The Changing Landscape of Celebrity Plastic Surgery
For as long as our society has been captivated by pop culture and celebrity news, we've been conjecturing about alterations in stars' looks, no matter how minor. Marilyn Monroe faced speculation regarding changes to her chin and nose, and nowadays, countless celebrities' bodies are closely examined by paparazzi, editors, and avid fans on social media, seeking any modifications.
In recent times, however, a shift has occurred – celebrities are coming forward to disclose their surgical procedures. Notably, a wide array of female stars have shared that not only did they previously undergo breast augmentation surgery but have now chosen to remove their implants, including Chrissy Teigen, Victoria Beckham, Tori Spelling, and Yolanda Hadid. This is refreshing, especially considering the significant influence celebrities have on cultural beauty standards. But the question remains: Why now? Here, we analyze three major developments that are motivating stars to reveal their explant surgeries and what this implies for the future of breast augmentation.
The Aesthetic and Style Trend Cycle
If you or a family member ever owned Buns of Steel on VHS, you're familiar with the style of the '80s: leg warmers and neon leotards worn by slender figures. When the next decade arrived, the curvaceous bodies of the stars of Baywatch became the new norm. But as fashion enthusiasts have observed, the late '80s and early '90s are making a strong comeback – including the preference for smaller and more athletic-looking breasts.
"In the past three to five years, clothing has undergone significant changes, and an athletic appearance is more in vogue than ever before," says Nashville-based board-certified plastic surgeon Dr. Melinda Haws. "I'm creating more B cups than I ever have throughout my entire career, and I've been practicing for over 20 years." Specifically in relation to athleticism, Glee star Heather Morris cited workout pain as one of the main reasons for her breast implant removal. Other stars, like Chrissy Teigen, desired to be able to wear dresses in their true sizes.
Dr. Haws adds that both doctors and patients have improved communication, leading to advancements in breast enhancement. Previously, when patients requested fuller breasts, many surgeons defaulted to breast implant surgery. "An implant makes you larger, not necessarily fuller – but often, what many women didn't express clearly is that they merely wanted a breast lift," says Dr. Haws. In fact, Ayesha Curry revealed in an issue of Working Mother that what she truly wanted during her breast enhancement was a lift, but what she received – and later removed – were breast implants that were uncomfortably large.
Breast lift, also known as mastopexy, has gained popularity in recent years, likely contributing to the explant trend. It's also worth mentioning that breast lifts are often performed concurrently with breast implant removal, as Chrissy Teigen disclosed. "The objective [with explant surgery] is to rectify what the implant has caused and leave the woman with a breast that resembles her original one," explains Beverly Hills, California, board-certified plastic surgeon Dr. Kelly Killeen. "I typically repair the muscle if it's been lifted and then undertake some intricate internal procedures to strive for a rounder and narrower breast." If more work is necessary – especially when an en bloc capsulectomy has been performed; more on this later – Dr. Killeen will perform some fat grafting or a breast lift. "Things evolve over time, and they can look better even with a straightforward removal," she adds.
Dr. Haws concurs, noting that while many patients believe obtaining large implants will permanently distort their breasts, this is not typically the case. "It's truly astonishing how elastic the breast is," she remarks. "Provided that you haven't undergone substantial weight changes or pregnancies with prolonged breastfeeding, they often return to their pre-implant state." When working with patients removing their old saline implants (which were particularly popular in the '90s and early '00s), Dr. Haws often deflates them beforehand. "When they allow their breasts to contract, 90% of the time, they are amazed by how much better and how much more breast tissue they have than they anticipated," she says.
Body Positivity and Celebration of Individuality
While unsolicited critiques of women's bodies have persisted in the media, they never seemed as blatant as in the early 2000s. The typical body ideals of that era: slender bodies with extremely flat stomachs (that you could flaunt in ultra-low-rise jeans, of course), and large breasts (think Christina Aguilera in her "Dirrty" phase). The advent of digital journalism and social media only expedited the popularity and normalization of these body types.
