Associations Between Breast Implant Characteristics, Autoimmune Disease History, and Post-augmentation Symptom Reporting Among Puerto Rican Women

Background Breast augmentation surgery (BAS) is one of the top cosmetic surgical procedures performed in the United States every year. There are various breast implant options, such as saline, silicone, smooth, and textured implants. Breast implant illness (BII) is a disorder associated with a wide array of symptoms presenting post breast implant surgery and is often associated with autoimmune disorders. Despite its prevalence, no comprehensive studies have investigated the occurrence of concerning symptoms after breast implant surgery in Puerto Rico (PR), and specific risk factors remain unidentified. This study aims to address this knowledge gap, evaluating self-reported symptom presentation post BAS in Puerto Rican women with respect to their specific implant type, surface finish, and past medical history. Methods This was a cross-sectional, quantitative survey study. A structured 18-item questionnaire was administered to Puerto Rican women over the age of 21 who had undergone breast augmentation. Participants were recruited through social media, referrals, and a breast radiology clinic. The survey included questions on demographics, medical history, implant characteristics, and symptomatology. Descriptive and inferential statistical analyses were performed. Results Among the 361 complete survey responses evaluated, 56.7% of participants reported having silicone implants, 35.8% saline, and 5.2% were unsure of their implant type. Additionally, 11.3% of participants had textured implants, 52.1% smooth, and 36.4% were unsure of their implant's surface finish. Overall, 30.6% of participants reported experiencing concerning symptoms following implant placement. The most prevalent symptoms were anxiety or depression (69.4%), body or joint pain (66.7%), cognitive or memory dysfunction (63.9%), muscle pain (54.6%), and abnormal fatigue (50%). When evaluating symptoms based on implant surface finish, 41.02% of those with textured implants reported concerning symptoms, compared to 27.02% of those with smooth implants. However, a chi-square test did not find a significant association between implant type and symptom presentation (p=0.250) or between surface finish and symptom presentation (p=0.085). Personal history of autoimmune disease was significantly associated with increased symptom reporting (odds ratio (OR) = 2.77; 95% CI: 1.67-4.59), whereas family history was not. Symptom prevalence was highest among individuals aged ≥55 (44.4%) and those with implants placed five to nine years prior (39.7%). Conclusion Patients in PR experienced concerning symptoms following breast implant surgery. Frequently reported symptoms such as anxiety, depression, body/joint pain, and cognitive dysfunction may suggest a possible link to mental health. No significant association was found between the type of implant and the development of these symptoms. This finding suggests that other factors, such as individual patient susceptibility or environmental influences, may play a critical role in symptom development. However, there was a trend indicating that patients with textured implants and those with a history of autoimmune disease may experience symptoms at a higher rate. This trend underscores the need for further research aimed at collecting more comprehensive data, including longitudinal follow-up, to better understand the potential mechanisms behind these symptoms and to identify specific risk factors within the Puerto Rican population.