Smooth Surface Implants Research Articles

Breast Augmentation: Procedure, Complications & Treatment.

Breast Augmentation is one of the most common aesthetic procedures performed with a very high satisfactionrate. After the description of first report of implant placement in 1964 by Cronin and Gerow, the popularity of theprocedure is on the rise. The complications are few but require thorough understanding of each one of them fortheir prompt management and treatment. The procedure is generally performed by a prosthesis or implant.These implants are available in different sizes, shapes and profile and the surface of implant shell can be textured, micro textured or smooth with advantages to each type.Procedure can be performed through submammary, intra-areolar, axillary or transumblical approach. These implants can be placed in partial submuscular, dual plane, muscle splitting biplane, subfascial and subglandularpockets with advantages to each.In this chapter, over 1700 breast augmentations performed by the author were reviewed. All procedures wereperformed under general anaesthetic. Textured and smooth surface implants were used and using intra-areolaror submammary incisions, the devices were placed in partial submuscular, subglandular and muscle splitting biplane. All patients had at least single intravenous antibiotic and most of the procedures were performed as daycases.Complications following breast augmentation are few and may present early or late. Early common complicationsare haematoma, seroma, infection and Mondors’ Disease. Late complications include capsular contracture, implant rupture, malplacement of implant, dynamic breasts, implant flipping and rippling of the implant etc.The management and treatment of these complications were assessed and out come evaluated.Synmastia, bottoming down, periprosthetic infection and dynamic deformities are revisited and their treatmentplans redefined. Mondors disease incidence, asymptomatic as well as symptomatic, was researched and its various presentations associated with breast augmentation described. Implant rupture, its association with qualityand handling was reviewed. Implant rupture, its presentation and treatment plan redefined. Relationship of infection to length of antibiotic is analysed and various treatment modalities of periprosthetic infection and their outcome was assessed and suggestions and strategies for their management outlined.Breast augmentation is a procedure with a very high satisfaction rate however complications arising followingaugmentations needs to be carefully evaluated and require a proactive and appropriate action plan. An informedconsent should ideally include information outlining benefits of breast augmentation, possible complicationsalong with the management plan of each one of them.

Influence of nanocoated calcium phosphate on two different types of implant surfaces in different bone environment: an animal study

The purpose of this study was to evaluate the osseointegration of two different types of surfaces, smooth and roughened surface implants nanocoated with calcium phosphate (CAP) around different bone environment. Five male mongrel dogs were used in this study. The premolars and molars were extracted on both sides of the mandible. Eight weeks after extraction, implants were submerged on both sides of the mandible. On the left, CAP nanocoated roughened surface (RCAP) implants were installed whereas, the CAP nanocoated smooth surface (SCAP) implants were installed on the right side. The control group had no defect, on the other hand, three-wall intrabony defects were surgically created adjacent to the implant in the experimental group. The dogs were sacrificed after 12 weeks. Histological and histomorphometrical analysis were performed with the specimen. The SCAP and RCAP implants showed good osseointegration with no statistical significance in the control group. Histologically, the SCAP group showed little resolution of the defect compared with the RCAP group. In the experimental groups, there was a significant difference in defect fill between SCAP and RCAP. Within the limits of our study, it can be concluded that SCAP and RCAP implants show no difference in sufficient bone area whereas, CAP nanocoating on roughened implant surface may enhance osseointegration in deficient bone environment.

Bilateral Calf Augmentation for Aesthetic Purposes

The shape of the calf is determined by the development of the soleus and gastrocnemius muscles, the length and orientation of the crural bones, and the distribution of subcutaneous fat. Some people have a naturally thin or underdeveloped calf that remains small despite exercise. Calf augmentation is indicated for cosmetic reasons or for reconstruction of a shrunken lower leg resulting from injury, illness, or congenital disability. A total of 53 consecutive patients (40 women and 13 men) had surgery for calf augmentation between January 2004 and January 2007. The patients ranged in age from 25 to 51years (mean, 29.5years). All the patients included in the study requested calf augmentation for aesthetic purposes. Asymmetric-base silicone elastomer smooth-surface implants were used. Overall satisfaction after silicone calf augmentation was rated on a scale of 1 (poor), 2 (fair), 3 (good), 4 (very good), and 5 (excellent). All the patients had surgery by the same team of surgeons (L.H.P., A.S., B.N.). The evaluation was made at follow-up office consultations after 1year. The total mean follow-up time was 4.4years. In this study, 53 bilateral calf augmentations were performed, for a total of 106 procedures. The 125-ml implant was used in 37 bilateral cases, the 70-ml implant in 10 cases; and the 175-ml implant in 6 cases. In three cases, unilateral seroma formation needed to be drained by a partial skin incision opening. There were no cases of infection or hematoma. Hypertrophic scar was observed in four patients bilaterally. One patient requested removal of the implants, and the procedure was performed on an outpatient basis. There were no cases of compartment syndrome or deep vein thrombosis, and no pulmonary embolisms occurred. There were no cases of rotation or displacement of the implant. At 12months, 73% of the patients rated their appearance after calf augmentation as "very good" to "excellent," and 19% responded that their appearance was "good." Only 8% of the patients thought their appearance was less than good. At this writing, the average follow-up time for this group of patients has been 3.4years. Calf augmentation by silicone-filled implants for cosmetic purposes appears to be effective, safe, and aesthetically pleasing, with minor side effects.

