Former cosmetic surgeon Robert Yoho, MD, after retiring from medical practice in 2019, became an author and health care whistleblower and recently addressed the “explant” trend in which breast implants are surgically removed. According to the American Society of Plastic Surgeons, 306,196 women bought breast augmentation in 2024. In 2021, the FDA added a boxed warning to implants cautioning that they are linked to breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), squamous cell carcinoma, and systemic symptoms known as breast implant illness (BII). Complications increase over time, adds the warning. As people reconsider or decline implants, are there market implications?
“The backlash does not threaten that model. It extends it,” says Dr. Yoho. “Explant, dissolving, restoration, and revision are all billable, all cash, and all performed on women who have already proved they will pay. Insurance usually refuses to pay for the removal on the grounds that the first operation was cosmetic. So, the woman who paid to put them in pays again to take them out, at a higher price, and pays a third time to rebuild what is left.”
According to Dr. Yoho, silicone gel implants rupture silently (which is why the FDA suggests getting baseline scans), but when a saline implant fails, the recipient knows within a day, because the breast goes flat. Yet warnings are scarce in a system that he says is a closed loop.
“The [cosmetic surgery] consultation is a sales meeting run by a man in a white coat and the product is an operation on a healthy body,” he cautions. “Almost nowhere else in medicine are the diagnosing doctor, the treating doctor, and the salesman the same person, with nobody else in the room.”
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Dr. Yoho adds that studies given to prospective patients are “designed, paid for, and published by the people selling the device” and that a woman who started surgeries at 25 has “spent the price of a house down payment on a body” by buying a device that will need replacing for the next foreseeable 60 years. To protect themselves, patients should ask the surgeon how many procedures he did last year and how many revisions he performed on his own patients. They should also ask a surgeon what his repeat-surgery rate is at 10 years, whether the changes are permanent and, if not, what the upkeep costs will be.
People who pursue cosmetic surgery, especially repeat patients, may suffer from mental issues according to medical literature, and it’s a real problem, says Dr. Yoho. Body dysmorphic disorder, in which the person is tormented by a flaw other people cannot see, drives about one patient in seven, he calculates, and is often worsened by surgery.
“Nobody in any of these rooms checks the patient’s mind. Here is a psychiatric condition present in 15 percent of the customers, which the product reliably worsens, and which nobody in the industry has a financial reason to find. If Pharma sold a drug with that profile, the class-action lawyers would own the company. In cosmetics it is called a busy practice.”
Martha Rosenberg is an investigative reporter whose work has appeared in the British Medical Journal (BMJ), Consumer Reports, Public Citizen, the Center for Health Journalism at USC Annenberg, the Nieman Foundation for Journalism at Harvard University, and other outlets. She studied at Rush Medical School and writes on health care, food, medicine, and public policy.
Rosenberg’s reporting has been cited by Memorial Sloan Kettering Cancer Center, Mayo Clinic Proceedings, Public Library of Science Biology, ScienceDirect, the Journal of Pain & Palliative Care Pharmacotherapy, the Journal of Trauma & Dissociation, Britannica, National Geographic, Hastings Law Journal, and Wikipedia. She is the author of several books, including Multidisciplinary Management of Chronic Pain: A Practical Guide for Clinicians, Born With a Junk Food Deficiency, Big Food, Big Pharma, Big Lies, and Food, Clothes, Men, Gas and Other Problems. She publishes on Substack, OpEdNews, and her Amazon author page.
