Does Implant Surface Texture Affect the Risk of Capsular Contracture in Subglandular Breast Augmentation and Breast Augmentation-Mastopexy?

Abstract

Background Previous studies have reported decreased rates of capsular contracture associated with the use of textured surface breast implants placed in the subglandular plane during breast augmentation. However, since the publication of these studies, our understanding of the pathophysiology of capsular contracture, as well as the surgical techniques utilized to minimize bacterial contamination of the implant, have advanced considerably. Objectives The purpose of this study was to re-evaluate the relation between implant surface texturization and capsular contracture rates for breast implants placed in the subglandular plane during primary breast augmentation. Methods Retrospective chart review was performed of all primary subglandular breast augmentation procedures involving the use of either smooth or textured round silicone gel implants, with or without simultaneous mastopexy. The primary outcome measures included clinically significant capsular contracture (Baker grade III/IV) and revision surgery for capsular contracture. Results Between 2010 and 2017, 526 patients underwent primary subglandular breast augmentation with either smooth (n = 212) or textured (n = 314) round silicone gel implants; 248 patients underwent breast augmentation, whereas 278 underwent breast augmentation-mastopexy. Average follow-up was 756 days in the textured group and 461 days in the smooth group. Five cases of capsular contracture were observed in the textured group, and 7 cases of capsular contracture were observed in the smooth group (P = 0.20). Conclusions Smooth surface implants placed in the subglandular plane were not at a significantly increased risk of capsular contracture compared with textured surface implants. We suggest that adherence to a surgical technique focused on minimizing bacterial contamination of the implant is of greater clinical significance than implant surface characteristics when discussing capsular contracture. Level of Evidence: 4

Defining the Relationship Between Pocket and Breast Implant Surface Area as the Basis for a New Classification System for Capsular Contracture

“…58 Therefore, although the quality of study design may also play a role, it is likely that any or all of these complicating factors are at least partially responsible for the strikingly different rates of capsular contracture that have been noted in the literature. 18,21,46,48,63–67…”

Revision Breast Augmentation

“…Aseptic technique to minimize bacterial contamination and biofilm formation was thought to be more important than implant surface characteristics. 27 This is particularly important to consider as the risk of anaplastic large cell lymphoma (ALCL) continues to question the use of textured devices.…”

Einfluss der Brustdimension bei der einzeitigen Augmentationsmastopexie auf die Implantatauswahl – Erfahrungen aus 103 konsekutiven Brustaugmentationen mit nanotexturierten Silikonimplantaten

“…körperreaktion [17,23]. Obwohl texturierte Implantate in einigen Studien mit einer reduzierten Kapselfibrose assoziiert sind, bleibt die klinische Evidenz uneinheitlich [6,9,[25][26][27][28]. Darüber hinaus werden gegenwärtig primär makrotexturierte Implantate mit der Entstehung von BIA-ALCL in Verbindung gebracht, wobei hingegen auch bei glatten Implantaten BIA-ALCL-Fälle beschrieben worden sind [29][30][31].…”

“…Vorherige Metaanalysen legten die Assoziation einer niedrigeren Kapselfibroserate für submuskuläre Implantatlagen im Allgemeinen dar, während höhere Wahrscheinlichkeiten für eine Implantatdislokation und Brustanimation beobachtet wurden [30,31]. Die subpektorale Implantattasche als ideale Lage wird gegenwärtig in Frage gestellt und intensiv diskutiert [28,32]. Die aktuelle Studie zeigt, dass die subglanduläre Lage von nanotexturierten Implantaten mit gleichwertig niedrigen Komplikationsraten wie bei partiell submuskulären Implantatlagen assoziiert sein kann.…”

“…Dieses Ergebnis deckt sich mit Daten aus der Literatur, wobei die Gesamtkomplikationsrate durch niedrigere implantatbedingte Komplikationen reduziert erscheint [1][2][3]37]. Obwohl bislang noch kein direkter klinischer Vergleich von nanotexturierten Implantaten zu Implantaten anderer Hersteller erfolgt ist, deuten die Ergebnisse vorangegangener Studien darauf hin, dass die Komplikationsrate bei der AM insbesondere durch niedrigere Kapselfibroseraten gesenkt werden könnten [10][11][12]28].…”