Breast Implants (BIs) are prosthetic devices which are widely used for breast reconstruction following cancer, a BRCA gene diagnosis, or most commonly, for cosmetic reasons in the private sector. The use of implants has contributed to enhancing body image in women who have had breast implants in all of these settings. In addition, there is data available that the quality of life after breast reconstruction (either with autologous tissue or with breast implants) is better in women who have mastectomy plus reconstruction as opposed to mastectomy alone. In the purely aesthetic setting data are less clear: the majority of women with implants, especially in the short to medium term, value their implants and benefit from their perception of enhanced aesthetic appearance. In the long term, however, studies demonstrate that the quality of life of women who had silicone-gel filled breast implants is lower when compared with age matched women of similar socioeconomic status.

Despite the widespread use of breast implants, globally, there have been reports of inferior quality materials being used in the construction process, inadequate safety testing, and links to serious adverse outcomes and systemic symptoms, including auto-immune diseases, severe fatigue as in myalgic encephalomyelitis/chronic fatigue syndrome, widespread pain as observed in fibromyalgia, malignancies such as breast implant-associated anaplastic large cell lymphoma and (very rarely) death. The impact upon psychological well-being and self-identity in those who have suffered from these negative impacts has been significant, with many women feelings they were inadequately informed before surgery, and impeded from access to care and support. These feelings have been further compounded when explantation is discouraged for some women: for example, in women with concerns about PIP implants or BIA ALCL when they are advised that the risks of removal outweigh those of potential disease. In addition, there are some financial constraints relating to explantation surgery since often only explantation but not reshaping (to address the inevitable droop that occurs after explantation) or re-implantation is reimbursed. Furthermore, sometimes even explantation is not reimbursed.

The cosmetic breast augmentation industry is a financially lucrative business and features a diverse range of competing vested interests (e.g. regulatory, manufacturing, clinical, and political) which require careful navigation. Medical implant regulation and legislation between countries is often inconsistent, with a lack of global consensus about health outcomes, risks, manufacture, provision, accessibility and removal. This has resulted in confusion about the safety of these devices. Since registries for breast implantation were until recently non-existent, the data about safety were largely based on observational data in specialized clinics, and hence subject to bias. These are complex problems, but a prerequisite to tackling them is to mobilize cross-border and cross-disciplinary collaborations to create a coherent framework for understanding, which can subsequently better inform, support and engage citizens.

This Research Topic welcomes submissions specifically focused on the health and quality of life impacts associated with breast implants for example:

• Positive aesthetic and quality of life effects of breast implants in the aesthetic and reconstructive settings
• BIA ALCL
• other immunological/ systemic health problems associated with implants including BII
• implantation and explantation
• epidemiological studies
• advances in surgical techniques and their impact on health-related quality of life
• safety/ toxicology
• regulatory and legal frameworks and issues
• Implant registries
• patient/ clinician experiences of care e.g. decision making, informed consent
• community and media perspectives
• lived experience of breast implants and their impact upon quality of life as a result of diagnosis, symptoms, treatments and access to healthcare, social support, family and relationship dynamics
• cross cultural perspectives
• health economic considerations

This Research Topic welcomes a diversity of submissions, which seek to enhance our understanding and knowledge in this area from authors working in an international context, including but not exclusively: Original Research, Systematic and Narrative Reviews, Data Reports, Study Protocols, Community Case Studies, Case Reports, Theoretical Perspectives and Opinions.

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Dr. Anand Deva is an advisor and research coordinator for Abbvie (Allergan) and 3M. All other Topic Editors declare no conflicts of interest.

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Frontiers in Global Women's Health

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