Despite breast augmentation being the most popular aesthetic surgery in the United States for more than a decade, a peculiar trend has emerged: the case volume for breast augmentation dropped by 4 percent in 2019, while breast implant removal case volume has continued to rise rapidly, by 6 percent in 2018 and 15 percent in 20191. To better understand this phenomenon, we performed large data analysis using Google Trends (Google Inc., Mountain View, Calif.).
Google Trends is an analytics tool that allows users to assess normalized Google search volume over time and across geographical boundaries. Because Google is the predominant search engine used by the estimated 313 million Americans with internet access, Google Trends is often used in large data analysis as a proxy for public interest.2,3 Since its inception, Google Trends has been applied to analyze a range of medical topics, from cosmetic surgery to infectious disease outbreaks.4,5 We therefore applied Google Trends to help characterize the recent changes in breast augmentation and breast implant removal demand.
Between 2006 and 2019, Google Trends analysis demonstrated a 235 percent increase in “breast implant removal” relative search volume as well as a 527 percent increase in “explant” relative search volume, suggesting growing public interest in breast implant removal procedures. In addition, Google Trends geospatial analysis demonstrated that breast implant removal interest spread extensively across state boundaries from 2006 to 2019, concomitant with the overall explosion in relative interest (Fig. 1). Indeed, 11 new states—Washington, Nevada, Arizona, Colorado, Michigan, Georgia, Ohio, Pennsylvania, New York, New Jersey, and Maryland—demonstrated search interest in breast implant removal in 2019 but not in 2006.
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Fig. 1.: A comparison between 2006 and 2019 for relative Google search interest (0 to 100) for the query “breast implant removal + explant.”
To better understand potential drivers for these trends, a plot of Google Trends–generated related queries was created to identify hot topics associated with breast implant removal (Fig. 2). It was found that search interest in “breast augmentation” has steadily dropped over time, while the search query “breast implant illness” rose dramatically after becoming mainstream circa 2016. Interestingly, the spike in interest for “breast implant illness” appears more distinct than that of “ALCL,” suggesting that public awareness of breast implant illness may be the more influential driver in recent breast implant removal trends.
Fig. 2.: Search interest over time for breast implant removal–related search queries generated by Google Trends. BIR, breast implant removal; ALCL, anaplastic large-cell lymphoma; BII, breast implant illness.
The general increase of public interest in breast implant removal highlights a paradigm shift in how patients understand and perceive breast implants, especially given the recent decline in breast augmentations. Our finding of the geospatial spread of interest in breast implant removal from 2006 to 2019 also suggests that this phenomenon is not confined by state boundaries, indicating a new need in the field of plastic surgery.
It is imperative, therefore, for providers to understand patients’ perception of the safety of breast implants, as well as the general social drivers for the observed trends in breast implant removal. In this context, platforms such as Google Trends have proven to be invaluable. With Google Trends providing highly accessible spatial and temporal data for a vast array of search queries and topics, tech-savvy health care providers can be well-prepared to empower their patients and inform decision-making.
DISCLOSURE
None of the authors has a financial interest in relation to the content of this article.
REFERENCES
1. American Society of Plastic Surgeons. Plastic surgery statistics. Available at:
https://www.plasticsurgery.org/news/plastic-surgery-statistics. Accessed November 15, 2020.
2. Clement J. Internet usage in the United States.
Statista Available at:
https://www.statista.com/topics/2237/internet-usage-in-the-united-states/. Accessed November 30, 2020.
3. StatCounter Global Stats. Search engine market share United States of America. Available at:
https://gs.statcounter.com/search-engine-market-share/all/united-states-of-america. Accessed November 30, 2020.
4. Motosko CC, Zakhem GA, Saadeh PB, Hazen A. Googling aesthetic plastic surgery for patient insights into the latest trends. Plast Reconstr Surg. 2018;142:1478–1485.
5. Teng Y, Bi D, Xie G, et al. Dynamic forecasting of zika epidemics using Google Trends. PLoS One 2017;12:e0165085.
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