Management of Symptomatic Patients with Textured Implants

Area of Science:

• Plastic Surgery
• Oncology
• Biomaterials Science

Background:

• Textured breast implants were developed to reduce complications like capsular contracture.
• Their use declined with the advent of newer smooth implants, but they remained globally dominant until recently.
• A 2019 FDA recall of Allergan Biocell implants highlighted an increased risk of BIA-ALCL.

Purpose of the Study:

• To review data and outcomes concerning textured surface breast implants.
• To examine the disease-associated risks, specifically BIA-ALCL.
• To outline management strategies for revisionary surgery and device surveillance.

Main Methods:

• Review of existing literature and clinical data on textured implants.
• Analysis of BIA-ALCL incidence and risk factors.
• Evaluation of diagnostic and surgical management strategies for textured implant patients.

Main Results:

• BIA-ALCL is a known risk associated with textured implants, particularly Allergan Biocell.
• Bacterial control during insertion has not proven effective in preventing BIA-ALCL.
• Symptomatic BIA-ALCL requires complete surgical excision; asymptomatic patients do not need implant removal.

Conclusions:

• Management of symptomatic textured implant patients must prioritize oncologic screening.
• Diagnostic workup for suspicious cases should include CD30 immunohistochemistry.
• While total capsulectomy during revision may be considered, it's not universally advocated and doesn't eliminate future BIA-ALCL risk.