Defining “Breast Implant Illness”: Patient-Reported Outcomes After Breast Explantation
Corinne Wee1, Joseph Younins1, Arvin Smith1, Nazilla Seyed Forootan1, Samuel Boas1, Kelsey Isbester1, Donald Harvey1, Anand Kumar1, Lu-Jean Feng2.
1Case Western Reserve University, Cleveland, OH, USA, 2The Lu-Jean Feng Clinic, Pepper Pike, OH, USA.
BACKGROUND: Breast Implant Illness (BII) after aesthetic breast enhancement remains an understudied syndrome with patients attributing a menagerie of symptoms to breast implants including joint/muscle pain, hair loss and difficulty breathing. We hypothesized that patients presenting with BII constellation syndrome would have significant improvement in symptoms after implant removal/capsulectomy surgery. The aim of this study was to measure patient-reported outcomes before and after implant removal surgery.
METHODS: A retrospective study of all patients presenting to a single-surgeon plastic surgery practice requesting removal of breast implants over a four-year period was conducted. Patients were given a pre-operative survey evaluating 11 commonly cited symptom domains on a linear continuous aggregate scale from 0 (absent) to 5 (very severe). Patients received the same survey at each post-operative visit; pre- vs. most recent post-operative survey scores were used for comparison. Statistical analysis included an Exact Sign test for analysis of nonparametric and nonsymmetric data. RESULTS: Seven hundred forty-eight (748) patients were identified during the study period with a post-operative response rate of 75.9%. Most recent follow-up ranged from post-operative day 2 to 937 (mean: 91). The median pre-operative survey score and symptom severity was significantly higher, 27/55 vs. the median post-operative score of 8/55 (p<0.01). All 11 symptom domains demonstrated statistically significant improvement (p<0.01), including numbness and tingling in the extremities, arthralgias and myalgias, alopecia, memory/recall, dry eyes, chronic fatigue, breast pain, rash/urticaria, irritable bowel syndrome, flu-like symptoms, and difficulty breathing. CONCLUSION: This study demonstrates patients presenting with constitutional symptoms after breast augmentation had consistently and significantly improved quality of life as reported in multiple study domains after implant and capsule removal. While Breast Implant Illness remains understudied and controversial in the plastic surgery literature, our study findings highlight the potential health benefits of removal of breast implants in select breast augmentation patients.
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