Surgical Management of Textured Breast Implants: Assessing Risk and Analyzing Patient-Reported Outcomes

Background: Textured implants have been linked to breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). Patients who undergo explantation have options for reconstruction, but data on safety and patient-reported outcomes (PROs) are limited. The purpose of this study was to classify complications and PROs in patients opting for surgical management of textured implants. Methods: Complication rates and BREAST-Q scores were compared between (1) asymptomatic patients who underwent conversion from textured to smooth implants (n = 224), (2) symptomatic patients who underwent conversion from textured to smooth implants (n = 83), (3) patients who underwent explantation without replacement (n = 44), and (4) patients who underwent replacement with autologous reconstruction (n = 33). Linear regression examined PROs controlling for clinical and surgical variables. Results: Overall complication rates in 384 patients (637 implants) differed across groups (P = 0.034), with the highest rate (25%) in patients who underwent explantation without replacement. These patients were specifically more impacted by minor complications, notably seroma. Capsulectomy extent did not significantly impact complications. Asymptomatic and symptomatic smooth implant patients had improvements in Satisfaction with Breasts (P < 0.05). Autologous reconstruction patients had significant improvements in Satisfaction with Breasts sustained after 3 months postoperatively (P < 0.01) and Sexual Well-being sustained after 6-months postoperatively (P < 0.05). Patients who underwent removal without replacement had lower Physical Well-being of the Chest scores at 1 year or more than the other groups. Conclusions: Replacement of textured implants with smooth implants or flaps is safe and is associated with improved satisfaction with breasts and quality of life. The degree of capsulectomy does not appear to impact the incidence of perioperative complications.