Surface treatment at the cervical region and its effect on bone maintenance after immediate implantation: an experimental study in dogs

The aim of this study was to evaluate the effect of surface treatment at the cervical region of endosseous dental implants on the alveolar bone remodeling after implantation immediately after tooth extraction in a dog model. The third and fourth premolars of 6 dogs were bilaterally extracted with a full-thickness flap, and threaded implants presenting a textured or a polished surface at the cervical regions were placed on the distal root extraction sockets. Submerged healing was allowed for 4 weeks, and bone-to-implant contact (BIC) and buccal and lingual bone loss were morphometrically measured. The BIC and lingual bone loss were not significantly different between textured and polished groups. Significantly lower buccal bone loss (P < .01) was observed for the textured surface at 4 weeks in vivo. Textured surface implants placed immediately after tooth extraction resulted in less bone loss only at the buccal cervical region compared with smooth surface implants.

Late Seroma Formation after Breast Surgery with Textured Silicone Implants: A Problem Worth Bearing in Mind

Sir: In mammary implantation surgery, when breast enlargement occurs, physicians should first exclude infection and then investigate the presence of friction irritation or a true allergic response.1 Late hematoma and seroma are rare complications with an unknown incidence; current theories on their cause are as yet unproven. Several authors have suggested that microtrauma of the textured surface on the capsule causes the formation of granular tissue with neovessels that with rupture may lead to hematoma formation.2–4 In fact, cases of late hematoma and seroma unrelated to macroscopic trauma have been strictly associated with textured or polyurethane implants.3,5 We report a series of eight late seromas (five subglandular and three submuscular) accounting for a 1.84 percent incidence in our series. Patients presented a progressive monolateral breast enlargement (Figs. 1 and 2), but just four reported that a trauma had occurred a few days before. Ultrasound-guided needle aspiration of the fluid permitted us to exclude infection after aspirate culture. All patients experienced seroma recurrence and underwent reoperation with prosthesis removal. Removed implants did not present macroscopic signs of rupture. Immediate implant replacement was performed only if a new submuscular pocket could be created after capsulectomy. Otherwise, the implant was reintroduced into the same submuscular pocket after a period of 6 months. No seroma recurrence was observed at 1-year follow-up.Fig. 1.: Clinical photograph of a patient who underwent bilateral subglandular breast augmentation and developed a right late seroma (frontal view).Fig. 2.: Echographic image showing the intracapsular late seroma.Textured-surface and polyurethane implants have been preferred because of their lower rates of capsular contraction than smooth-surface implants in the subglandular compartment. However, it is noteworthy that reports of late seromas started only after the introduction of textured implants; indeed, late seromas are not mentioned in earlier studies investigating complications associated with smooth implants. The majority of reports of late seromas are associated with textured implants. Moreover, all reports of late seromas and hematomas related to smooth implants are associated with additional factors believed to be the cause.3 Lastly, unbroken textured or polyurethane implants have been associated with late seromas and hematoma in the absence of any apparent causative factor.2–4 Thus, the assumption that textured breast implants may cause late seroma seems to be correct. The incidence of these complications may be higher than believed because most reports are presented as single cases and not as part of wider, long-term studies. On the basis of our findings and the data reported concerning the etiopathogenetic mechanisms of late hematomas and seromas, we probably should consider changing the type of the implant from textured to smooth whenever a prosthesis needs to be replaced after these complications occur. Indeed, the smooth implant eliminates the risk of the friction irritation caused by the textured implant. Although we did not replace in our patients any of the textured implants with smooth ones to preserve implant symmetry and, also, any recurrence, we would seriously consider the possibility of doing so should any other cases of late seroma come to our attention. The inclusion of these complications in the informed consent form may be worth considering. Long-term studies designed to investigate the underlying causes of late intracapsular seroma and hematoma are warranted to prevent these complications. Marco Mazzocchi, M.D., Ph.D. Department of Plastic and Reconstructive Surgery Perugia, Italy Luca A. Dessy, M.D., Ph.D. Bruno Carlesimo, M.D. Francesco Marchetti, M.D. Nicolò Scuderi, M.D. Department of Plastic and Reconstructive Surgery University “La Sapienza” Rome, Italy DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

