Management of Asymptomatic Patients With Textured Breast Implants: A Survey Analysis of Members of The Aesthetic Society

Frojo, Gianfranco; Nguyen, David C; Boyd, Louisa; Roider, Laura; Qureshi, Hassan A.; Christopher, Kara M.; Xu, Kyle Y.; Lund, Herluf

doi:10.1093/asj/sjab101

Cited by 2 publications

(1 citation statement)

References 9 publications

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“…[19][20][21][22][23][24] However, the management for asymptomatic patients with textured devices remains unclear and is based primarily on expert opinions, such as those published by McGuire et al 14 Frojo et al recently conducted a study that surveyed The Aesthetic Society to investigate practice trends for management of asymptomatic cosmetic patients with textured implants, which demonstrated significant heterogeneity in nonoperative and operative management. 25 Similarly, our study evaluates current practice management trends, although focusing on the breast reconstruction population, who often have higher operative risk due to factors such as thin mastectomy flap coverage of implants, previous irradiation, and presence of ADM in the pocket. Additionally, this population demonstrates higher anxiety levels due to prior cancer diagnosis.…”

Section: Takeawaysmentioning

confidence: 99%

Practice Trends in the Management of Asymptomatic Breast Reconstruction Patients with Textured Implants: A Survey Analysis

Roider

Nguyen

Ramkumar

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Despite the increasing prevalence of breast implant associated anaplastic large cell lymphoma, there remains a paucity of literature guiding management of asymptomatic patients with textured breast implants. This risk can be anxiety provoking in breast reconstruction patients given their history of cancer or increased future risk. The purpose of this study is to evaluate current practice trends when managing the concerned asymptomatic patient following textured implant-based breast reconstruction. Methods: An electronic survey was distributed to members of the American Society of Plastic Surgeons, regarding management of asymptomatic breast reconstruction patients with textured devices. Anonymous responses were collected, and statistical analysis was performed. Results: A total of 304 responses were received. Of respondents, 237 (92%) have managed asymptomatic patients with textured devices. Historically, the overwhelming majority (89%) used textured devices; however, only 25% report current use. Regarding management of asymptomatic breast reconstruction patients, 87% recommend conservative management, while 13% recommend surgical management. When surgery is performed, 16.3% of respondents elected for implant exchange, 33.8% recommended implant exchange with partial capsulectomy, and 49.8% elected for implant exchange with total capsulectomy. Evaluation of practice patterns based on demographics demonstrated statistically significant differences in current use of textured devices and management of acellular dermal matrix. Conclusions: Despite decreased current use, there is a significant population of asymptomatic breast reconstruction patients with a history of textured devices concerned for risk of breast implant associated anaplastic large cell lymphoma. This survey demonstrates ongoing variability in surgeon recommendations regarding conservative and surgical management of these patients and the need for continued development of evidence-based guidelines.

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Section: Takeawaysmentioning

confidence: 99%

Practice Trends in the Management of Asymptomatic Breast Reconstruction Patients with Textured Implants: A Survey Analysis

Roider

Nguyen

Ramkumar

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Outcomes of In-Office, High Resolution Ultrasound Silicone Breast Implant Surveillance by Plastic Surgeons

Glener,

Sergesketter,

Adams

2024

Aesthetic Surgery Journal

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Background Implant rupture is a known complication in cosmetic breast surgery but access and cost barriers hinder proper implant surveillance. Objectives This study aims to validate High Resolution Ultrasound (HRUS) for diagnosing silicone implant rupture, and secondarily, explore the predictors of implant rupture in a single-surgeon cohort. Methods A retrospective chart review identified patients who underwent HRUS of silicone breast implants that were placed by the senior author (WPA). HRUS sensitivity/specificity and predictive values were calculated. Multivariable logistic regression assessed predictors of implant rupture. Kaplan-Meier methods estimated 10 and 15-year implant survival. Results Among 254 patients (508 implants) included, 52 patients (104 implants) underwent operative exploration for various reasons; 20 implants had confirmed ruptures. Examining this operative cohort, HRUS had excellent positive and negative predictive value, respectively, 100% (95% CI 83.1-100%) and 97.6% (95% CI 91.6-99.3%); the sensitivity was 90.9% (95% CI 70.8-98.9%) and specificity was 100% (95% CI 95.6%-100%). The median age of the implant at the time of ultrasound was 119 months (10 years; IQR 79-152 months). After multivariable adjustment, the only the implant age was a significant predictor of implant rupture (p=0.04). Across the entire cohort, Kaplan-Meier methods estimated a 10-year and 15-year implant survival rate of 0.98 (95% CI 0.96-0.99) and 0.80 (95% CI 0.71-0.87), respectively. Subgroup analysis showed 10 and 15-year implant survival rates of 0.99 and 0.92, respectively, for surveillance-only HRUS patients. Conclusions Plastic surgeon delivered office-based HRUS surveillance is a highly sensitive and specific method to assess silicone breast implant integrity.

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Management of Asymptomatic Patients With Textured Breast Implants: A Survey Analysis of Members of The Aesthetic Society

Cited by 2 publications

References 9 publications

Practice Trends in the Management of Asymptomatic Breast Reconstruction Patients with Textured Implants: A Survey Analysis

Practice Trends in the Management of Asymptomatic Breast Reconstruction Patients with Textured Implants: A Survey Analysis

Outcomes of In-Office, High Resolution Ultrasound Silicone Breast Implant Surveillance by Plastic Surgeons

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