Prospective Controlled Cohort Study of the Incidence, Trajectory, and Clinical Correlates of Persistent Systemic Symptoms in Women With and Without Silicone Breast Implants

Inclusion Criteria: * Female sex and age 18 years or older. * Planning primary aesthetic breast augmentation with silicone implants or planning nonimplant aesthetic breast surgery such as mastopexy or reduction. * No prior permanent breast implant. * Completion of the full baseline systemic-symptom and psychosocial assessment before surgery. * Ability to participate in annual follow-up for five years. * Written informed consent. Exclusion Criteria: * Breast reconstruction after cancer, prophylactic mastectomy, congenital deformity, or major trauma. * Known active autoimmune, inflammatory, neurologic, endocrine, infectious, or malignant condition expected to cause major systemic symptom change, unless the final protocol intentionally includes and stratifies these conditions. * Current pregnancy or breastfeeding. * Prior permanent breast implant or tissue expander. * Inability to complete validated questionnaires in the authorized language. * Planned simultaneous major surgery expected to dominate systemic recovery beyond the prespecified postoperative window.