What do we really know about the implants we use in our surgical practice?

A vast array of implant textures with different surface features produced with different methods are available in the global market.

Salt or sugar crystals used to imprint a texture on the silicone shell, polyurethane interconnected open pore foam networks, polyurethane open-celled foam, direct imprinting from a textured treated mandrel: these are the most commonly used methods to create textured breast implant surfaces.

Breast implant manufacturers like to describe their texture in a way that distinguish their breast implants from the others, frequently using subjective terminology to characterize pore depth and surface area: “macro”, “micro”, “nano” texturizations are the terms that we use every day, but do we really know the implications of different textures in terms of implant interaction with breast tissues and biofilm formation?

With textured breast implants, the bigger the pore opening, the less likely bacteria are able to survive and subsequently develop biofilms. This would translate in higher biofilm formation, capsular contracture rates and BIA-ALCL development in the textured implants with lower pore opening ranges, expecting fewer incidences of biofilm-associated complications in macro-textured products…

If we believe in the biofilm theory for the pathogenesis of BIA-ALCL, high-surface-area textured implants should be associated with increased rates of BIA-ALCL, because a larger surface area would be available for bacterial contamination, promoting inflammation and T-cell stimulation.

Well, even though data are not conclusive, there are some trends towards an association of “macro-texturization” with BIA-ALCL development more than “micro” or “nano” texturizations but this observations would be in contrast with the previous “infectious theory” as textured implants with smaller surface areas (i.e. macro-textured implants) would be less likely to give rise to biofilm formation, capsular contracture and BIA-ALCL.

Clearer information about implant and surfaces characteristics are needed from the manufacturers, texture terminology should be determined with standardized approaches.

A round table with the opportunity of sharing hypothesis and ideas with implant manufacturers on implant characteristics and their impact on surgical outcomes will be held on Wednesday 12th of December.

Don’t loose the opportunity of expressing your opinion! Be active part of the discussion!

We wait for you in Milan!

More info here.

What do we really know about the implants we use in our surgical practice? #MBN2018 #MBNBreastMeeting #NeverStopLearning Condividi il Tweet

References:

1. Brown T, Harvie F, Stewart S. A Different Perspective on Breast Implant Surface Texturization and Anaplastic Large Cell Lymphoma (ALCL).Aesthet Surg J. 2018 Apr 6. doi: 10.1093/asj/sjy091.

2. Ramião NG, Martins PS, Barroso ML, Santos DC, Fernandes AA. In vitro degradation of polydimethylsiloxanes in breast implant applications. J Appl Biomater Funct Mater. 2017 Nov 10;15(4):e369-e375.

3. Keizers PH, Vredenbregt MJ, Bakker F, de Kaste D, Venhuis BJ. Chemical fingerprinting of silicone-based breast implants. J Pharm Biomed Anal. 2015 Jan;102:340-5.

4. Valencia-Lazcano AA, Alonso-Rasgado T, Bayat A. Physico-chemical characteristics of coated silicone textured versus smooth breast implantsdifferentially influence breast-derived fibroblast morphology and behaviour. J Mech Behav Biomed Mater. 2014 Dec;40:140-155.

5. Formes A, Diehl B. Investigation of the silicone structure in breast implants using ¹H NMR. J Pharm Biomed Anal. 2014 May;93:95-101.

Nicola Rocco MD

Oncoplastic Breast Surgeon in Naples (Italy)
Founder and Scientific Director of G.RE.T.A.