What's New in Dentistry

What's New in Dentistry

Marginal bone loss around three different implant systems: radiographic evaluation after 1 year

This study was designed to radiographically evaluate the effect of surface macro-and microstructures within the coronal portion of the external hex implant at the marginal bone change after loading. The fifty-four patients included in the study were randomly assigned to treatment groups with rough-surface implants (TiUnite, n = 45), a hybrid of smooth and rough surface implants (Restore, n = 45) or rough-surface with microthreads implants (Hexplant, n = 45). Clinical and radiographic examinations were conducted at the time of implant loading (baseline) and at 1-year post-loading. A three-level mixed-effect ancova was used to test the significance of the mean marginal bone change of the three implant groups from baseline to 1-year follow-up. At 1-year, significant differences were noted in marginal bone loss recorded for the three groups (P < 0.0001). The rough surface with microthread implants had a mean crestal bone loss of 0.42 +/- 0.27 mm; the rough surface implants, 0.81 +/- 0.27 mm; and the hybrid surface implants, 0.89 +/- 0.41 mm. Within the limitations of this study, a rough surface with microthreads at the coronal part of implant maintained the marginal bone level against functional loading better than implants without these two features.

What's New in Dentistry

What's New in Dentistry

Sandblasted/Acid-Etched vs Smooth-Surface Implants: Implant Mobility and Clinical Reaction to Experimentally Induced Peri-Implantitis in Beagle Dogs

This study uses a sandblasted/acid-etched implant vs a smooth-surface implant to compare implant mobility and clinical reactions of peri-implant tissues to experimentally induced peri-implantitis in Beagle dogs. The right and left mandibular premolars were extracted from 5 Beagle dogs, and 2 smooth-surface (SS) implants and 2 sandblasted/acid-etched (SLA) implants were placed in each animal. After 120 days, healing abutments were connected. Fifteen days later, the prosthetic abutments were connected, the hygiene regimen was suspended, and peri-implantitis was induced by the insertion of cotton ligatures into the soft tissue around the implants. At baseline and 30, 60, and 90 days later, clinical attachment level (CAL), probing depth (PD), and mobility (MO) were measured. Probing depth increased significantly in the SLA group alone when baseline PD was compared with 30-, 60-, and 90-day evaluations (P < .05). No significant differences were noted between the 2 implant groups (P > .05). The loss in CAL was significant in both groups when the baseline value was compared with 30-, 60-, and 90-day evaluations (P < .02). Comparison between the 2 implant groups revealed a greater loss in CAL in the SLA group at the 90-day evaluation period (P = .04). A significant increase in mobility was seen in both groups when baseline values and 90-day evaluations were compared (P < .04). However, no statistically significant differences were noted between the 2 implant groups (P > .05). Experimentally induced peri-implantitis results in a greater loss of CAL in SLA implants than in SS implants in dogs; however, no differences in mobility or in PD have been noted between the 2 implant groups.

The evaluation of healing patterns in surgically created circumferential gap defects around dental implants according to implant surface, defect width and defect morphology

Purpose: The aim of this study was to evaluate the factors affecting healing patterns of surgically created circumferential gap defects around implants in dogs. Materials and Methods: In four mongrel dogs, all mandibular premolars were extracted. After 8 weeks of healing periods, implants were submerged. According to the surface treatment, turned surface was designated as a group A and rough surface as a group B. In each dog, surgical defects on the left side were made with a customized tapered step drill and on the right with a customized paralleled drill. Groups were also divided according to the width of the coronal gaps: 1.0mm, 1.5mm, or 2.0mm. The dogs were sacrificed following 8 weeks and the specimens were analyzed histologically and histomorphometrically. Results: During the postoperative period, healing was uneventful and implants were well-maintained. As the size of the coronal gap was increased, the amount of bone-to-implant contact was decreased. The bone healing was greater in rough surface implants compared to the turned ones. About the defect morphology, tapered shape showed much bone healing and direct bone to implant contact even in the smooth surface implants. Conclusion: Healing of the circumferential defect around dental implant is influenced by the implant surface, defect width and the morphology of the defect. When using rough surface implants, circumferential gap defects within 2 mm do not need any kinds of regenerative procedures and the healing appeared to be faster in the tapered defect morphology than the paralleled one. (J Korean Acad Periodontol 2008;38:385-394)

