The Surgeon Minute

The Safety of Now Infamous Textured Implants

The Safety of Now Infamous Textured Implants

Patient safety is a primary concern for any plastic surgeon. Regardless of the procedure, it is the responsibility of the surgeon to inform his or her patient about any potential risks and any steps that can be taken to reduce these dangers. With the ever increasing popularity of breast augmentation surgery, it is vital that patients stay informed as to what they can do to help avoid future complications such as capusular contracture or dangers to their health such as Anaplastic Large Cell Lymphoma (ALCL), a rare cancer.

One of the best ways that a patient can ensure his or her safety is to see a board certified plastic surgeon. These physicians are at the cutting edge of research and education, knowing the most recent and pertinent information and techniques to keep patients safe and their results great. Dr. Brad Calobrace of Louisville is one such surgeon and has recently reviewed all of the literature and written a paper for his colleagues on the safety of breast implants, both smooth and textured. With the recent media-fueled blitz as to the dangers of textured implants and Breast Implant-Associated ALCL, Dr. Calobrace’s findings, summarized below, are a must read for anyone considering breast implants.

The Safety of Textured Implants

Breast implants are considered one of the most studied medical devices in the world. Over the last 15 to 20 years, there have been any number of great studies done in the United States to show that silicone gel breast implants are safe. They are safe if they’re round. They are safe if they’re shaped. They are safe if they’re smooth and they are safe if they are textured. In his paper, Dr. Calobrace reminds his colleagues of this fact. He believes that it is paramount to have a myriad of breast implant options for his breast surgery patients.

The reason for the renewed emphasis on breast implant safety is the recent FDA release denoting a potential link between BIA-ALCL and textured implants.

ALCL & Textured Implants Debate

Anaplastic Large Cell Lymphoma (ALCL) is a very rare type of non-Hodgkins lymphoma. Since this is a cancer of the lymphatic system, part of the immune system, it is a fast growing cancer that needs to be treated quickly and aggressively.

In the last five years, both the World Health Organization and the FDA have recognized breast implant-associated anapestic large cell lymphoma (BIA-ALCL) as a rare T-cell lymphoma that can develop following breast augmentation with implants. Although the incidence seems to be higher with textured implants, there is still more unknown than known when it comes to the causes of this disease. However, the media has jumped on the anti-textured implants bandwagon, as well as causing a scare by downplaying the rareness of the disease. There is a great deal of confusing information recently put out there that makes textured implants appear universally unsafe. Is this the case?

Putting ALCL Risk in Perspective

There have been incidences of ALCL being associated with implants, and especially textured implants, but it is extremely rare. While it can be alarming for any patient to just hear textured implant and cancer in the same sentence, Dr. Calobrace believes in putting the risk in perspective for his patients. “The risk of developing ALCL is maybe 1 in 30,000 to 1 in 60,000 patients. It’s very rare. I’ve never seen a patient with ALCL and I’ve done thousands and thousands of patients.”

Around the world, anywhere from 90% to 98% of the implants that are used in breast augmentation surgery are textured. The United States is really the only country that uses smooth implants. And while textured implants have been in wide use for a very long time, there have only been 300 cases of BIA-ALCL.

Like all good plastic surgeons, Dr. Calobrace informs his breast patients about ALCL. But he presents them with the facts. When the risk of ALCL is 1 in 60,000 and the risk of breast cancer is 1 in 8, he is more worried about making certain that their implants don’t interfere with early detection of breast cancer than that they will develop a very rare cancer.

Benefits of Textured Implants

If a plastic surgeon can use either smooth or textured implants then why, in light of the BIA-ALCL scare, use textured implants at all? In some cosmetic cases, and certainly in many reconstructive cases, a plastic surgeon needs options for matching an existing breast. Textured implants are a great option because they are intrinsically linked to shaped implants. All shaped implants are textured implants. “If we eliminated texture from implants in the United States then we no longer have shaped implants” explains Dr. Calobrace. And women will suffer.

“So texture has a lot of positive qualities to it that really create what I would have a hard time turning away from because I get my best breast results when I use a textured implant” says Dr. Calobrace. As his paper argues, to eliminate them for something that is extremely rare is not a smart idea.

Risks and Sensationalism

While there may be some link between textured implants and BIA-ALCL, the rare occurrence of the disease has few plastic surgeons worried. The FDA’s announcement that made the media go into a tizzy was simply due diligence, not an attempt to scare the population. As Calobrace mentioned, the risks of contracting the disease is 1 in 60,000 patients who undergo breast augmentation. Considering that the risks of breast cancer is 1 in 8 for anyone who is a woman, it becomes clear why passing up an opportunity for breast augmentation – and, more pointedly, the surgeon’s professional suggestion to use textured implants – is somewhat extreme.

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