Management of Symptomatic Patients with Textured Implants
by Asaad, Malke; Offodile, Anaeze C.; Santanelli Di Pompeo,
Fabio; Bevers, Therese B.; Stelly, Sharon; Carew, Lori A.; Barnea, Yoav;
Miranda, Roberto N.; Butler, Charles E.; Clemens, Mark W.
Plastic and
Reconstructive Surgery: May 2021 -
Volume 147 - Issue 5S - p 58S-68S
Summary:
Proper management of
symptomatic textured implant patients is critical to identify and treat
associated oncologic disease. Textured surface breast implants were first
introduced more than 50 years ago in an effort to decrease high rates of
capsular contracture and implant malposition observed with first-generation
smooth surface breast implants. Textured implants were dominant over smooth
devices in the United States in the late 1990s, but they fell out of favor for
newer-generation smooth implants, while texture remained the dominant selling
implants worldwide until recently. A class I device recall by the US Food and
Drug Administration in 2019 precipitated a removal of the highest selling
implant worldwide, Allergan Biocell, due to a disproportionately increased risk
of breast implant–associated anaplastic large cell lymphoma (BIA-ALCL).
Operative strategies, such as bacterial control at the time of textured implant
insertion, have not been credibly shown to affect or prevent the future
development of BIA-ALCL. BIA-ALCL patients require complete surgical excision
of their disease, whereas textured implant patients who are otherwise
asymptomatic do not require surgical removal. For suspicious cases, diagnostic
testing with CD30 immunohistochemistry should be performed before any surgical
intervention. Capsules are evaluated with 12 strategic regional biopsies in a
standardized approach. If surgeons are revising or exchanging textured
implants, they may reasonably consider a total capsulectomy, though this is not
advocated by the Food and Drug Administration or national societies, and has
not been shown to mitigate future risk of BIA-ALCL. The purpose of this article
is to review data on and outcomes for textured surface implants,
disease-associated risk, and the management strategy for revisionary surgery
and device surveillance.
