Textured vs. Smooth Breast Implants Using the Jones Criteria—What Is the Currently Available Evidence for BIA-ALCL?: A Systematic Review

Abstract

Breast-Implant-Associated Anaplastic Large-Cell Lymphoma (BIA-ALCL) is a rare low-incidence type of T-cell non-Hodgkin lymphoma, arising in the capsule around breast implants, and predominantly associated with the use of macro-textured breast implants. The purpose of this study was to use an evidence-based approach to systematically identify clinical studies comparing smooth and textured breast implants in women with regard to the risk of developing BIA-ALCL. Methods: A literature search in PubMed in April 2023 and the article reference list of the French National Agency of Medicine and Health Products decision from 2019 were screened for applicable studies. Only clinical studies where the Jones surface classification could be applied (required information: breast implant manufacturer) for comparison of smooth and textured breast implants were considered. Results: From a total of 224 studies, no articles were included due to the lack of fit to the strict inclusion criteria. Conclusions: Based on the scanned and included literature, implant surface types in relation to the incidence of BIA-ALCL were not evaluated in clinical studies and data from evidence-based clinical sources plays a minor to no role in this context. An international database that combines breast implant-related data from (national, opt-out) medical device registries is, therefore, the best available option to obtain relevant long-term breast implant surveillance data on BIA-ALCL.

Breast implant iatrogenics: challenging the safety narrative

“…It can be argued that the best risk reduction technique would be to avoid exposure to a causative factor. However, apart from a few nations like France with a total ban on all textured implants, the use of (macro)textured implants remains unrestricted ( 27 ). Controversy persists as some plastic surgeons prefer textured implants for their reported benefits, such as reduced risk of capsular contracture ( 28 – 30 ).…”