A recent article looked at the rate of capsular contracture 5 years after silicone implant breast augmentation (Plastic and Reconstructive Surgery 2013; 132: 1115 – 1123). Scar tissue, called a capsule, forms around every breast implant. In some cases this scar tissue may contract, a condition known as capsular contracture (CC), producing a deformed breast (“looks like a grapefruit!!”) that may be painful. CC is one of the most frequent complications following breast augmentation. Please see my blog, “Why Are My Breasts So Hard After Breast Augmentation” from October 22, 2011, for more details on this condition.
In the article mentioned above, a group of patients were followed for 5 years after breast augmentation to determine whether or not they developed CC. Some patients had textured and some had smooth implants, some had implants placed in front of the pectoralis muscle and some behind the muscle. As expected, the implants placed behind the muscle had less CC than those placed in front of the muscle. What was surprising to me was how much less CC there was for textured as opposed to smooth implants under the muscle – 2.1% for textured implants and 4.9% for smooth implants. Going in front of the muscle, the CC rate was 5.1% for textured and 21.0% for smooth. In summary: the textured implants had a 50% lower CC rate than smooth behind the muscle, smooth behind the muscle had about the same CC rate as textured in front of the muscle, and smooth in front of the muscle had the highest CC rate.
Why are both smooth and textured implants used in breast augmentation if the CC rate is lower with textured devices? The reason: Other than a lower CC rate, textured implants tend to have a higher rate of problems than smooth implants. They have ripples that are more easily felt and seen, fluid buildup around these implants occurring months to years after surgery may require their removal and replacement, they tend to feel firmer, etc. Some textured implants are shaped in a teardrop fashion. These are particularly useful in reconstructive cases following a mastectomy. These implants, however, are filled with an even firmer silicone gel to maintain their shape, causing even more firmness to the implant. They also require longer incisions for their insertion, require a longer recovery period, and are more expensive. Teardrop implants are used less frequently in cosmetic breast augmentation because of these issues.
If there are all of these problems with textured implants, why use them at all? The main reason is that they lessen the chance of CC. In the U.S., textured implants are not used as much as in the rest of the world. The reason for this dates back to the early 1990’s when the silicone implant controversy in the U.S. resulted in the use of saline implants for augmentation. Textured saline implants had a great deal of wrinkling and a significant leakage rate, and for this reason, smooth implants were primarily used. When the FDA approved silicone implants for general usage several years ago, the habit of using smooth implants continued. The lesser rate of CC with textured implants documented in the article may change that to some degree.
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George Sanders, M.D.
