First, some background. Breast implants are available in both round and tear drop shapes and each type can have either a smooth or rough (textured) outer surface (Figure 1). The material inside the implant, either saline water or silicone gel, have both been proven safe after decades of investigation and are not in question. However, there is a new controversy regarding the association of textured surface implants and a very rare type of cancer called anaplastic large cell lymphoma, or ALCL. Smooth surface implants do not appear to have this risk. Among the millions of women with breast implants approximately 300 cases of ALCL involving textured implants have been found, so the risk is very low. While some deaths have been reported, this type of tumor is very treatable by removing the implant and surrounding capsule tissue. These tumors typically first appear over 5 years after implantation, presenting with either fluid around the implant or a firm area usually near the chest surface.
smooth implant on the right.
Why use textured surface implants?
Our practice does not use textured implants for breast augmentation but many surgeons still do. Textured implants are used for two reasons: to prevent implant hardening (capsular contracture) and to prevent tear drop implants from rotating inside the implant pocket. The latter is achieved by a Velcro type action between the rough surface of the implant and the surrounding tissue. Our belief, based on decades of scientific evidence, is that textured implants are not more effective than smooth implants in preventing breast hardening if the implant is placed under the pectoral muscle. We believe that all implants should be placed under the muscle anyway, for both superior upper breast contour and for better breast imaging with mammograms. Furthermore, we recently published a rigorous scientific study that showed no aesthetic advantage of tear drop shaped implants over round implants, so we do not see their utility. With these points in mind we conclude that there is no role for textured surface implants in breast augmentation today.
What if you have textured implants?
If you have textured implants (again, none of our patients do) there is no immediate reason to have them removed given the extremely rare incidence of ALCL. No guidelines have been issued to date by either our specialty, industry, or the FDA regarding this matter. If you have textured implants and they are over five years old it would not be unreasonable to obtain a MRI scan to confirm that there are no abnormalities that cannot be seen or felt. MRI scans should be routinely obtained every two years thereafter anyway to monitor for silicone implant rupture, itself a harmless event indicating that the implants are simply worn out. It is strongly recommended that when the time comes the textured implants should be changed to the smooth surface type.
