Physician Perspectives on Breast Implant Illness: A Survey of Members of the American Society of Plastic Surgeons
Kimberly Khoo1,Arya Akhavan1,Joseph Puthumana1,Rafael Felix Tiongco1,Leen El Eter1,Alexander Sun1,Carisa Cooney1,Michele Manahan1
1Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD
Purpose: Breast implant illness (BII), a broad constellation of symptoms in patients with breast implants, is increasingly being reported by patients, providers, and in online communities. Though BII is not a definitive diagnosis, patients are still presenting to their healthcare providers with concerns about unexplained symptoms and requests to remove their breast implants. Current literature seeks to understand patient perspectives of BII, yet few studies examine the other half of the contributors to conversations surrounding BII: physician opinions. This pilot study aims to understand plastic surgeons' perspectives on BII, as well as how physicians are managing the condition in their practices and how patients are being referred to these surgeons. MethodsAn IRB-approved survey was distributed to all members of the American Society of Plastic Surgeons (ASPS). Eligible participants are board-certified plastic surgeons who are active members of ASPS. The survey consisted of questions inquiring about the surgeon's experience with BII as well as their own opinions about the diagnosis. Survey responses were analyzed using qualitative coding and descriptive statistics.
Results: A total of 589 responses were collected. Regarding opinions on whether BII is a distinct clinical entity, 26% (n=153) of respondents believe it is while 36.2% (n=213) feel that the current scientific evidence is insufficient. Of the 492 physicians who reported having previously seen at least one patient who believed they had BII, 88.2% (n=434) answered that these patients had received information about the condition from their own internet searches, 63.8% (n=314) had received this information through social media, and 51.6% (n=254) had received information about the condition through Facebook support groups. The most common reported symptoms that these patients saw their physician for were fatigue (93.1%), joint pain (72.4%), brain fog (71.5%), and muscle pain (63.6%). A subset of survey respondents answered that these patients had been referred to them by another provider (n=201), most commonly by a primary care physician (78.6%) or a medical subspecialty physician (38.8%) such as a rheumatologist or chronic pain specialist. Reported alternative differential diagnoses included endocrine, psychiatric, rheumatologic, and autoimmune disorders.
Conclusion: While no scientific consensus identifies BII and its characteristics as a distinct disease, plastic surgeons are nonetheless encountering patients seeking relief from its symptoms. Understanding plastic surgeons' opinions on BII at leadership levels can guide future research, efforts for patient counseling, and collaboration with primary care providers and other specialists who may interface with this clinical entity.
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