Trends in Plastic Surgery – Series 1: Breast Augmentation

Drop in use of textured breast implants due to safety concerns

Are you considering a breast augmentation (breast enlargement) with breast implants?

Our senior surgeon, Mr Allan Kalus recently attended the Annual Meeting of The American Society of Aesthetic Plastic Surgery which was held in Las Vegas in the United States. One popular trend discussed was the large move away from the use of textured breast implants in the United States.

In fact, currently, in the US, 73% of plastic surgeons now recommend smooth breast implants over textured breast implants.

This is because of the realization that the textured surface on breast implants encourages growth of bacteria. This results in a biofilm which can then lead to firm fibrous encapsulation of the breasts.

Even more dangerous is the fact that the bacteria around textured implants have been implicated in the causation of a disease known as ALCL – Anaplastic Large Cell Lymphoma.

This is a type of cancer growing in the scar capsule around the implant.  It only ever occurs around textured implants.  Although it is very rare there have been 7 recorded deaths due to ALCL.

Despite this clear risk.  It is interesting that only 25% of surgeons in the United States warn their patients of the risk of ALCL and its association with textured breast implants.

The first sign of an ALCL is often some fluid forming around the breast implant.

Most cases have been identified 8 years after insertion of the implant.

Because of the extensive use of textured breast implants by surgeons here in Australia we unfortunately have a cluster of cases of ALCL here in Australia.

The question arises as to how should one advise a woman who has already had a textured breast implant inserted.  Should the implant be removed and replaced with a smooth-walled implant? Or should she retain the implant and thereby continue to be at risk of ALCL for as long as she has the implant?

No doubt there will be a lot of debate on this subject in the future, but Mr Kalus’ view is that we should do whatever we can to reduce risk and therefore he would personally recommend that any textured implant be removed.

Following removal of breast implants the options are:

  1. To replace the volume either with another implant (with a smooth-walled surface – either silicone or saline).
  2. To replace the volume with your own fat. Breast augmentation using your own fat is our fastest growing procedure at Avenue Aesthetic Surgery. We were the first in Melbourne, Australia to offer this procedure and now have over three years of experience with excellent results.
Surgeon preference for round breast implants

There was also considerable discussion at the meeting about whether implants should be anatomically shaped or round.

Overwhelmingly  American surgeons prefer the use of round breast implants.  This is because a number of studies have shown that it is impossible to tell the difference between an anatomical and a round breast implant once they have been inserted into the body!

Furthermore, anatomical (or shaped) implants have many complications that are not seen with round implants.  They can flip, rotate, rollover and, as they are textured, are associated with complications such as seroma, encapsulation and ALCL.

At this meeting 80% of surgeons in the audience preferred using round breast implants.

In terms of implant location (in front of or behind the pectoralis major muscle) it is interesting that 93% of surgeons in the United States are using a sub muscular pocket to insert their implants.

At Avenue Aesthetic Surgery we recommend that smooth round implants be placed under the muscle for the most natural looking and trouble-free result.