It is necessary to know that each texture has its indications, and this is important when choosing the type of implant. It is also necessary to know the shape of the implant, the type of surgery and the anatomical characteristics of the patient.
In addition, a good assessment must be made in consultation beforehand, taking into account the patient’s desires and tastes and the anatomy of the female breast.
When to choose the smooth cover?
As a general rule, the greater the roughness, the lower the incidence of capsular contracture. Consequently, smooth surfaces are associated with a higher incidence of capsular contracture.
However, a higher roughness of the texture is also related to a higher risk of seroma due to tissue irritation, since the rough texture produces a continuous rubbing on the surrounding tissues.
On the other hand, smooth covers also have a greater possibility of implant rotation. This risk means that, once the implant is placed, it can rotate inside the capsule. In the case of round prostheses, there is no problem, since there is no difference between upper and lower pole. But in the case of anatomically shaped prostheses, this rotation would cause a deformation of the breast. That is why anatomical implants are not made with smooth textures.
When to choose the Rough cover?
Within the textured surfaces, we can find, in turn, depending on whether the cover is more or less rough, respectively:
- macrotextured
- microtextured
- nanotextured
Rougher textures reduce the risk of capsular contracture, but the rougher the texture, the higher the risk of seroma.
Nanotextured covers are a good option, since by reducing the roughness of the implant surface, the friction capacity decreases and, consequently, the risk of seromas is also reduced. However, in anatomical implants, the nanotextured surface may not be sufficient for the risk of implant rotation or rotation.
In our experience, at Dr. Lopez Burbano Aesthetic Clinic we prefer:
- Microtextured cover for anatomical implants, which reduces the risk of implant rotation and generates less tissue irritation compared to macrotextured surfaces.
- Nanotextured coating on round or ergonomic implants, which are not affected by the risk of rotation, and minimize the effect of tissue irritation.
When to choose Polyurethane coating?
Although polyurethane surfaces are not new, they have gained popularity in recent years. They are textured silicone prostheses to which a thin layer of polyurethane foam is added.
This type of cover offers a very good subjection to the tissues, since, in these cases, the periprosthetic capsule is formed intertwining with the implant cover, in such a way that it is totally fixed to it. This significantly reduces the risk of implant rotation.
In our experience, implants with polyurethane cover offer good results in the following cases:
- Prosthesis replacement: when there has been a previous capsular contracture with a silicone implant with another surface.
- In some cases of mastopexy in patients with very lax tissues, where there may be a higher risk of implant rotation.
- In cases where a secondary displacement of the implant can be foreseen or has already occurred previously and we cannot rectify the pocket.
The incidence of anaplastic large cell lymphoma
Anaplastic large cell lymphoma is a rare type of lymphoma that originates in the periprosthetic capsule. And although this type of lymphoma has a very low incidence of 1 in 100,000 cases, it can occur.
Likewise, it is a low-malignancy neoplasm and can be easily cured if detected in early stages. Although it is a rare problem, it is advisable to maintain periodic surveillance in all patients with implants to detect problems in this regard.
There are still no studies significant enough to be able to draw conclusive data, but there seems to be a certain relationship between the degree of texturization of the implant cover and the incidence of this type of lymphoma. Therefore, the less irritating textures are farther away from this problem.
The realization of a simple annual ultrasound will allow not only to check the good condition and integrity of the implants, but also to monitor the health of the surrounding tissues, both the breast and the state of the periprosthetic capsule.