A Threshold Technique Study to Understand Patient Preference for Smooth Versus Textured Breast Implants

Breast implant surfaces are categorized as smooth or textured. Compared with smooth implants, textured surface implants have a higher risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) but may have a lower risk of capsular contracture (CC). This study aimed to quantify whether survey respondents would be willing to accept a higher risk of BIA-ALCL in exchange for the potential reported benefits of textured breast implants.

We fielded a threshold technique survey to 405 respondents from 4 cohorts: (1) patients with breast cancer who were considering but did not receive reconstruction with implants, (2) patients with breast cancer who had received reconstruction with implants, (3) persons considering breast augmentation with implants, and (4) patients who had received breast augmentation with implants.

The average maximum increase in the risk of BIA-ALCL that the survey respondents were willing to accept in exchange for textured implants-with both a teardrop-shaped option and a 10% reduction in the risk of CC-were as follows: 0.83% for patients who were considering breast reconstruction, 0.61% for patients who had received breast reconstruction, 0.85% for persons considering breast augmentation, and 0.60% for patients who had received breast augmentation.

We found respondents generally were willing to accept the higher risk of BIA-ALCL associated with textured implants to gain the potential benefit of reduced risk of CC and the option of the teardrop-shaped implant. Patient perspectives and preferences are integral, and continued assessment of patient perspectives can help inform regulatory and care paradigms.