Reply: Intraoperative Comparison of Anatomical versus Round Implants in Breast Augmentation

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We welcome the authors’ commentary regarding our article,1 but noticed a mixed message. While discussing the option of using less aggressive texturization in light of current breast implant–associated anaplastic large-cell lymphoma (ALCL) research findings, they express concern that anatomical implant stability within the pocket would be compromised by so doing. They also wonder why little notice has been given to the lack of aesthetic consequences when malrotation is discovered unexpectedly at reoperation. The latter, which we too have witnessed, is further evidence that anatomical implants do not impact breast shape differentially compared to round implants.
Anatomical implants are far more popular outside the United States, particularly in Europe. A more laissez-faire attitude toward texturization exists there because of the strong belief in the aesthetic superiority of anatomical implants. Our study was conducted to establish the truth in the matter, and for selfish reasons too. We were concerned we might be missing something by not using these devices in our practice, but now we know we are not.
The handwriting is on the wall for implant texturization. Already proven not to be of notable advantage in the treatment of capsular contracture, the association with breast implant–associated ALCL will prove its fatal flaw. Although industry, our specialty, and the U.S. Food and Drug Administration are slow to proactively condemn textured devices, the legal system is not. We recently saw a television ad by a Phoenix, Arizona, law firm trolling for ALCL cases despite the rarity of the condition. As the evidence mounts through continued unbiased scientific research, implant texturization will ultimately prove indefensible.
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