Histologic Analysis of Zafirlukast’s Effect on Capsule Formation Around Silicone Implants

The most common complication experienced by patients who have undergone mammary implant surgery is capsular contracture. This matter concerns physicians and patients, but to date, there is no effective way to avoid this complication. Surgical intervention usually is required. In 2002, the use of zafirlukast, a leukotriene inhibitor (a drug used for asthma treatment), was reported for the treatment of capsular contracture, with good results. For this study, 30 female Wistar rats were used. These animals received two silicone implants each: one with a smooth surface and one with a textured surface. All the animals received daily intraperitoneal injections for 90 days and were divided as follows: control group (C) receiving only saline solution, experimental group 1 (E-I) receiving 1.25 mg/kg/day of zafirlukast, and experimental group 2 (E-II) receiving 5 mg/kg/day of zafirlukast. Histologic analysis used hematoxilin and eosin to verify vessels, capsule thickness, and inflammatory cells. Immunoistochemical analysis with smooth muscle anti-actin antibody was used for myofibroblast verification. Picro-Sirius under polarized light was used for collagen analysis. Textured implant experimental groups presented smaller numbers of vessels, thinner capsules, lower collagen density, and smaller numbers of mastocytes and eosinophils than the control group. No significant differences were found in smooth surface implants, as compared with the control group. Zafirlukast reduced the occurrence of factors directly and indirectly connected with capsular contracture.

Scanning Electron Microscopic Analysis of Diode Laser-Treated Titanium Implant Surfaces

The objective of this study was to analyze the possible morphological alterations of the surface implants after using 980-nm diode laser irradiation (InGalAsP) at various energies. Laser-based protocols have been proposed for decontaminating dental implant surfaces when treating peri-implantitis, although few studies have addressed this topic directly. Five smooth surface implants (TiOblast ST, Astra Tech AB, Mölndal, Sweden) were irradiated with 980-nm diode laser, and one implant that was not lased served as the control. The surface of each implant was treated for 60 sec on implant neck to apical threads. The experiment consisted of exposing the dental titanium implants to diode laser irradiation. Then the surfaces were analyzed by scanning electron microscopy (SEM). SEM analysis demonstrated any damage or alteration of titanium surfaces. Regardless of the power setting, there was no visible difference between lased and non-lased titanium surfaces after irradiation with the 980-nm diode laser. The results of this study suggest that the InGalAsP diode laser (980 nm) does not damage titanium surfaces, and seems to be safe and useful of treating peri-implantitis, irrespective of power output.

Significance of Keratinized Mucosa in Maintenance of Dental Implants With Different Surfaces

The need for keratinized mucosa (KM) or immobile keratinized mucosa (i.e., attached mucosa [AM]) for the maintenance of osseointegrated endosseous dental implants has been controversial. The purpose of this study was to investigate the significance of KM in the maintenance of root-form dental implants with different surfaces. A total of 339 endosseous dental implants in place for at least 3 years in 69 patients were evaluated. The width of KM and AM, modified plaque index (mPI), gingival index (GI), modified bleeding index (mBI), probing depth (PD), and average annual bone loss (ABL) were measured clinically and radiographically by a masked examiner. Based on the amounts of KM or AM, implants were categorized as follows: 1) KM <2 mm (KL); 2) KM > or =2 mm (KU); 3) AM <1 mm (AL); and 4) AM > or =1 mm (AU). Implants were further subdivided into the following four subgroups based on their surface configurations: 1) smooth surface implants (SI) with KM <2 mm (SKL); 2) SI with KM > or =2 mm (SKM); 3) rough surface implants (RI) with KM <2 mm (RKL); or 4) RI with KM > or =2 mm (RKM); or 1) SI with AM <1 mm (SAL); 2) SI with AM > or =1 mm (SAM); 3) RI with AM <1 mm (RAL); or 4) RI with AM > or =1 mm (RAM). The effect of KM or AM on clinical parameters was evaluated by comparing the different KM/AM groups. In addition, the significance of the presence of KM on implant prostheses types (i.e., fixed versus removable) and on implant locations (i.e., anterior versus posterior) was evaluated. Comparison of ABL among the four subgroups in KM or AM failed to reveal statistically significant differences (P >0.05); however, statistically significantly higher GI and mPI were present in SKL or SAL compared to the other three subgroups (P <0.05). GI and mPI were significantly higher in KL (0.94 and 1.51) than KU (0.76 and 1.26) and higher in AL (0.95 and 1.50) than AU (0.70 and 1.19) (P <0.05), respectively. The difference in GI between posterior implants with or without an adequate amount of KM was also significant (P <0.05). The absence of adequate KM or AM in endosseous dental implants, especially in posterior implants, was associated with higher plaque accumulation and gingival inflammation but not with more ABL, regardless of their surface configurations. Randomized controlled clinical trials are needed to confirm the results obtained in this retrospective clinical study.

