The Truth About Textured Implants

When a woman decides to pursue breast augmentation, there are a number of decisions that must be made during the planning phase. For example, the amount of information available about the types of implants alone is dizzying, and it can be hard to separate fact from fiction. A recent study on textured implants has found that they are more susceptible to bacterial infection than smooth implants, and this infection may lead to capsular contracture, a hardening of scar tissue that is the most common complication from breast augmentation.

Given this latest research, here are Dr. Reedy’s thoughts on textured implants and whether they should be considered for a breast enhancement.

Why were textured implants created?
They were created under the concept that texturing of the outer surface of the implant would lead to less capsular contracture. After a breast augmentation, the body naturally forms a capsule of scar tissue around an implant; in a small percentage of cases, this tissue becomes hard and tightens around the implant—this is capsular contracture.

There is a public perception that there are no medically proven pros or cons to textured implants. Is that really the case?
In some ways, that is true. The literature has been conflicted. There is some evidence that there is less capsular contracture with a textured implant in a subglandular position. However, a submuscular augmentation is, for the most part, a far superior technique. A submuscular augmentation provides a more natural appearance, a more natural feel. It makes mammography and breast exams easier, and there is significant decrease in capsular contracture.

When you place a textured implant in a submuscular position, the data is inconsistent. In addition, textured implants have been associated with a higher rate of breakage/leaking, as well as rippling. It is for that reason that I personally rarely use a textured implant. While this is my opinion, most plastic surgeons use smooth walled implants.

Why would a plastic surgeon recommend textured implants instead of smooth implants?
A textured implant is used specifically when you are doing a sub-glandular augment or using a shaped implant. With a textured surface, the implant will stay put. It doesn’t move. It becomes attached to the surrounding tissues.

For the most part, a more natural result in terms of both look and feel is achieved when a smooth-walled implant is able to slide and move around in the pocket. However, when you have a shaped implant, you need to keep it in place. You don’t want it to move because if it rotates off axis, the shape of the breast will then change. It’s in those times where a textured implant is particularly helpful.

However, there is some evidence that textured implants are slightly more susceptible to a type of bacterial infection referred to as biofilm. That is a subtle seeding of the implant as well as combined irritation of local tissues, where you can get a secondary capsule and a biofilm that forms.

After surgery, what should patients keep an eye out for as they recover?
Whether using textured or smooth implants, the answer is the same. Infection from an implant is incredibly rare, but redness, tenderness, swelling, pain, or fever would be standard things to look for. In terms of capsular contracture, usually when it presents, it starts to present in the early post-op period and is evidenced at around 6 to 12 weeks. However, a capsular contracture can occur at any time in the late and distant post-op period. That results in a firmness to the feel of the breast and implant. In more severe cases, a change in shape of both the implant and the contour of the breast are apparent and in rare, infrequent, and late cases, even pain.

Plastic or cosmetic surgery is still surgery, and there is always risk involved. What advice would you offer patients on how to judge safety when looking for a plastic surgeon?
In terms of safety, while on the surface a breast enhancement appears relatively straightforward, there are a number of subtleties to this surgery in terms of choosing the appropriate shape, size, and type of implant. These factors all relate to surgical technique, to not only achieve an aesthetically pleasing result but also to get a superior result over the long term.

When you look at the literature, there is a wide variance of capsular contracture anywhere from 2-9%. In addition, there is a wide variance in re-operation rates due not only to complications such as capsular contracture, but also re-operation rates due to displeasure with size, shape, or appearance of the breast. Rates vary among individual surgeons. In my practice, the capsular contracture rate is less than 1%, and re-operation rate is rare.

You want to choose a surgeon that specifically specializes in breast surgery, and you want to see a lot of his or her before-and-after photographs to see the type of work he/she does, possibly even talk to previous patients.

In regards to where the surgery is performed, it’s important that the patients realize the licensure of the operating room. As to the level of licensure and safety in my operating room, I am rated Medicare Class C, which is the highest level of licensure—the same as a hospital. Additionally, I work with a board certified anesthesiologist for all surgical procedures.

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