What goes around comes around “ why some people are using smooth implants again
I was recently at a meeting in London and I was chatting to some of my colleagues and it is interesting to hear that some people are going back to use smooth silicone implants.
If you look at the history of breast implants, the very first breast implants were smooth silicone implants, but they found that they had a high rate of capsular contracture and polyurethane foam implants were developed which dramatically reduced the risk of capsular contracture.
However, then there was the controversy about polyurethane implants (you can read more about this in my blog here), and so they needed to find a way of mimicking polyurethane foam which is when they came up with textured silicone implants.
In fact Mentor, which is a large American manufacturer of implants, actually make the texturing by making an impression of polyurethane foam onto a smooth silicone implant whilst the silicone is wet to give the texturing effect, which reduces the risk of capsular contracture compared with smooth silicone implants.
Ever since then, the textured silicone implants have been the most commonly used implant and certainly in the UK, smooth implants have hardly ever been used.
However recently a very rare type of cancer called ALCL has been discovered, which is a cancer of the capsule around the implant.
The numbers of described cases are very small in comparison with the number of patients who have breasts implants, but it is clearly something that the plastic surgery community is very concerned about.
One of the statistics of note is that there have been no cases of ALCL reported in patients with smooth silicone implants, and this is the reason that many doctors are now recommending smooth silicone implants for their patients.
The worry however, is that we will start seeing an increasingly high rate of capsular contracture which carries with it its own problems and potential morbidity.
I do not think there is an answer, certainly at the moment, as we do not really know what causes ALCL and so are only speculating that having a smooth silicone implant is protective.
It might simply be that the number of patients with smooth silicone implants is small and so no cases have been described yet.
We have always done our best to try and inform patients as well as we can to make the best options for themselves when it comes to having surgery and this involves giving information.
I really do not know what to recommend because there are pros and cons with smooth implants, textured implants, and polyurethane foam implants.
We are about giving patients the information that is currently available to allow them to make the best decision as to what is right to be into their body.
We tell everybody about the risk of ALCL and perhaps most importantly, anyone with breast implants should look out for any swelling or lumps associated with their breasts and seek help and investigation in order to rule out this rare but potentially serious complication.
It is certainly an option to have a smooth silicone implant if that is your wish and one of the great things about the Staiano Clinic is that we are independent and not tied to any implant manufacturer and so we can use any type of implant that you would like.
Obviously you would have to be aware of the increased potential of a capsular contracture associated with smooth implants, and so this would need to be balanced against the potential benefits.
I am sorry it is not clear cut, but I would be careful of any surgeon who suggests to you that it is clear cut and tries to tell you that one implant is better than another.
Certainly amongst all the major implant manufacturers they are all made to a very high standard of safety and quality and there is no clear evidence that one is safer than other.
I know it is sometimes easier to hear that you should have this implant because it is the best and if you were to have any problems and then researched it and discovered that there is no best, you may have preferred to have had all the information so that you could make an informed decision yourself.
If you have any questions we’d love to hear from you. You can e-mail us or call us.
Or you can ask our director, Jonathan Staiano, a question LIVE on Facebook at 7 o’clock every Tuesday evening, so feel free to drop firstname.lastname@example.org.