• #1-2. What Is Behind The Recent Popularity of Microtextured Implants?

     

    Findlay² also explains that he has used a 410 implant which resulted in higher incidences of capsular contracture, later seroma and double capsule. He uses only smooth walled implants. Allergan’s Biocell has a weak tissue adherence that cannot resist against the shear force and gets separated, leading to late seroma and double capsule.

     

    Wan et al. even reported that after corrective surgeries of capsular contracture, there was a significantly higher rate of capsular contracture recurrence with textured shell compared to the smooth shell.³ It would be more correct to say that texturing does not reduce the risk of capsular contracture but reduces malposition and rotation due to increased friction.

    Polyurethane was seen to cause definite tissue ingrowth and a significantly lower incidence of capsular contracture. On the other hand, previous microtextured products such as Siltex or macrotextured products like Biocell do not allow tissue ingrowth but loose tissue adherence. This does not prevent capsular contracture.  

    Allergan (formerly called McGhan) first used a salt loss technique for texturing which separates the salt crystals from the shell. This creates a rough surface with micro bumps resembling air bubbles.

    Electron microscopic image of Biocell shell is shown in Image 1. Allergan Biocell’s pores range 200~500um in width and 600~800um in depth.

     

    Image 1. Source: S. Barr, BSc, Current Implant Surface technology: An Examination of Their Nanostructure and Their Influence on Fibroblast Alignment and Biocompatibility,; Open Access Journal of Plastic Surgery, 2016:9:198-217.

     

    The Biocell implant surface is rough with large pores and plastic surgeons call it “macrotextured.” Naturally, this rough surface does form a strong adhesion to the adjacent tissues. However, the adhesion can be characterized as a weak Velcro-like attachment that can separate easily. This cannot be compared to the tissue ingrowth of polyurethane and does not prevent capsular contracture.

    Mentor, who developed textured implants around the same time as Allergan, used a very different approach to create textured implant shells. They use negative imprinting for texturing implant shells and Mentor is the only major manufacturer of breast implants that uses this method. Negative imprinting results in a very refined, gentle texture. The electron microscopic image is shown in Image 2.

     

    Image 2. Source: S. Barr, BSc, Current Implant Surface technology: An Examination of Their Nanostructure and Their Influence on Fibroblast Alignment and Biocompatibility,; Open Access Journal of Plastic Surgery, 2016:9:198-217.

     

     

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    The above image is drastically different from Allergan’s texturing. The Siltex implant surface seems more refined than that of Biocell. Microbumps on Mentor implants are 40um wide and 203um deep. Macrotextured and microtextured surfaces can be compared as below.

     

    Image 3.

     

    Silimed, another FDA approved implant, uses evaporation for texturing. The microbumps on the implant surface are 150~300um wide and 80~150um deep, which fall somewhere between those of Siltex and Biocell. The electron microscopic image of True Texture implant surface is shown in Image 4.

     

    Image 4. Source: S.Barr, BSc, Current Implant Surface technology: An Examination of Their Nanostructure and Their Influence on Fibroblast Alignment and Biocompatibility,; Open Access Journal of Plastic Surgery, 2016:9:198-217.

     

    We call Sillimed’s True Texture “intermediate texture” which lies between the very fine texturing of microtexturing and rough texturing of macrotexturing. Some doctors also categorize True Texture as macrotextured.  

    In my experience of performing revision surgery, Biocell adhered to surrounding tissues like Velcro as shown in Image 5. It separates easily with a slight pull.  

     

    -To be continued

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