What Implants are best in 2021?
The implant market has changed a lot over the years, but more so with a move to less textured implant surfaces or even using implants that have no texture at all. Implant texturisation has been around for over 40 years with different degrees of texturing by different manufacturers. Having texture has always been regarded as a good thing to help maintain the stability of the implant in its pocket behind the breast. This was very important when the tear drop style of implant was used as no one would want an implant that slid out of shape. The other advantage of texturing was that it greatly reduced capsular contraction of the implant when it was placed behind the breast, but in front of the muscle (sub-glandular), compared to if a smooth implant was used. But we also know that many studies have since shown a similar capsular contraction rate if a smooth implant is placed behind the muscle (sub-pectoral positioning).
Why not use textured breast implant devices all the time?
The use of textured implants might be avoided when the risk of a breast implant lymphoma is considered. Although it is very uncommon even with the highest grade of texturing at approximately a 1 in 1000 to 1 in 3000 life time risk, or 1 in 10,000 to 30,000 life time risk with microtextured types, this is still over 100 times lower than an average patient’s lifetime risk of a breast cancer who does not have implants (1 in 8). However, perceptions of risk vary and for some the worry about things that are uncommon cannot be helped, such that it might be better not to have any implants at all, or if you really must have them, consider the option of a smooth implant.
Does BIA-ALCL affect smooth breast implants?
As of 2021 there has been just one confirmed report of breast implant lymphoma in a woman with smooth implants who had never previously had a textured device, so on this basis it is technically possible albeit very unlikely. Other cases have been reported where a textured implant was previously used, but later was swopped to a smooth implant after which an ALCL formed. It has therefore been thought that the textured implant may have been the culprit. But until the exact cause of this very uncommon cancer is understood, there will always be debate. What is important is to only use the implant that you are most comfortable with and even though risk is small, try to minimize it where possible. On the other hand, if complications are higher with capsular contraction then perhaps a microtextured implant is the preferred option, especially if sub-glandular implants are planned. A thorough discussion about this is pivotal and you must ensure your surgeon talks about it otherwise you should quickly find another surgeon!
So what implants are best???
I don’t think we can say anyone type is definitely better than another out of the implant manufacturers that I would use. However, I would be very uncomfortable using any macrotextured or even polyurethane coated implants without a very good reason to do so now. This is because we should always try to minimize risks and use alternatives where they are available. I would also recommend using mainstream manufacturers that are well known and have stood the test of time. Being totally belt and braces about it, I like to use an FDA approved implant such as the Mentor brand, given the long term data associated with this type. But ultimately, all implants can cause problems and they should never be simply left inside waiting for a complication to occur. Here, patients do have a responsibility too and should attend to see a specialist for a proper review. Be prepared to fund a consultation (usual cost £150) and a non-contrast breast MRI (approx cost £500) as part of your routine follow up.
