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Quantifying The Increasing Awareness Of Breast Implant Illness: Temporal, Seasonal, And Geographical Trends In Breast Explantation Using Google Trends
Arvin Smith, BA1, Corinne Wee, MD2, Yida Cai, BA1, Mohamed Awad, MD2, Samuel Boas, BS1, Robert Clark, BS1, Anand Kumar, MD2.
1Case Western Reserve University School of Medicine, Cleveland Heights, OH, USA, 2University Hospital, Cleveland Heights, OH, USA.

Breast Implant Illness (BII), a constellation of symptoms affecting women with breast implants, has gained increasing national attention. Public interest and patient internet investigation querying breast explantation after the 2011 FDA BIA-ALCL report remains understudied. Google Trends is a contemporary database that documents relative search volumes since January 2004. We hypothesized that relative search volumes of BII and explantation have significantly increased over the past 15 years. The aim of this study was to study the geographic, temporal, and seasonal interest in BII/explantation surgery.
The search terms "Breast Implant Illness", "Breast Implant Removal", and "Implant Removal" were inputted in the Google trends database. Data points collected were monthly relative search volumes. Statistical analysis was performed using the "season" package on R Version 3.6.0. A non-stationary cosinor model was utilized to determine both significant trends over time and seasonal patterns.
Relative search volume of "Breast Implant Illness" increased by 441% (p<0.05) from May 2016 to September 2019. Relative search volume of "Breast Implant Removal" and "Implant Removal" both initially decreased by 38% from 1/2004 to 9/2019 and 30% (p<0.05) from 1/2004 to 9/2019 respectively, followed by a significant increase of 195% (p<0.05) since 2/2011 and 231% (p<0.05) since 9/2008 respectively. Cosinor analysis showed significant seasonality (p<0.025) for all three search terms. For "Breast Implant Illness", "Breast Implant Removal" and "Implant Removal" respectively, the highest number of searches were performed in early April (4.1, p<0.025), early May (5.0, p<0.025), and mid-May (5.4, p<0.025); the fewest searches were performed in early October (mean 10.1, p<0.025), early November (11.0, p<0.025) and mid-November (11.4, p<0.025) (Figure 1a-c, Table 1). The highest search volumes for all three terms were in southwest states, including Oklahoma, Arizona, and Utah; lowest search volumes for all three terms were in northeastern states, such as Massachusetts and New York, and Midwestern states such as Wisconsin (Table 2).
Google Trends analysis demonstrated significant temporal, seasonal, and regional trends associated with Breast Implant Illness and explantation surgery. Internet searches peaked during spring and summer months and geographic interest was highest in the southwest. A social awakening occurred in 2016, 4 years after the first FDA report of FDA BIA-ALCL. Further study will correlate google trends to actual surgical explantation volume.

Table 1
Search Term"Breast Implant Illness""Breast Implant Removal""Implant Removal"
Month with Highest Search VolumeEarly April (4.1)Early May (5.0)Mid May (5.4)
Month with Lowest Search VolumeEarly October (10.1)Early November (11.0)Mid November (11.4)

Table 2
Search Term"Breast Implant Illness""Breast Implant Removal""Implant Removal"
States with Highest Search Volume1.Utah 2.Oklahoma 3.Nevada1.Nevada 2.Arizona 3.Oklahoma1.Nevada 2.Oklahoma 3.Florida
States with the Lowest Search Volume1.New York 2.Massachusetts 3.Connecticut1.New York 2.Virginia 3.Pennsylvania1.Virginia 2.Wisconsin 3.Massachusetts

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