Surface Properties of Endosseous Dental Implants After NdYAG and CO 2 Laser Treatment at Various Energies

Dental lasers have been used for uncovering submerged implants as well as decontaminating implant surfaces when treating peri-implantitis. The objective of this study was to compare the possible alterations of the smooth surface and resorbable blast material (RBM) surface implants after using NdYAG and CO(2) lasers at various energies. Ten smooth surface implants and 10 RBM surface implants were used. Two smooth surface implants and 2 RBM surface implants served as a control group that was not lased. The remaining implants were treated using NdYAG and CO(2) lasers. The surface of each implant was treated for 10 seconds on the second and third threads. The smooth surface implants (group 1) were treated using a pulsed contact NdYAG laser at power settings of 1, 2, 3.5, and 5 W, which are commonly used for soft tissue surgery; the corresponding energy and frequency were 50 mJ and 20 Hz, 100 mJ and 20 Hz, 350 mJ and 10 Hz, and 250 mJ and 20 Hz, respectively. The group 2 RBM implants were treated using a pulsed contact NdYAG laser. The group 3 smooth surface implants were treated using a pulsed wave non-contact CO(2) laser at 1, 2, 3.5, and 5 W, and the group 4 RBM implants were treated using a pulsed wave non-contact CO(2) laser. Data were analyzed using scanning electron microscopy. The control surface was very regular and smooth. After NdYAG laser treatment, the implant surface showed alterations of all the surfaces. The amount of damage was proportional to the power. A remarkable finding was the similarity of the lased areas on the smooth and RBM surfaces. CO(2) laser at power settings of 1.0 or 2.0 W did not alter the implant surface, regardless of implant type. At settings of 3.5 and 5 W, there was destruction of the micromachined groove and gas formation. This study supports that CO(2) laser treatment appears more useful than NdYAG laser treatment and CO(2) laser does not damage titanium implant surface, which should be of value when uncovering submerged implants and treating peri-implantitis.

In vivo behavior and mechanical stability of surface-modified titanium implants by plasma spray coating and chemical treatments.

The geometric design and chemical compositions of an implant surface may have an important part in affecting early implant stabilization and influencing tissue healing. In this study, in vivo behavior and mechanical stability in implants of three surface designs, which were smooth surface (SS), rough titanium (Ti) surface by plasma spray coating (PSC), and alkali- and heat-treated (AHT) Ti surface after plasma spray coating, were compared by histological and mechanical analyses. Surface morphologies of the implants were observed by optical microscopy and scanning electron microscopy. Chemical compositional surface changes were investigated by energy dispersive spectroscopy. The implants were inserted transversely in a dog thighbone and evaluated at 4 weeks of healing. At 4 weeks of healing after implantation in bone, the healing tissue was more extensively integrated with an AHT implant than with the implants of smooth (SS) and/or rough Ti surfaces (PSC). The bone bonding strength (pull-out force) between living bone and implant was observed by a universal testing machine. At 4 weeks' healing after implant placement in bone, the pull-out forces of the SS, PSC, and AHT implants were 235 (+/-34.25), 710 (+/-142.25), and 823 (+/-152.22) N, respectively. Histological and mechanical data demonstrate that appropriate surface design selection can improve early bone growth and induce an acceleration of the healing response, thereby improving the potential for implant osseointegration.