"Fame has truly become a full-fledged, addictive response to clicks and likes, which has supplanted a more prolonged path to fame," explains Dr. Donna Rockwell, a celebrity psychologist and expert on fame. "Fame arrives rapidly, and no one is prepared for it." And while we all know many undergo plastic surgery for themselves, regardless of societal input, we also know that numerous individuals get procedures done to be more appealing to others, including celebrities. Supermodel Gisele Bündchen shared this with People: "I was constantly praised for my body, and I felt as though people had expectations of me that I couldn't fulfill," said Bündchen, who opted for implants to balance her appearance after breastfeeding. She also disclosed in her memoir that she immediately regretted the procedure. In an interview with Glamour UK, Chrissy Teigen also revealed that her implant surgery was driven by her modeling career, especially for swimwear campaigns: "I thought, 'If I'm going to be posing, lying on my back, I want them to be perky!'"
"There is such pressure to conform to a certain appearance that middle America deems appropriate, such that commercialism can maximize its profits by making everyone – particularly women and girls – vulnerable to feeling inadequate," says Dr. Rockwell. "It makes them believe they are not valuable based on the most fundamental aspect of their humanity, leading to this addiction to maintaining an attractive appearance to feel a sense of worth."
But fortunately, these trends have been reversing, especially over the past decade. "We've witnessed a considerable amount of history in a relatively short period within the context of women's rights in this country," opines Dr. Rockwell. "The #MeToo movement truly redirected the conversation regarding how a woman interprets her uniqueness and reclaims her true self." Body positivity and the willingness to be more vulnerable without shame have made it more comfortable to be our authentic selves – and this also means that now "we can trust ourselves when we sense something is amiss," says Dr. Rockwell. This is reflected in the statements of some stars who previously had breast augmentations – such as Adrienne Bailon, Pamela Anderson, and Mena Suvari – who have confessed that the procedure negatively impacted their self-esteem and made them feel less like themselves, prompting them to remove their implants and restore both their bodies and their confidence levels.
And for many women, these cultural shifts have led to changes in their mindsets, redefining the concepts of aging and bodily changes. In 2018, Melissa Gilbert told People that she realized she had been exerting an excessive amount of pressure on herself to remain youthful. She decided to remove her implants so she could "age gracefully and appropriately and allow my body and my face to become whatever they will," adding, "I simply had to step back, reevaluate, and find my path, and I'm truly glad that I did."
Wellness Culture and Breast Implant Illness
Consuming nutrient-rich foods, detoxifying our beauty regimens, practicing mindfulness – being more attuned to our bodies and focusing on self-care are excellent aspects of wellness culture. But one could also argue that society has never been more unhealthy. A key example of this is the rising prevalence of anxiety among people of all ages, largely attributed to social media. Since the dawn of humanity, our brains' amygdalas have played a crucial role in threat analysis. While our ancestors might have worried about saber-toothed tigers, today's threats are more psychological, such as concerns over toxins in our skincare and aesthetic treatments. Anxiety and intrusive thoughts like "What's wrong with me?" – whether there is actually something wrong or not – cause your brain to search for answers, for better or for worse.
One such instance is the emergence of breast implant illness (BII), a relatively new condition with a variety of symptoms affecting everything from intestinal health to mental well-being, including persistent body pain and chronic fatigue. However, it's important to note that this is a controversial disorder: No clinical tests have thus far been able to confirm 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 undergoing explants, and women getting breast enhancement without implants. Regardless of the method of implant removal for the participants, the majority experienced significant and lasting improvement in their symptoms. "But there's no laboratory value, which is what we've been striving to discover in the study," says Dr. Haws. "We haven't found hard, objective data that you can measure to assert, 'This constitutes breast implant illness.'"
As women have sought the causes of their mysterious symptoms – and been turned away by providers who do not acknowledge them or the potential existence of BII – they have established online communities like The Heal Is Real and Breast Implant Illness and Healing by Nicole for connection and validation. In such spaces, women can share their personal experiences and advice, including types of surgeries and providers.
For some time now, Dr. John Paul Tutela, a board-certified plastic surgeon in Livingston, New Jersey, has been one of the leading providers in the BII community in the NYC area. Shortly after completing his medical training, a patient came in and shared a list of symptoms she had been experiencing, an online community she had discovered, and her self-diagnosis of BII. "I was surprised that I first heard of it from a patient rather than during my training," explains Dr. Tutela, who, after researching the condition, found that many women were experiencing symptoms. The patient explicitly requested an en bloc capsulectomy, which Dr. Tutela complied with. "She had an excellent outcome visually and with her symptoms – many of which resolved immediately after surgery," he says. Explants constitute approximately 5 percent of his practice.
