With the talk of seromas, biofilm, and the fear of ALCL from textured implants (for more on that, read my ALCL blogs), there is some discussion that all textured implants are not the same. There are three major breast implant manufacturers we use in the US, and they texture their implants differently.
So what does that mean?
This is a study out of the Aesthetic Surgery Journal June 2019. Get ready for the super title, “Microtexture and the Cell/Biomaterial Interface: A Systematic Review and Meta Analysis of Capsular Contracture and Prosthetic Breast Implants.”
In English, they looked at the published studies looking at the type of texturing and the material used to texture. How does this affect capsular contracture?
Study:
- Study review from 1995-2017.
- 19 studies were analyzed. (673 studies were found, 51 were looked at in more detail. Only 19 were chosen for analysis)
- They looked at age, populations size, man follow up , number of capsular contracture cases, number of seroma cases, and nuber of rippling cases.
- They looked at the capsular contracture rates for the three types of implants
- Foam textured
- Imprinted textured
- Salt loss textured.
Findings?
- Overall rates for capsular contracture in primary augmentation patients
- 3.8% for imprinted textured
- 4.9% for foam textured
- 5.27% for salt loss textured
- 15.5% for smooth implants
My thoughts?
I was a bit disappointed by this meta analysis. The studies on texturing having lower capsular contracture rates are real, but they do not address the studies where biofilm rates are higher or the issue with seromas, malrotation, and ALCL. Are the implants gel or saline? What incision was used? Are they in front or behind the muscle?
The issue they have is the issue of retrospective studies in general – they can’t control the variables and they don’t have a control.
I know I put in breast implants totally differently than I did ten years ago. I soak in triple antibiotics, use Keller funnels, have patients prep with surgical soap preoperatively, and practice “no touch” techniques.