BACKGROUND: The United States Food and Drug Administration (FDA) recommends silicone breast implant rupture surveillance using MRI or ultrasound beginning at 5-6 years post-insertion and every 2-3 years thereafter. No surveillance guidelines exist in Canada or the UK. This study aims to identify surveillance practices and perceived barriers to surveillance among plastic surgeons in Canada and the UK and compare surgeon practices between public and private sectors. METHODS: All active members of the Canadian Society of Plastic Surgeons (CSPS) and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) with an interest in breast surgery were surveyed. Surgeon demographics, screening practices and perceived barriers to screening were analyzed. Fisher's exact test was used to detect significant associations. RESULTS: The survey response rate was 16%. Most surgeons (68%, n=58/85) were familiar with FDA guidelines
however, only 2.4% (n=2/85) followed them. Surgeons in private practice screened significantly more than surgeons in the public sector [45% (n=13/29) vs 13% (n=7/56), p<
0.002]. Among surgeons, ultrasound and high-definition ultrasound were the most common screening modalities and a perceived lack of clinical necessity followed by a perceived lack of satisfactory evidence qualifying these guidelines was the most reported barrier to screening. CONCLUSION: Despite awareness of FDA guidelines, compliance among surgeons surveyed remains low, reportedly due to a perceived lack of necessity or evidence base. Most public sector surgeons opt not to screen and do not recommend surveillance, even without barriers. While governing bodies should consider current practices to shape guidelines, increasing surgeons' awareness on their evidentiary foundation and potential consequences of silent ruptures is imperative. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.