The BII community strongly believes that en bloc capsulectomy is the ideal choice for explant surgery. During this procedure, a surgeon removes the entire capsule, or scar tissue formed around an implant, along with the implant in one piece. "They say that you should remove the implant, the capsule, and a rim of healthy tissue to prevent the spread of toxins," 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 after the operation. En bloc capsulectomy is also a riskier procedure with higher side effects and can result in more cosmetic damage to the breast. "We see people every day with horribly deformed breasts after this type of removal," says Dr. Killeen, adding that this experience is even more emotionally distressing 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 seen a resolution in BII symptoms. Still, even as a popular provider in this community, Dr. Tutela points out that BII is a gray area in medicine. "The symptoms are very vague," he says. "I always tell my patients that it's important to also consult another physician to conduct a comprehensive examination 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, all of her symptoms disappeared.
Naturopath Dr. Peter Bongiorno, who has treated multiple patients with BII symptoms, has discovered that many who experience these symptoms have 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 so often, you encounter individuals who are genetically susceptible," he says. Often, these patients have had prior issues, such as food sensitivities, intestinal inflammation, or hormonal imbalances, that can contribute to inflammatory problems. "Then a breast implant and the immune system's response push them over the edge," says Dr. Bongiorno. "It's likely multifactorial because if it weren't, you would see a significant number 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 who have spoken out about their symptoms have managed to shed light on this concerning issue, "but as beneficial as social media can be, it can also be quite detrimental," says Dr. Tutela. "I've had patients come in feeling as though they've been bullied and pressured... harsh treatment for someone who's merely 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 range 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 lover of aesthetics, is frustrated by the black-and-white nature of the BII community. "I truly believe self-love and body positivity come in numerous diverse forms and are highly personal... that's the beauty of it," she says. She remembers being attacked on Instagram after her explant surgery for simple things like getting her nails done, with members of BII groups criticizing her for "increasing her body's toxic load." "I was made to feel uncomfortable because I love beauty and to them, that was seen as not loving myself enough, which couldn't be further from the truth," says Donlan. (For what it's worth, Donlan still undergoes aesthetic treatments – though none that involve foreign objects.) Not only does she love herself since her explant surgery, but she now truly feels like herself – and the skin on her breasts has fully recovered, leaving her very satisfied with her post-procedure appearance.
Beyond BII, another concerning aspect regarding implants in recent years is BIA-ALCL, or breast implant–associated anaplastic large-cell lymphoma. Thankfully, this form of cancer is extremely rare, has a low mortality rate, and is mainly associated with textured implants, some of which have been recalled by the FDA. BIA-ALCL typically presents as sudden swelling of one breast long after surgery, often years later. To assess for cancer, your provider would likely drain the fluid and send it to a laboratory. Early detection is crucial – but it typically occurs, as patients often come in due to concerns about their swollen breast. "When it's detected early, it's fortunately very easy to treat and doesn't require chemotherapy in most patients," says Dr. Killeen.
A more prevalent health concern related to breast implants is wear and tear. Although implants are FDA-approved devices, their longevity is only understood within the body. "It's something to consider, but it's not as if you have a time bomb inside you," says Dr. Killeen. The most common issue is leaks. According to Dr. Killeen, ruptures frequently occur when ripples in an implant rub together; over time, this friction can cause a microtear and subsequent leak. Though she has seen patients who have had the same implants for 20 years without any problems, she typically recommends that a patient gets a replacement at the 10-year mark. "There is maintenance [required] for 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 such as Sharon Osbourne, Pamela Anderson, Stevie Nicks, and Yolanda Hadid have all stated that 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 than those of the past – schedule an appointment with your provider for ultrasound imaging. "High-definition ultrasound from a skilled practitioner is as effective as MRI," says Dr. Killeen. "In my experience, it's less costly and easier to obtain, and I've had success getting insurance to cover it for my cosmetic patients." Dr. Killeen suggests getting an ultrasound along 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 regarded as role models by many – are being open about their plastic surgery is encouraging, but there's still much work to be done. One of the goals at Ruli is to eliminate the stigma associated with cosmetic procedures; breast augmentations and removals are elective, meaning the choice is yours, and you alone determine whether a particular procedure is right for you. We celebrate individuals making informed decisions about what's best for their bodies, whether that means living naturally or trying the latest surgical enhancements.
