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Surgical Management of the Textured Breast Implant: Where Are We Now?
Ethan L. Plotsker, BA1; Francis D. Graziano, MD1; Robyn N. Rubenstein, MD1; Kathryn Haglich, MS1; Jasmine Monge, BS1; Joseph J. Disa, MD1; Robert Allen Jr, MD1; Joseph H. Dayan, MD1; Babak J. Mehrara, MD1; Evan Matros, MD MPH MMSc1; Carrie S. Stern, MD1; Jonas A. Nelson, MD MPH1*
1Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.

Background: Textured breast implants have become linked to breast implant-associated anaplastic large-cell lymphoma. Despite the FDAs recommendation against surgical removal, many patients with these implants are concerned about their chances of malignancy and seek surgical management. Other patients with symptoms such as capsular contracture may also seek removal. There is limited data on the safety and of the different management options (removal, removal and replacement, conversion to autologous reconstruction) as well as how the extent of capsulectomy correlates with postoperative complications. Our aim was to characterize the safety of different surgical interventions for management of the textured implant and concurrent capsulectomy.
Methods: This was retrospective review of patients who sought surgical intervention for their textured implants between January of 2018 and June 2021. We defined four management classes: 1) textured to smooth conversion in asymptomatic patients; 2) textured to smooth conversion in symptomatic (e.g., capsular contracture, ruptured) patients, 3) explantation without replacement; 3) textured to autologous conversion. Capsulectomy was classified as either none, partial, or complete. The primary outcomes of interest were reconstructive failure (of the smooth implant or flap, as applicable), hematoma, capsular contracture, seroma, cellulitis, and wound dehiscence. Complications were defined at the patient level.
Results: 384 total patients were included in this study: 224 were in the first management class, 83 in the second, 44 in the third, and 33 in the fourth. We observed a difference in complication rates, with the group undergoing explanation without replacement experiencing the highest rates (p=0.022), with 18.2% of this group experiencing seroma. We found no relationship between rates of reconstructive failure (p=0.348), cellulitis (p=0.635), hematoma (p=0.440), capsular contracture (p=0.694), wound dehiscence (p=1.000) and surgical management type. We found no differences in complications based on extent of capsulectomy (p=0.119)
Conclusion: Our study provides critical information regarding surgical outcomes after procedures to address textured implants. Patients seeking explantation of textured implants without replacement or conversion to autologous reconstruction should be counseled on the risk of seroma formation, potentially recurrent. This data challenges the paradigm that capsulectomy is necessarily associated with an increased postoperative complication rate and provides evidence that can guide shared-decision making regarding whether to pursue surgical removal of textured implants.


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