Patient-reported Outcomes following Implant Removal for Breast Implant Illness

Abstract

PURPOSE: Current evidence has not linked breast implants to autoimmune or other systemic diseases; however, women continue to pursue explantation due to a heterogenous constellation of symptoms referred to as “breast implant illness” (BII). Although BII has no clear medical definition, pathophysiological explanation or diagnostic testing, a subset of patients report symptomatic improvement after explantation. Although several studies have attempted to clarify and better define this phenomenon, none have considered patient satisfaction and quality of life following implant removal. This study aims to assess patient reported satisfaction with the removal of implants through the use of the BREAST-Q. METHODS: Patients who underwent breast implant removal due to concerns for BII were asked to complete the augmentation BREAST-Q. Additionally, a survey was administered that queried 35 different BII-related symptoms and their response to implant removal. Questions specifically referencing the implants were removed because they were not applicable to this cohort. Consistent with scoring guidelines, missing data were replaced with the mean of remaining scores as long as 50% of questions were still completed. Outcomes in this cohort were compared with normative data for all modules this information was available for. Furthermore, satisfaction for patients who underwent explantation alone was compared with those who pursued explantation with cosmetic reconstruction. RESULTS: Of the 29 patients who underwent implant removal for BII, 16 patients (55.2%) completed the BREAST-Q and symptom survey. Mean age was 49.1 ± 10.8, and mean BMI was 25.1 ± 8. Interestingly, all patients were Whites. En bloc capsulectomy was requested by patients and performed in 100% of cases. The average time between augmentation and implant removal was 11.3 ± 6.2 months. Only 11 patients (68.8%) underwent implant removal and the other five underwent a cosmetic procedure (either autologous reconstruction or mastopexy) in addition to implant removal. Subjects report on average a total of 13.1 symptoms with brain fog, fatigue, chest discomfort, and anxiety being the most common. On average, symptoms of 14.9% of patients did not improve, those of 48.1% partially improved, and those of 37.0% were completely resolved. Compared with normative data, BII patients with implant removal alone had scores comparable to those of normative BREAST-Q data in the psychosocial well-being (P = 0.928), sexual well-being (P = 0.819), and satisfaction with breast modules (P = 0.529). They had lower scores for physical well-being (17 versus 86, P < 0.001). Upon subgroup analysis, implant removal with cosmetic procedures had a higher score in the satisfaction with breast module when compared with implant removal alone (76 versus 48, P = 0.022), though no other differences were seen. CONCLUSIONS: Concurrent with previous literature, patients with BII report some degree of symptomatic improvement after removal of implants. Patient-reported outcomes are similar to normative data in recently augmented patients. However, despite reported improvement of symptoms, physical well-being remains lower for patients with breast implant illness even after implant removal. Implant removal may be combined with cosmetic procedures to improve satisfaction with breasts. These results may aid in preoperative patient counseling.