“I find it very hard to find a compelling reason to use textured implants,” Dr. Alyssa Golas, plastic surgeon at NYU Langone Health told SurvivorNet.
At the Food and Drug Administration’s hearings on textured breast implants and the risk of causing cancer, patients who were diagnosed with cancer after receiving breast implants told their stories to an FDA panel. "Cancer was not a choice, and we sure as heck didn't elect to get it," Dawn Criss of Alberta, Canada, told the panel.
Read MoreAnd even with textured implants, your risk of developing cancer is still fairly low. “There is a 1 in 1,000 to 1 in 10,000 risk with textured implants that you could get cancer, and as long as people are aware of that they are still okay. But patients have to be okay with it, and if they aren't okay with it, you have to do something else.”
“It is important to know that there are reconstructive options that don't include breast implants,” Dr. Golas continues. “Taking tissue from the abdomen, for example. These are bigger and longer surgeries, but reconstruction definitely does not require breast implants.”
Pros and Cons Of Textured Implants
Some doctors used to think textured implants were preferable, because they reduced another health risk that other types of implants can cause. “It used to be thought that textured implants reduced the risk that capsular contracture, which is the body making scar tissue around the implant, which can be uncomfortable or it can change the appearance and deform the implant, or both.”
As it turns out, capsular contracture may not be as closely tied to textured implants as doctors once thought. “But as we learn more about capsular contracture, it seems to be more related to very low grade infection, as opposed to the texture of the implants.”
Rather, there are factors that may contribute more directly to increased risk of capsular contracture. “There's some data to suggest that certain techniques that the surgeon uses while putting the implant in can reduce the risk of capsular contracture. It's not a totally well understood phenomenon, but that's what we think now,” says Dr. Golas. “Also if women get radiation for cancer, then they are also at higher risk for capsular contracture.”
Aesthetics of Textured vs. Smooth Implants
Aesthetic reasons can also play a role in the decision between textured and smooth implants. “Sometimes people want tear drip shaped (called “anatomic” implants) instead of round implants. And because the narrow part has to be at the top and the round part at the bottom, the texture prevents them from flipping around inside the body. If they're not textured, they can move and flip around inside the body. So if it's a round implant and it flips around, it's no big deal.”
“Some people like that the implants stay exactly where you put them, and so some surgeons like that feature, and think it's important to use them. I don't,” continues Dr. Golas. “I don't see breasts as fixed objects. I think they're more natural when they move around.”
Dr. Golas also noted that smooth implants don’t increase the risk of cancer. “There hasn't been any patient found with all with only smooth implants. There have been some patients who have had textured implants in the past, and then had them removed and then had smooth implants and developed ALCL, but there is no instance of a patient with only smooth implants. So it's possible that exposure to textured implants at some point in your life could put you at risk.”
When asked what makes textured implants increase the risk of cancer, Dr. Golas says it is still unclear. “There are some studies about it now — maybe something to do with chronic inflammation. But there is a lot of research happening right now to try to answer that question,” says Dr. Golas.
FDA Warning On Breast Implants
The Food and Drug Administration has acknowledged that it has known of a potential relationship between breast implants and increased risk of ALCL since 2011. Now they've updated that information.
"After a thorough data analysis, we are reporting that, as of September 2018, the agency has received a total of 660 total medical device reports regarding BIA-ALCL cases since 2010," the report said. "Of the 660 MDRs, our in-depth analysis suggests that there are 457 unique cases of BIA-ALCL, including 9 patient deaths," the report continued. "MDR" stands for Medical Device Reports, so there's been an increase in the number of reports the FDA has received about instances of the disease.
"We understand that the information presented shows an increase of 246 new MDRs since last year," said the FDA. "These types of increases in the MDRs are to be expected and may include past cases that were not previously reported to the FDA. The increased number of MDRs contributes to our evolving understanding of BIA-ALCL and represents a more thorough and comprehensive analysis."
"In addition, it is difficult to determine the total number of cases or estimate risk from the MDR reporting system due to potential under-reporting of events, possible duplicate reporting, and lack of data about the exact number of breast implants," the FDA warned.
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