D33. Surgical Management of Textured Breast Implants: Assessing Risk and Analyzing Patient-Reported Outcomes

Abstract

PURPOSE: Textured implants have been linked to breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). Following explantation, patients have different reconstructive options, however data on safety and patient-reported outcomes (PROs) is limited. We aimed to 1) characterize the safety of surgical interventions for textured implant management and, 2) compare PROs across intervention groups using BREAST-Q scores. METHODS: We retrospectively reviewed patients who sought surgical intervention for textured implants between January 2018 and June 2021 and defined four management cohorts: 1) textured to smooth conversion in asymptomatic patients; 2) textured to smooth conversion in symptomatic patients, 3) explantation without replacement; and 4) textured to autologous conversion. RESULTS: We included 384 patients: 224 in the first cohort, 83 in the second, 44 in the third, and 33 in the fourth. We observed a difference in complication rates between management groups (p = 0.034), with patients undergoing explantation enduring the greatest complication rate, however we found no difference based on extent of capsulectomy. A subgroup PRO analysis, including 239 patients, showed patients converting to smooth implants or to autologous reconstruction had significantly higher satisfaction with their breasts postoperatively (p<0.05). The autologous group also had significantly improved sexual well-being 6 months and 1+ years postoperatively (p=0.005, p=0.043). CONCLUSION: Patients seeking surgical management for textured implants have acceptable rates of surgical complications. The data challenges the paradigm that complete capsulectomy is associated with increased complication rate and highlights postoperative satisfaction and well-being. This can guide patients considering surgical management and open a dialogue for shared decision making.