A comparison of Breast Implant Illness-related symptoms between breast cancer survivors and breast augmentation recipients

Background – ‘Breast Implant Illness’ (BII) refers to non-specific constitutional, rheumatic, mental and cognitive symptoms experienced by women with silicone breast implants (SBIs). This potential late effect of SBIs challenges the safety of SBI-use in oncologic breast reconstruction (BR). Previous studies on BII mainly focused on women with cosmetic SBIs. It remains unclear whether symptoms reported in this population differ from those reported by breast cancer (BC) survivors with SBI-based BR. Methods – We conducted a cross-sectional survey in a Dutch cohort including 578 breast augmentation recipients and 2, 884 BC survivors, of whom 1, 039 had an SBI-based BR. Eighteen BII-related symptoms were assessed. Multivariable logistic regression was used to compare breast augmentation recipients with BC survivors with and without SBIs. Results – Median follow-up time was 8.0 (IQR, 3.9) years. Overall, breast augmentation recipients had a higher risk of myalgia (Odds ratio (OR) 2.10, 95%CI [1.25–3.54]) and food intolerance (OR 1.77, 95%CI [1.01–3.09]) than BC survivors with SBIs, whereas the latter group did not report more BII-associated symptoms than BC survivors without SBIs. In a sensitivity analysis excluding BC patients treated with (neo)adjuvant systemic therapy, breast augmentation recipients reported more BII-related symptoms—headache, myalgia, hair loss, muscle weakness, sleep impairment, and morning stiffness (ORs 1.69–3.35; all p < 0.05) compared to BC survivors with SBIs. Conclusions – Breast augmentation recipients report more BII-related symptoms than BC survivors with or without SBIs. These findings do not support the hypothesis that BII is a distinct disease entity mediated by a generic SBI-related pathogenesis that exists across different populations. Trial registration: This study was preregistered at ClinicalTrials.gov on June 2 ^nd 2022 (NCT05400954).