This self assessment for BII will help to determine if you would benefit from a consultation with Dr. Whitfield and his BII team. Dr. Whitfield sees patients from all over the world. His BII recovery program includes top of the line lab testing, innovative technology and devices, BII curated supplements and more all in his Breast Implant Illness & Explant Clinic, headquartered in Austin,Texas.

Did you begin experiencing increasing amounts of fatigue after getting your breast implants? *

Yes

What type of breast implants do you have? *

Saline

Silicone

Textured

I’m not sure

How long was your post-implant surgery recovery? *

I was back to myself in 6 weeks

My recovery to full function was 6 - 12 months

My breast implants still give me problems

When did you start feeling “off” or begin noticing symptoms after getting your breast implants? *

Immediately

Within 6 months.

After the first year

After 2 years

After 3-5 years

Issues really started after 8-10 years with implants

I have had implants for 20 years and am having issues.

I haven’t had any issues since getting my implants.

How many breast augmentation surgeries have you had? *

Only one, the original surgery.

Two, either due to size change, rupture or capsular contracture.

Three or more, due to complications or personal choice.

Have you had an accident or injury to the breast? Fallen, car accident, exercise related injury? *

Yes

Have you had blood work and labs done or seen more than one doctor for your symptoms? *

Yes and my blood work always comes back fine even though I feel like something is wrong.

My blood work is not ok but doctors still do not know what is wrong

I have seen countless doctors, specialists and still have no answers.

Have you suspected that your breast implants could be causing your health problems but doctors have dismissed your concerns? *

Yes and no one will listen to me.

I told my doctor but they aren’t convinced my implants are the issue.

My doctor agrees that my health issues may be related to my breast implants.

Have you had your hormone levels checked? *

Yes I have had my hormones checked and they are great.

Yes I have had my hormones checked and they are out of balance.

Yes, I have my hormones regularly checked and I am on hormone replacement therapy.

I have not had my hormones checked in a year or more.

Have you been exposed to mold? *

Yes I lived or visited a house with visible mold.

No, I have never been exposed to mold.

I do not know if I have ever been exposed to mold.

Have you moved into a different home since getting your breast implants? *

Yes I moved into a different home after getting breast implants.

No, I have always lived in the same home.

When was your home built? *

My home is new or was built within the last 5-10 years.

My home is 10-20 years old.

My home is 20-30 years old.

My home was built over 40 years ago.

Have you lived in a home as it was being renovated, or do you work as a real estate agent or designer and regularly visit homes during remodeling? *

Yes I have lived in a home as it was being renovated.

I am a real estate agent or designer and visit homes being remodeled

I have remodeled my home but did not live there or visit it during remodel.

I visited my home as it was being remodeled and did not wear a N-95 mask.

No, I live in a home that has never been remodeled since I moved in.

Your Breast Implant Illness Self-Assessment is now complete. Please fill in your details so we can send you your report:

First Name *

Last Name

Phone *

Email *

City *

State

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