Future Directions in Breast Implant Surgery

Breast implant surgery will remain a major component of the practice of plastic surgery. The future may hold promise for the introduction of new implants for the augmentation of the breast and for reconstruction. The constant demand and pressure placed on the manufacturers to keep developing new fillers are proof that satisfaction with saline implants is lacking. Today, however, the saline implant may be believed to be the safest breast implant available for clinical application. The demand necessitates that implants be used for enhancement of a woman's self image and for reconstruction. The smooth-surface implants are considered more popular and safer for patients, perhaps because it has been well documented that the shell may have been the cause of the problem. However, the constancy in holding on using and reapplying the same principles of a faulty shell may not be as scientific an endeavor as we have done in the past, and to keep placing different fillers in the faulty shell. Perhaps the lamination process used in manufacturing, the air in the shell, or wear and tear produces mechanical weakening of the shell that eventually will lead to loss of integrity of the silicone-shell breast implant. The global community is looking to plastic surgeons for a solution. The applications and the demand for breast implants are global in nature. Meanwhile, as clinicians are waiting for a new implantable breast device, they will continue to use what is available and advise patients that the implantation of a breast prosthesis is not a life-long endeavor. There is a need, however, for the implants to be maintained by the process of exchange every 8 to 10 years. Breast reaugmentation is to be performed as a standard because plastic surgeons will be waiting for further clarifications from the regulators or the scientific community. The goal is to produce a good outcome and maintain safety for the patients with a high standard of care.

The Development of Surface Roughness and Implications for Cellular Attachment in Biomedical Applications

AbstractThe application of a microscopic surface texture produced by ion beam sputter texturing to the surfaces of polymer implants has been shown to result in significant increases in cellular attachment compared to smooth surface implants in animal studies. A collaborative program between NASA Glenn Research Center and the Cleveland Clinic Foundation has been established to evaluate the potential for improving osteoblast attachment to surfaces that have been microscopically roughened by atomic oxygen texturing. The range of surface textures that is feasible depends upon both the texturing process and the duration of treatment. To determine whether surface texture saturates or continues to increase with treatment duration, an effort was conducted to examine the development of surface textures produced by various physical and chemical erosion processes. Both experimental tests and computational modeling were performed to explore the growth of surface texture with treatment time. Surface texturing by means of abrasive grit blasting of glass, stainless steel and polymethylmethacrylate surfaces was examined to measure the growth in roughness with grit blasting duration by surface profilometry measurements. Laboratory tests and computational modeling was also conducted to examine the development of texture on Aclar® (chlorotrifluoroethylene) and Kapton® polyimide, respectively. For the atomic oxygen texturing tests of Aclar®, atomic force microscopy was used to measure the development of texture with atomic oxygen fluence. The results of all the testing and computational modeling support the premise that development of surface roughness obeys Poisson statistics. The results indicate that surface roughness does not saturate but increases as the square root of the treatment time.

Quality of the capsule in reconstructions with textured or smooth silicone implants after mastectomy.

Many women desire some kind of reconstruction after mastectomy for breast cancer to improve the cosmetic result. Since the introduction of silicone breast implants, capsular contracture has been the most common complication of breast augmentation or reconstruction. The aim of the present study was to evaluate the capsule quality in patients with breast cancer who had undergone reconstructions with either textured (rough) or smooth silicone implants after simple or modified radical mastectomy. Forty-three consecutive patients had reconstructions with textured silicone implants (49 implants) and were evaluated 32 months post-operatively in a prospective clinical trial. The last 43 consecutive patients who had reconstructions with bilumen smooth silicone implants (49 implants) acted as controls. The results were graded by Baker's classification. Among the patients with textured implants only 9% (4/47) was graded as having moderate or severe capsular contracture in contrast to 24% (11/46) in patients with bilumen smooth-surface implants (p < 0.05). These results confirm previous reports that favour textured silicone implants in breast augmentation and reconstruction.

Textured or smooth implants for breast augmentation? A prospective controlled trial

This study examines the hypothesis that textured surface silicone implants reduce the incidence of adverse capsular contracture in breast augmentation. A total of 53 patients were entered into a prospective study; they were randomly assigned to receive either smooth or textured implants which were placed in the submammary plane. Of these, 50 patients were assessed at 12 months by a panel of observers who did not know which type of implants had been used. Adverse capsular contracture (Baker grades 3 and 4) was found in 28 breasts augmented with smooth surface implants (58%) and in 4 breasts in the textured surface implant group (8%). This reduction in adverse contracture using textured surface implants was highly significant (p<0.0001). Careful trial design is essential in studies of this sort in order that we can obtain useful data regarding the causes and prevention of adverse capsular contracture.