Breast Implant Prevalence in the Dutch Female Population Assessed by Chest Radiographs

Mintsje de Boer, Michele van Middelkoop, Michael Hauptmann, Noortje van der Bijl, Jorn A. W. Bosmans, Narda Hendriks-Brouwer, Sijmen J. Schop, Jan Paul de Boer, Nathalie J. Hijmering, Lucy I. H. Overbeek, Marc B. Lobbes, Caroline A. H. Klazen, Daphne de Jong, Hinne A. Rakhorst, Rene R. W. J. van der Hulst, Flora E. van Leeuwen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Breast implant-related health problems are a subject of fierce debate. Reliable population-based estimates of implant prevalence rates are not available, however, due to a lack of historical registries and incomplete sales data, precluding absolute risk assessments.

Objectives: This study aimed to describe the methodology of a novel procedure to determine Dutch breast implant prevalence based on the evaluation of routine chest radiographs.

Methods: The validity of the new method was first examined in a separate study. Eight reviewers examined a series of 180 chest radiographs with (n = 60) or without (n = 120) a breast implant confirmed by a computed tomography or magnetic resonance imaging scan. After a consensus meeting with best-performing expert reviewers, we reviewed 3000 chest radiographs of women aged 20 to 70 years in 2 large regional hospitals in the Netherlands in 2015. To calculate the national breast implant prevalence, regional prevalence variations were corrected utilizing the National Breast Cancer Screening Program.

Results: Eight reviewers scored with a median sensitivity of 71.7% (range, 41.7%-85.0%) and a median specificity of 94.6% (range, 73.4%-97.5%). After a consensus meeting and a reevaluation by best-performing expert reviewers, sensitivity was 79.9% and specificity was 99.2%. The estimated national prevalence of breast implants among women between 20 and 70 years was 3.0%, ranging from 1.7% at 21 to 30 years to 3.9% between 51 and 60 years.

Conclusions: The novel method in this study was validated with a high sensitivity and specificity, resulting in accurate prevalence estimates and providing the opportunity to conduct absolute risk assessment studies on the health consequences of breast implants.

Original languageEnglish
Pages (from-to)156-164
Number of pages9
JournalAesthetic Surgery Journal
Issue number2
Publication statusPublished - Feb 2020


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