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Post-Scan Survey - No Suspected Rupture (5A) |
THIS FORM IS TO BE COMPLETED BY THE SUBJECT IF THERE IS A SUSPECTED RUPTURE
This survey is designed to learn how you feel about possible silent rupture of your silicone gel breast implants after learning the results of the ultrasound scan. Questions refer only to your current silicone gel implants, not any implants you may have had previously. Check one answer for each question, unless otherwise indicated.