TRAINING ONLY: CRF Pre-Scan Survey (#3)

Survey Description

This survey is designed to learn how you feel about possible silent rupture of your silicone gel breast implants prior to an ultrasound scan. Questions refer only to your current silicone gel implants, not any implants you may have had previously. Check one answer for each question, unless otherwise indicated.

Question Title

1. Have you been concerned that you may have a ruptured implant?

No, I have never been concerned that I have a ruptured implant

Yes, I have been concerned that I have a ruptured implant only within the past year

Yes, I have been concerned that I have a ruptured implant for longer than the past year

Question Title

2. Did you know the FDA recommends an MRI scan to screen for silent rupture of silicone gel implants after 3 years and then every 2 years for life?

Yes

Question Title

3. Have you had a Magnetic Resonance Imaging (MRI) scan to screen for silent rupture of your silicone gel implants?

Yes, I have had 3 or more MRI scans since receiving my implants

Yes, I have had 2 MRI scans since receiving my implants

Yes, I have had only 1 MRI scan since receiving my implants

No, I never have had an MRI scan to screen for silent rupture of my implants

Question Title

4. Would you like to know if you have a ruptured implant?

Yes

Question Title

5. If you learn an implant has a rupture, which of the statements below would apply to you? (check all that apply)

I would be concerned that I didn’t know the implant was ruptured

I would be concerned about how long the implant had been ruptured

I would be concerned about silicone gel coming in contact with my body tissue

I would be concerned about the time, cost or extent of surgery needed for revision

I would be concerned about other potential complications

Nothing would concern me

Question Title

6. If you learn an implant has a silent rupture but you do not have symptoms, would you like to have it removed?

Yes

Question Title

7. If you chose to remove your ruptured implant, what course of action would you take? (check all options you would consider)

Replace the implant with another silicone gel implant, only if the costs are reduced by warranty

Replace the implant with another silicone gel implant, even if the costs are out-of-pocket

Replace the implant with an alternative to silicone gel implants (structured implant or saline implant), even if the costs are out-of-pocket

I would not replace the implant