We are thankful for the opportunity to respond to Dr. Montemurro and colleagues. It is widely accepted that the thinner the tissue cover is, the more obvious becomes the shape of the implant. The inclusion of the body mass index or the patient’s chest dimension would probably have increased the quality of our study. We will consider this appreciation for future studies.
We agree that patients with a short nipple-to–inframammary fold distance could benefit more from anatomical implants. These patients were not included in the study because the senior author (J.A.L.) uses anatomically shaped implants in these cases; however, the superiority of anatomical implants has not been proven yet.
Anatomical implants have disadvantages compared with round implants; they are more firm, have malrotation potential, require mandatory texturization, have greater cost, have limited incision choices, need longer incision, require more complex operative technique, can appear odd in the supine position, and have limited applicability in secondary cases. In addition, late seroma and anaplastia large-cell lymphoma are more likely to occur with textured anatomical implants compared with smooth round implants.1–5
None of the studies comparing round implants and anatomically shaped implants has found a significant aesthetic difference between them.6–9 A recent randomized controlled trial of anatomical versus round implants has been published by Hidalgo and Weinstein. This is a study with level I evidence showing no aesthetic superiority of anatomical over round implants.10
We do not suggest that any implant shape is superior. In our study,9 we conclude that it is not possible to differentiate the type of implant. Presuming that our conclusion is true, does the use of anatomical shaped implants make sense? Our study is not the final answer but without doubt increases the evidence toward the absence of aesthetic differences between round and anatomically shaped implants.
The authors have no commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in this communication.
Carlos G. Rubi, M.D.IMED ValenciaBurjassot, Valencia, Spain
Elena Leache, M.D.Jose Angel Lozano, M.D., Ph.D.Complejo Hospitalario de NavarraPamplona, Navarra, Spain
Alberto Pérez-Espadero, M.D.IMED ValenciaBurjassot, Valencia, Spain
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