“Not all breast implants are equal: a 13-year review of implant longevity and reasons for explantation”

Background: Augmentation mammoplasty is the most common aesthetic procedure. Textured implants control implant position and have improved capsular contracture rates; however, the impact of texturing on longevity and clinical findings at explantation is unclear. Methods: All cases of explantation between January 2005 – April 2017 from an aesthetic practice were reviewed retrospectively. Patient demographics, implant characteristics, time-to-explantation, and clinical presentation and intraoperative findings at explantation were analyzed. Results: 539 breast implants were explanted during the study period: 249 saline, 147 smooth gel, 123 Biocell®, and 20 other nonaggressively textured breast implants. Average time from placement to explantation was 7.5 years, 5.6 years, 4.9 years, and 4.0 years for saline, other textured, smooth gel, and Biocell® implants, respectively (p-value = 3.25e-08). The percentage of implants removed associated with implant performance failure was 50.3%, 57.5%, 75.0%, and 85.4% for smooth gel, saline, other textured, and Biocell® implants, respectively (p-value = 7.25e-09). 21.1% of Biocell® implants versus 1.5% of all other implants presented with pain (p-value = 2.71e-15). 45 Biocell® implants had double capsules; this phenomenon was not observed with any other implant type (p-value = 5.85e-37). Seven Biocell® implants had late seromas, compared to three late seromas with any other implant type (p-value = 0.0013). Conclusions: Here, we provide evidence that Biocell® implants have the shortest time-to-explantation and the highest proportion of implants associated with implant performance failure. This information should complement the informed consent process when selecting an appropriate implant. Financial Disclosure Statement: Nicholas J. Carr (consultant Allergan, Mentor) Aaron Van Slyke and Michael Carr have nothing to disclose. This article was funded by an academic research grant from the UBC Division of Plastic Surgery Presented at: UBC Division of Plastic Surgery Research Day 2017 in Vancouver, B.C. All authors have met the ICMJE guidelines for authorship credit as follows: Aaron C. Van Slyke: conception and design, acquisition of data, analysis and interpretation; drafting the article and revising the article critically for important intellectual content; final approval of the version to be submitted; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Michael Carr: acquisition of data, analysis and interpretation of data; revising the article critically for important intellectual content; final approval of the version to be submitted; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Nicholas J. Carr: conception and design of the study; interpretation of the data; revising the article critically for important intellectual content; final approval of the version to be submitted; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AKNOWLEDGEMENTS: This study was funded by a 2016 UBC Division of Plastic Surgery Academic Research Grant. Statistical analysis was performed by Karey Shumansky from the Applied Statistics and Data Science Group through the UBC Department of Statistics. Corresponding author: Aaron C. Van Slyke, MD, MSc, Division of Plastic Surgery, Burn and Trauma Unit, University of British Columbia (UBC) and Vancouver General Hospital, 2nd Floor, JPP 899 West 12th Avenue, Vancouver, BC, Canada. V5Z 1M9, vanslykeaaron@gmail.com ©2018American Society of Plastic Surgeons

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