year, she left modelling and retrained in fitness, becoming a personal trainer specialising in Pilates. Still struggling with the systemic symptoms, she began to read about breast implant illness (BII), and realised other women were going through the same thing as she was.
She finally had the implants and the hardened tissue surrounding them removed in 2022 – against the advice of her surgeon, who told her BII was 'just a hypothesis'.
"I woke up from the surgery, and my head felt clear for the first time in years," she says.
"It was like a weight had literally been lifted. The inflammation and the rashes are gone now, and while the chronic fatigue is still a problem, it's something I'm working through.
"I am receptive that may be other things at play, but in my mind, the implants were causing inflammation in my body, and I just wanted them out.
"If I could go back, I would give 18-year-old me a hug and tell her she didn't have to do that to her body to conform to society's expectations of beauty."
She has now developed a following on Instagram and TikTok, where she regularly answers questions about breast implants and BII, trying to demystify the process and make sure other women considering implants have vital information she did not.
The challenges of breast implant illness
Sadly, stories like Baylee's are not uncommon.
About 20,000 Australian women get breasts implants every year, whether for cosmetic reasons or for reconstruction following breast cancer, but there is little data available on complications.
Good results: Professor Anand Deva, pictured, who established the world-first Breast Implant Clinic at Macquarie University, says In a six-month follow-up after removal, 80 per cent of patients with BII symptoms reported feeling significantly better.
There are no figures on how many women experience the better-known problems of leakage, rupture or deformity, let alone the myriad symptoms linked to BII, such as autoimmune disease, gastritis, chronic fatigue, joint pain, hair loss, anxiety and depression.
Head of Plastic and Reconstructive Surgery at Macquarie University Hospital, Professor Anand Deva has been performing breast augmentations and reconstructions for three decades.
In 2018, he set up the world-first Macquarie University Hospital Breast Implant Clinic to provide women with a low-cost, convenient way of having their implants checked and seeking help for complications.
Everyone with implants should have a yearly check, then after three to four years, think about getting some imaging done to make sure there's no pathology around them.
Since then, Professor Deva has been filling the gap in the understanding of complications by gathering data from his patients.
"About 80 per cent of women are coming to the clinic to seek help for physical complications, but we are seeing a rise in women with the symptoms of BII as more people learn about the condition," he says.
"It's still hard to put a number on how many women get these systemic symptoms, and we still don't know what causes them.
"There is such a wide range of symptoms and they vary not only from patient to patient but even in the same patient from month to month."
Some BII patients have leaking or ruptured implants, but most don't, so in trying to find the root cause, he and his colleagues have been investigating other aspects including the presence of bacteria and foreign body parties, as well as psychological links. They have found inflammation and changes in the tissue surrounding implants that suggests changes due to contact with foreign bodies, but the answer is likely to be more complex than a single cause.
Unknowns remain: After three years studying the symptoms of breast implant illness it is still not clear who is at risk, says Professor Deva, pictured.
The first option Professor Deva offers to all women with BII is removing their implants, and he and his colleagues are doing ongoing research on the physical and psychological results.
"What we do know is that when we offer these women explant surgery, with a full or partial capsulectomy to remove the thickened tissue that has formed around the implants, in many cases, most of their symptoms disappear and those that remain become less severe and less impactful in their lives," he says.
"But not everyone continues to feel great, which indicates there are likely to be other factors at play that we don't fully understand yet."
Removal success data
In a six-month follow-up after removal, 80 per cent of patients with BII symptoms reported feeling significantly better, and he recently presented at a conference in the US on new data that indicates this benefit continues in about 70 per cent of cases at the 12-month mark.
A common symptom of BII is anxiety, and in a collaborative study with psychologists that is now being finalised, women with BII symptoms were found to have anxiety levels three times higher than a control group of women with breast implants but no related health issues.
When the BII group's anxiety was assessed six months after explant surgery, it had returned to the same level as the control group.
"Taking the implants out and removing that concern of having something in their body that is making them sick is hugely beneficial to their mental health, and we know that the mind and body are closely linked," Professor Deva says.
"After studying this for three years, my thought is that must be a combination of physical, biological and psychological factors that leads some women to feel so unwell, but we still don't know who is at risk of developing BII."
The importance of regular check-ups
Breast implant design may have had a few tweaks along the way, but Professor Deva says implants are still essentially the same bag full of silicone that was created in the 1960s.
Being subjected to changes like pregnancy, breastfeeding, weight loss and menopause, they will eventually fail.
"Everyone with implants should have a yearly check, then after three to four years, think about getting some imaging done in the form of an ultrasound to mammogram to make sure there's no pathology around them," he says.
"There is still such a lack of understanding of BII that unless a clinician asks about systemic symptoms, they may never put two and two together.
"I also want to see surgeons taking responsibility for their own work, by doing these checks themselves and listening to their patients' concerns."
With the long history of regulatory failures, and the ongoing pressures of societal ideals of beauty, advertising and now social media, he says we are continuing to fail women – and we need to do better.
Professor Anand Deva is a Professor of Surgery at Macquarie Medical School, and Head of Reconstructive and Plastic Surgery at Macquarie University Hospital.
