• #1-3. What Is Behind The Recent Popularity of Microtextured Implants?


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    The relatively smooth surface of Siltex does not allow it to adhere to surrounding tissues, which results in poor tissue adherence. In some cases, water (slight seroma) can be seen around the implant. Findlay has stated that he avoids using Siltex for this reason.


    In the beginning, due to poor tissue adherence, Siltex fell behind Biocell in the market. However, as anaplastic large cell lymphoma (ALCL) is becoming an issue in the US, many surgeons are going back to Siltex or True Texture.


    A rough surface provides more space for microorganisms to form (including bacteria). This is along the same line of logic that a towel catches moisture from the skin better than a smooth cloth. If so, would a textured surface provide more opportunities for capsular contracture? There were a few papers that reported that the textured shell did lead to a higher incidence of capsular contracture compared to the smooth shell. And there were many studies that reported different findings. How can we be certain which is the truth?


    Capsular contracture is one of the most serioust complications of breast augmentation. As there are varying opinions on which shell type causes this complication, I ask this question.

    Would it be possible that the doctor’s surgical technique is directly related to the risk of capsular contracture regardless of the type of implant used?

    It would benefit us all to pay more attention to peer reviews, reliable studies as well as our own clinical experience and less attention to the aggressive marketing by manufacturers and distributors.

    I wonder if the reason behind numerous published studies on this topic reporting such widely varying results would be that the surgical skills and techniques may have a bigger impact on the incidence of capsular contracture rather than the type of implant.


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    I find consultations to be often difficult as patients rely more on their own online research and information on SNS than on the doctor’s words. They often ask me why I say the opposite of what other doctors are saying. They say that other doctors tell them the textured shell causes less capsular contracture and does not require post-surgical massaging and the smooth shell has a higher risk of capsular contracture and requires massaging. When the patient already has a firmly preconceived notion about which implant they want, it is very difficult to persuade them otherwise.  


    I guess many plastic surgeons are saying that the textured implant shells are superior. However, the consensus on capsular contracture prophylaxis focuses on clean operation and non-traumatic technique. There is never any mention of textured shell, or post-surgical prevention of capsular contracture. 


    -To be continued

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