Exploring Factors Associated with Implant Removal Satisfaction in Breast Implant Illness Patients: A PRO BREAST-Q Study

Abstract

Background: Breast implant illness (BII) is a poorly understood heterogeneous disorder treated with implant removal; however, patient-reported symptoms and outcomes after treatment remain unclear.

Methods: A retrospective review of patients undergoing bilateral breast implant removal related to BII by two surgeons at an academic medical center between 2018 and 2022 was conducted. Patients were surveyed using the BREAST-Q Reconstruction model with the American Society for Aesthetic Plastic Surgery BII survey extension. Outcomes were analyzed using multivariable logistic regression, adjusted for patient-associated factors.

Results: Forty-seven patients were surveyed with a response rate of 51% (n = 24). Of the 20 patients who completed the survey, the majority were White (85%), with 45% (n = 9) having a documented history of psychiatric illness. Six (30%) patients had capsular contracture and four (20%) had documented implant rupture. Most implant removal procedures (n = 12, 60%) were not covered by insurance. Fourteen (70%) patients reported a net improvement in their symptoms after implant removal, most commonly chest discomfort, muscle pain, fever, and headaches. Capsular contracture was predictive of reduced psychosocial, sexual, and breast satisfaction scores (P = 0.015). Self-pay was predictive of increased breast satisfaction scores (P = 0.009), but had no impact on symptomatic improvement. A reduced time to implant removal was predictive of fewer residual symptoms (P = 0.032). Psychiatric illness had no significant impact on the outcomes.

Conclusions: In the setting of suspected or diagnosed BII, a reduced time to implant removal may decrease the risk of residual symptoms and improve overall patient satisfaction. In patients with capsular contracture, preoperative counseling should emphasize that implant removal may only improve physical symptoms.

Fig. 1.

A summary of implant types removed. In a cohort of 20 patients, 20 pairs of implants (40 individual prostheses) were removed with the majority being smooth saline (70%, n = 14 pairs), four pairs being smooth silicone gel (20%), and only two pairs of implants being textured silicone gel (10%).

Fig. 2.

A summary of symptom improvement after breast implant removal. The graph displays the total number of patients reporting each symptom before intervention (light blue), and the number of patients who reported improvement in those symptoms post intervention (dark blue). Chest discomfort, muscle pain/weakness, headache, and fever were the least prevalent and most improved following implant removal.

Fig. 3.

Average BREAST-Q domain scores. The scores for each domain of the reconstruction BREAST-Q survey are displayed as mean values, along with SD, to represent the entire cohort.

Fig. 4.

Scoring breakdown of individual BREAST-Q components. The domain scores for psychosocial well-being (A), sexual well-being (B), satisfaction with breasts (C), and physical well-being (D) are broken down into four quartiles to represent lowest satisfaction, moderately low satisfaction, moderate satisfaction, and highest satisfaction, to accurately depict how many patients scored similarly for each component.