Textured implants were big news a little while back, as there is a rare cancer called ALCL caused by textured implants. Please read my blogs on the subject, but know a few major points:
- ALCL is super rare
- It presents usually with a fluid collection, called a seroma
- And it happens more in rough texturing, which was used primarily by the Allergan/style 410/Natrelle brand.
- ALCL blogs HERE.
But there is a reason textured implants were used. I personally rarely used textured implants, but I would do it for specific patients whose body was going to be prone to having issues with skin stretch and implant migration.
- Very thin skin
- Large implant
- Rib cage that slopes outward
So, now there is a stigma against textured implants. But we know that there was a difference in ALCL rates between brands, and those with finer texturing had much lower rates of ALCL.
Hence the study, “Transitioning from Conventional Textured to Nanotextured Breast Implants: Our Early Experience and Modifications for Optimal Breast Augmentation Outcomes.” in the February Aesthetic Surgery Journal.
Study:
- 415 cases, followed up for around 2 years
- They used 40% nanotextured, 60% conventional textured
- Complication rates for traditional texturing was .8% at 1 year, and 3.5% on overall follow up. The complication seen most frequently was capsular contracture.
- Complication rate for nanotextured group was 6.8% at one year, 8.7% overall, and the complication was bottoming out. They did see a decrease in complication rates over their time.
- They used a no touch technique, IMF incision, Keller funnel, triple antibiotic wash
- They were put in a postoperative bra 24/7 for up to 3 months post surgery.
Conclusion?
There is a learning curve for the new implants. They think the nanotexturing functions much more like a smooth implant, as they would see thinner capsules. For patient selection, they started only using them in women with better tissue quality (small and firm breasts) and lower volume (less than 350cc breast implant). This reduced their usage of nanotexturing to only 20% of their patients.
My thoughts?
Smooth implants have movement, and tissue stretch is a clear risk. I am just wondering if nanotexturing doesn’t offer the benefit of the traditional texturing (keeping the implant from stretching and migrating), why use it? The people I used textured implants in is the thin skin, large implant, tougher rib cage shape. If this study shows bottoming out is the primary issue, and their complication rate decreased only because they stopped using them in those specific patients, again, what is the primary role?
And what should we use for those patients?