The PIP SURVEY 2018*
If you have been affected by PIP implants, please help us to find answers to our questions about them by sharing your experiences. We are trying to obtain an accurate rupture rate, compile a list of common symptoms and get an indication of how many women are still awaiting PIP removal surgery. We are also interested in collecting information about the symptoms you may have experienced with your PIP implants.

Some women will complete this survey while they still have PIP implants and again when their implants are removed, if this is the case, please make sure you let us know at the end of this survey.

Thank you for taking part.

Behind every ruptured or leaking PIP implant there is a broken heart *
Foto: ANAP España
How old are you? *
Year of your original PIP surgery? i.e. 2004 *
If you have had more than one PIP surgery, please add the year of your most recent PIP surgery
Your answer
Have you had your PIP implants removed? *
About your PIP implants *
Please select ONE of the following
Date of PIP REMOVAL surgery
If You Have Had Your PIP Implants REMOVED
Have you had your PIP implants REMOVED and REPLACED?
How many years have you had PIP implants? *
Give the number of years
Your answer
Any Indication of PIP rupture or gel bleed BEFORE PIP REMOVAL Surgery?
Confirmed rupture(s) Ultrasound
Confirmed rupture(s) MRI
Confirmed gel bleed(s) Ultrasound
Confirmed gel bleed(s) MRI
Undiagnosed Rupture(s) discovered on REMOVAL surgery?
Also known as a Silent Rupture
If your PIP implants were removed INTACT, did you experience Gel Bleed(s)?
Gel Bleeds & Intact PIP Implants
Are your Lymph Nodes affected? *
How many PIP related corrective surgeries have you had? *
Your answer
Have you been diagnosed with any of the following?
Have you experienced any of the commonly reported general symptoms linked to PIP implants?
A third or more of women who responded to our previous survey reported the following symptoms:
Blurred Vision
Dry or itchy eyes
Headaches / migraines
Poor concentration
Memory loss
Cognitive loss (difficulty finding the right words)
Mood swings
Shortness of breath
Stiffness or pain in joints
Muscle seizures, cramps or spasms
Muscle weakness
Dry mouth
Dry skin
Skin rashes
Tingling or numbness in hands
Excessive sweating
Night sweats
Extreme tiredness or fatigue
Bowel Problems
Hair thinning or hair loss
Loss or reduction in sex drive
About your PIP Implants *
Did you have a mammogram while you had PIP implants?
Did you have a reconstruction after breast cancer or BRCA with PIP implants ?
Have you experienced any of the following with PIP implants?
Implants changed size or shape
Implants Wrinkled
Implants Stuck to the chest wall
Silicone in lymph glands
Wound infections
Breast inflammation
Breast pain
Breast lumps or cysts
Siliconoma(s) or granuloma(s)
Capsular contracture
Itching, tingling or loss of sensation in your breasts
Do you frequently suffer from any of the following?
Fungal infections
Skin Rashes
Mouth Ulcers
PIP IMPLANTS Pregnancy & Breast Feeding
Have you been pregnant & given birth with PIP implants?
Have you experienced any difficulties getting pregnant with PIP implants?
Have you breast-fed with PIP implants?
Have you experienced breast feeding difficulties with PIP implants?
Have you experienced any miscarriages with PIP implants?
PIP IMPLANTS : the impact on your life *
Have you visited your GP more than once with health concerns related to PIP implants?
Have you delayed seeing your GP to discuss health issues related to your PIP implants?
Have you taken any time off work due to PIP implants?
Have you experienced relationship problems due to PIP implants or your symptoms? *
Has your GP been sympathetic & helpful? *
No Help
Very sympathetic & Helpful
How anxious are you about PIP implants? *
Not at all
Extremely Anxious
Your Original Hospital / Clinic
Your answer
How helpful has your clinic been?
Not at all
Very Helpful
How would you rate your clinic?
Very Poor
Name of your PIP Surgeon?
Your answer
How would you rate your surgeon?
Very Poor
If you have had your PIP implants removed, are you feeling better?
Not At All
Much Better
If you have NOT had your PIP implants removed yet, what is the main reason?
At any time since finding out about your PIP implants have you felt *
This is an anonymous survey. *
Where in the world are you? *
Remember if you are in need of healthcare, please see your doctor.
Thank you for completing our survey!
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms