Comparative Analysis of Breast Implant Illness Symptoms in Implant-Based, Autologous, and No-Reconstruction...

Breast implant illness (BII) refers to a cluster of nonspecific systemic symptoms that some patients attribute to breast implants. This study compared long-term rates of "BII-compatible symptoms" among mastectomy patients who received implant-based reconstruction, autologous flap reconstruction, or no reconstruction.

A retrospective, propensity-matched cohort study was conducted in the TriNetX Global Collaborative Network. Women ≥18 years with breast cancer diagnosed between 2005 and 2025 who underwent mastectomy entered 3 mutually exclusive groups: implant-based reconstruction, autologous reconstruction without implants, or mastectomy only. Ten BII-compatible outcomes (fatigue, joint pain, anxiety, cognitive dysfunction, alopecia, major depression, rash, headache, abnormal weight loss, and abnormal weight gain) were captured 3 to 20 years postsurgery. Separate 1:1 nearest-neighbor matches balanced demographic, oncologic, and comorbidity covariates (standardized mean difference, <0.10). Risk ratios (RRs), absolute risk differences (RDs), 95% confidence intervals (CIs), and Kaplan-Meier hazard ratios were calculated within TriNetX; P < 0.05 signified significance.

After matching, cohort sizes were 2536 (implant vs autologous), 1716 (autologous vs no reconstruction), and 8188 (implant vs no reconstruction), with a mean follow-up of around 3.8 years. First instance of any BII-compatible symptom incidence was higher with implants than autologous flaps (8.2% vs 5.1%; RR, 1.6 [95% CI, 1.2-2.1]), lower with autologous flaps than no reconstruction (6.7% vs 9.5%; RR, 0.71 [0.52-0.96], and similar between implants and mastectomy only (8.9% vs 8.1%; RR, 1.09 [0.96-1.25]). Implants carried higher risks than autologous flaps for fatigue (RR, 2.42), joint pain (RR, 2.08), and rash (RR, 1.86). Autologous flaps were protective versus no reconstruction for fatigue (RR, 0.60) and joint pain (RR, 0.66). Compared with mastectomy only, implants showed a modest excess of depressive diagnoses (RR, 1.26) but fewer rashes (RR, 0.61); other symptoms did not demonstrate significance. Kaplan-Meier curves confirmed earlier symptom onset with implants than autologous flaps (adjusted hazard ratio, 1.41).

Autologous reconstruction confers the lowest long-term burden of BII-compatible symptoms, whereas implants increase fatigue, joint pain, and rash relative to autologous flaps but not relative to mastectomy alone. Systemic complaints after breast surgery appear multifactorial rather than implant-specific, supporting balanced patient counseling and prospective mechanistic research.