Research: Textured Implants
Board-certified plastic surgeon Dr. Domanskis is committed to educating his patients and potential patients about plastic surgery procedures they have had or are considering. While it is incredibly easy for anyone to find information online, Dr. Domanskis understands the importance of receiving the facts from someone with proven experience and expertise. Dr. Domanskis and the staff at his accredited Newport Beach surgery center believe in their patients’ right to be fully informed before making decisions about their plastic surgery plans. In particular, they believe it is important to provide information patients may not have access to otherwise, such as the following details about textured implants.
What is a textured implant?
A textured implant is a breast implant that has a coating or texturing layer.
Are all breast implants textured?
No, they either have a smooth coating or a textured coating.
Can saline-filled breast implants be textured?
Yes, saline implants can also be textured.
Why are breast implants textured?
The manufacturers of breast implants believed that the texturing prevented or limited the chances of capsular contracture.
About Capsular Contracture
What is capsular contracture?
Capsular contracture is when scar tissue, or a capsule, forms around a foreign object, like a breast implant, and “walls it off” from the rest of your body. Capsular contracture can develop to a degree that it becomes uncomfortable or painful, and the breast feels firm. A capsule that surrounds a breast implant may contract or scar and tighten around the breast implant, causing the breast to feel hard. This is called capsular contracture.
Are there different degrees of capsular contracture?
The degree of an incidence of capsular contracture is graded using the four-grade Baker scale: Grade I — the breast is normally soft and appears natural in size and shape. Grade II — the breast is a little firm but appears normal. Grade III — the breast is firm and appears abnormal.
Is capsular contracture dangerous?
No, capsular contracture is not dangerous. However, it can be uncomfortable or painful and make the breast hard and distorted.
Does capsular contracture occur on both sides in patients who have breast implants?
Not necessarily. It can occur on one side or both sides and just be a little firmer or feel very hard, like golf balls.
Why does capsular contracture occur?
In certain people who scar, it may be a “natural” process. In others, it could be due to bleeding, fluid, seroma formation, or previous or present infection.
Use of Textured Implants
Why is capsular contracture believed to occur less often with textured breast implants?
It is thought that the texturing, which is made up of uneven surfaces, breaks up the circumferential scarring.
Does texturing work?
Some studies of patients who have textured breast implants have shown the incidence of capsular contracture to be less.
Does the body really become attached to the textured breast implant?
In Dr. Domanskis's experience, the capsule becomes adherent, or grows attached to the texturing of a textured breast implant in the minority of the patients who have textured implants.
So, why use textured breast implants?
Dr. Domanskis did use textured implants for a while when they were introduced by the manufactures, Allergan and Mentor. However, he did not see a significant difference in the rate of capsular contracture and so stopped using them.
What are some of the other problems that can occur with textured breast implants?
Textured breast implants may cause a seroma or fluid within the capsule that surrounds the breast implant. However, the most troublesome problem is that an unusual lymphoma has been associated with silicone and saline breast implants: Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). To date, it has only been associated with textured implants. Individuals with breast implants may develop breast implant-associated anaplastic large cell lymphoma, or BIA-ALCL. BIA-ALCL is not breast cancer—it is a type of non-Hodgkin's lymphoma (cancer of the immune system).
How is this lymphoma diagnosed?
This lymphoma is diagnosed by pathological examination of the breast capsule. Laboratory tests are done on the fluid within the cavity if present. In a statement to healthcare providers, the FDA said they want doctors to consider whether BIA-ALCL is a possibility when a patient presents with a peri-implant seroma or fluid collection. The steps they want physicians to take include collecting fluid and sending it to a pathologist to look for signs of cancer. Additionally, if they see masses around an implant, they want them to consider the possibility it is BIA-ALCL.
What should I be looking for?
The most common symptoms are unexplained breast enlargement, asymmetry, fluid buildup, or a lump in the breast or armpit. However, rarely, symptoms may be more subtle, such as overlying skin rash and hardening of the breast. Women who develop these symptoms should see their physician to be evaluated with a physical exam and further testing.
Schedule a follow-up appointment with your treating physician to discuss any concerns you may have about your breast health.
Following a physical examination, patients with BIA-ALCL symptoms may receive an ultrasound or a magnetic resonance imaging (MRI) of the symptomatic breast to evaluate for fluid or lumps around the implant and in the lymph nodes.
If fluid or a mass is found, patients will require a needle biopsy with drainage of the fluid to test for BIA-ALCL. This fluid will be tested by a pathologist for CD30 immune staining (CD30IHC). Testing for CD30IHC is required to confirm a diagnosis or rule out BIA-ALCL. Fluid collections ruled out by CD30IHC for BIA-ALCL will be treated as typical seromas by a physician. Specimens not tested for CD30 may miss the diagnosis of BIA-ALCL.
Does this type of lymphoma occur with other textured implants besides breasts?
Recently, a patient who had textured buttock implants was diagnosed with this lymphoma.
Should I be concerned if I had textured breast implants or other textured implants?
BIA-ALCL is a rare and highly treatable type of lymphoma that can develop around breast implants. BIA-ALCL occurs most frequently in patients who have breast implants with textured surfaces. This is a cancer of the immune system, not a type of breast cancer. The current lifetime risk of BIA-ALCL is estimated to be 1:3817 – 1:30,000 for women with textured implants based upon current confirmed cases and textured implant sales data over the past two decades. When caught early, BIA-ALCL is usually curable.
Common symptoms include breast enlargement, pain, asymmetry, a lump in the breast or armpit, overlying skin rash, hardening of the breast, or a large fluid collection. These symptoms typically develop at least more than one year after receiving an implant and, on average, after 8 to 10 years. For any patient experiencing these or any symptoms, they should see their doctor for evaluation.
BIA-ALCL has been found with both silicone and saline implants and both breast cancer reconstruction and cosmetic patients. To date, there are no confirmed BIA-ALCL cases that involve only a smooth implant. BIA-ALCL patients seem to have an allergic reaction to textured devices over many years. Currently, it is not possible to test for who is at risk of this disease.
What is the treatment of this lymphoma?
When a woman is diagnosed with BIA-ALCL, her physician will refer her for a PET/CT scan to look for any disease that may have spread throughout the body. Any spread of the disease determines the stages, which is important for treatment.
Newly diagnosed patients will be referred to an oncologist for evaluation of BIA-ALCL, staging of disease, and treatment planning.
For patients with BIA-ALCL only around the implant, surgery is performed to remove the breast implant and the scar capsule around the implant.
Lumps in the armpit may be disease that has spread to the lymph nodes or may still be a normal enlargement of the lymph nodes. Testing of the lymph nodes may be performed with a needle biopsy or with a surgery to remove a lymph node for testing. Additional tests may sometimes include blood tests and a bone marrow biopsy.
Some patients with advanced cases may require further treatment with chemotherapy, and in rare cases, radiation therapy and/or stem cell transplant therapy.
Where can I find more information on this lymphoma?
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Plan Your Procedure
Understand your Implants
If you have textured implants and believe you are experiencing any of the symptoms described above, schedule a consultation with Dr. Domanskis to determine whether a breast revision surgery is right for you. He is highly knowledgeable in the rare complications associated with augmentation and can ensure that you will receive all of the appropriate follow-ups and aftercare.