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Evolving Trends in Textured Implant Use for Cosmetic Augmentation in the United States

Tandon, Vickram J. M.D.; DeLong, Michael R. M.D.; Ballard, Tiffany N. M.D.; Clemens, Mark W. M.D.; Brandt, Keith E. M.D.; Kenkel, Jeffrey M. M.D.; Cederna, Paul S. M.D.

Plastic and Reconstructive Surgery: December 2018 - Volume 142 - Issue 6 - p 1456-1461
doi: 10.1097/PRS.0000000000004977
Cosmetic: Original Articles
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Background: Breast implants have evolved for decades. In 2011, the U.S. Food and Drug Administration identified an association between textured breast implants and breast implant–associated anaplastic large cell lymphoma (BIA-ALCL). The purpose of this study was to identify the trends of textured implant use since that time.

Methods: Maintenance of Certification tracer data were queried between 2011 and 2015 for cosmetic breast augmentation cases submitted by American Board of Plastic Surgery diplomates. A nested random effects logistic regression analysis was used to identify associations between variables.

Results: Eleven thousand seven hundred sixteen breast augmentations were performed by 880 unique surgeons. The overall proportion of cases using textured implants increased steadily from 2.3 percent in 2011 to 13.0 percent in 2015 (p < 0.001). The proportion of surgeons whose cases included both textured and smooth implants increased (from 6.2 percent to 24.3 percent), as did those using only textured implants (from 0.4 percent to 4.4 percent) (p < 0.001). Significance remained after controlling for form-stable implants, suggesting an alternative motivation for use of textured implants. Subglandular cases (20.5 percent) were more likely to use a textured implant than submuscular (8.4 percent) or dual-plane (7.8 percent) (p < 0.001) cases.

Conclusions: Maintenance of Certification tracer data represent a random sampling of American Board of Plastic Surgery–certified plastic surgeons spanning the gamut of practice settings. Despite ongoing education regarding the association of BIA-ALCL with textured implants, American Board of Plastic Surgery diplomates have trended toward increased use of textured implants for cosmetic breast augmentation since 2011. This finding does not appear to be driven by the introduction of anatomical implants during the study period.

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Ann Arbor, Mich.; Los Angeles, Calif.; Houston and Dallas, Texas; and St. Louis, Mo.

From the Section of Plastic Surgery, Department of Surgery, University of Michigan; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, Los Angeles; the Department of Plastic Surgery, Division of Surgery, University of Texas M. D. Anderson Cancer Center; the Department of Plastic Surgery, University of Texas Southwestern Medical Center; and the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University.

Received for publication January 17, 2018; accepted May 24, 2018.

Disclosure:The authors report no financial conflicts of interest. This study was not funded.

Paul S. Cederna, M.D., Section of Plastic Surgery, 2130 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, Mich. 48109-0340

Copyright © 2018 by the American Society of Plastic Surgeons