Voluntary Survey

Home Voluntary Survey
by Surgical Times

This is a voluntary survey for women who had their breast implants removed for any reason.

We appreciate you taking the time to participate.

By participating, you acknowledge that the data you provide may form part of a tabulation and be published without self-identifying information.

For example, we may publicly share that “50% of women surveyed said…,” but we won’t publish who any one of those women are, nor what they/she said, without their/her prior written consent.

We’ve done our best to make the survey as inclusive as possible while minimizing the time required to complete it.

We deeply understand that, out of necessity, some of the questions and answer choices that follow may not suit your condition perfectly. If you encounter something that you feel impacts the accuracy of your survey response, please make note of it in the space provided under the last question.

Should you wish to share more

Surgical Times is also interested in hearing from women who explanted, whether the explant surgery fully resolved or failed to resolve any or all of the symptoms they were experiencing.

Should you wish to share your personal story with us, please note that in the final field below.

What to expect

  • This form can be completed in as few as 5-10 minutes.
  • Should you wish to, the final question allows you to provide additional information.
  • When the survey has been successfully completed and submitted, you will no longer see it.
  • This form includes questions that might prompt some people to reflect on traumatic past experiences; if you’re not comfortable doing so, please don’t take the survey.

Voluntary Breast Implant Illness Questionnaire

Breast Implants

About You:

About Your Breast Augmentation Surgery:

4. Brand of breast implants you received:
5. Type of breast implants you received:
6. Surface:
9. Prior to getting breast implants, which of the following were important sources of information for you on breast implants and breast augmentation surgery?

About Your Experience With Breast Implants:

10. Did having breast implants impact or adversely affect your personal health or wellbeing?
11. Do you consider that you had breast implant illness?
15. Prior to getting breast implant removal surgery, which of the following were important sources of information on your physical condition and on explant surgery:
16. Did the surgeon who initially placed your breast implants also remove them?
16a. You noted you saw a different surgeon for your explant surgery. Which if any of the following were factors in that decision:
18. Please select the statement that is most accurate to you:
20. Do you regret having had your breast IMPLANTS REMOVED?


In Closing:

Surgical Times provides objective public interest reporting on the practice of plastic surgery and is not affiliated with or funded by any surgeon or practice.