A small South Korean study found that women who had textured implants for reconstruction after breast cancer surgery had a small but statistically significant increase in the risk of the breast cancer coming back (recurrence).
The research was published online on Oct. 7, 2020, by JAMA Surgery. Read the abstract of “Association of the Implant Surface Texture Used in Reconstruction With Breast Cancer Recurrence.”
Textured vs. smooth implants
Most women who have mastectomy to treat breast cancer go on to have one or both breasts reconstructed. There are two main ways to reconstruct a breast:
- using tissue transplanted from another part of your body (such as your back, belly, or thighs)
- inserting an implant that's filled with saline (salt water) or silicone gel
The surface of an implant may be smooth or may have a slightly rough or bumpy texture.
According to Breastcancer.org Professional Advisory Board member Frank DellaCroce, M.D., a board-certified plastic surgeon and founding partner of the Center for Restorative Breast Surgery in New Orleans, textured implants were introduced in the 1980s as a solution to capsular contracture.
Once a breast implant is in place, scar tissue forms around it, creating what’s called a tissue capsule. These tissue capsules are usually soft or slightly firm and not noticeable. But in a small number of women, a hard tissue capsule forms that can be painful and distort the shape of the breast. This is called capsular contracture.
Adding texture to an implant is thought to help slow or stop the hard tissue capsule from forming by disorganizing the bundles of collagen that form the scar layer.
“In breast reconstruction, textured implants are more often selected because it helps them stay put,” DellaCroce explained. “It helps them not rotate, particularly when we have a shaped, or anatomic, implant, so that if it were to move, it would create an odd shape in the breast. Also, breast reconstruction tends to have a higher incidence of capsular contracture by default. And so that’s why textured implants were often more popular in breast reconstruction relative to breast augmentation.”
About the study
The study included 650 women diagnosed with early-stage breast cancer who had mastectomy and implant reconstruction between January 2011 and December 2016 at the Samsung Medical Center in Seoul.
About 75% of the women were diagnosed with stage I or stage II disease.
The 650 women had 687 implants placed. On average, the women were about 43.5 years old.
Of the 687 implants:
- 274 were smooth
- 413 were textured
Overall, 4% of the 650 women had some type of breast cancer recurrence after about 4.5 years of follow-up.
Five-year disease-free survival rates were:
- 97.8% for women with smooth implants
- 93.3% for women with textured implants
This difference was statistically significant, which means that it was likely due to the difference in implant type and not just because of chance.
The disease-free survival rate is the percentage of women who were alive without the cancer coming back.
“This cohort study found that use of textured implants in reconstruction appears to be associated with recurrence of breast cancer,” the researchers wrote. “Further investigation is required to verify these results.”
Other implant risks
The results of this study are troubling and add to the risks associated with implants.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare form of cancer that can develop in the scar tissue capsule and fluid surrounding a breast implant.
As of Jan. 5, 2020, the U.S. Food and Drug Administration (FDA) reported that 733 cases of BIA-ALCL had been diagnosed around the world and 36 women had died from the disease.
Of the 733 cases, 496 (68%) were diagnosed in women with textured implants.
In an editorial that accompanied the article, Michael Cassidy, M.D., and Daniel Roh, M.D., both of the Boston University School of Medicine, suggested that these risks make a case for stopping the use of textured implants.
“Given the association of textured implants with [BIA]-ALCL, and now the suggestion that they are associated with increased risk for breast cancer recurrence, surgeons who choose textured implants should counsel their patients with breast cancer about their possible consequences,” they wrote. “Many reconstructive surgeons across the world have already abandoned the use of textured implants altogether.”
In July 2019, the number of BIA-ALCL cases reported led to a global recall of Biocell textured breast implants and tissue expanders manufactured by Allergan. The FDA and Allergan have asked plastic surgeons to stop using Allergan Biocell implants and to return all unused Biocell implants to the manufacturer. The recall does not apply to implants that are already in use (in other words, women who have Biocell implants should not necessarily have them removed, according to the FDA).
What this means for you
Deciding whether to have a breast reconstructed after surgery to remove breast cancer is a very personal choice. If you’ve been diagnosed with breast cancer and are planning your surgery, you may decide not to have reconstruction, but it can be helpful to consider all your options.
If you are considering breast reconstruction with an implant, talk to your doctor about the risks and benefits of implants, including the differences between textured and smooth implants. The risks of recurrence and BIA-ALCL should be discussed as part of the informed consent process before any implant surgery.
“This is an important conversation for patients to have with their physicians. An implant should be chosen through shared decision-making,” says Mark Clemens, M.D., FACS, associate professor of plastic surgery at the University of Texas MD Anderson Cancer Center in Houston who studies BIA-ALCL and other health conditions linked to breast implants.
For more information, including types of reconstruction, the timing of reconstruction, and questions to ask your breast surgeon and plastic surgeon, visit the Breastcancer.org Breast Reconstruction pages.
For more information on BIA-ALCL, read our Breast Implant Illness and BIA-ALCL Special Report.
To talk to others considering reconstruction decisions, join the Breastcancer.org Discussion Board forum on Breast Reconstruction.
And stay tuned to Breastcancer.org for the latest information on breast implant safety.
Written by: Jamie DePolo, senior editor
Reviewed by: Brian Wojciechowski, M.D., medical adviser
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