Letter to the Editor
Response to “Clarification on Rotation Rates of Textured Breast Implants”
Aesthetic Surgery Journal 2015, Vol 35(5) NP124 Published by Oxford University Press on behalf of the European Society of Cardiology 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US DOI: 10.1093/asj/sjv031 www.aestheticsurgeryjournal.com
G. Patrick Maxwell, MD; Michael Scheflan, MD; Scott Spear, MD; Maurizio B. Nava, MD; and Per Hedén, MD, PhD
We appreciate the comments offered by Drs Wixtrom and Canady regarding our article, “Benefits and Limitations of Macrotextured Breast Implants and Consensus Recommendations for Optimizing Their Effectiveness.”1 Texturization of the surface of breast implants was originally developed in an effort to minimize capsular contracture. An additional benefit was to stabilize the position of the breast implant. While there are many factors that contribute to the stabilization of a breast implant—including patient selection, preoperative planning, operative technique, postoperative care, the surface area of the base dimension of the implant, the filler to shell ratio, and the character of the fill material—the focus of our article was on the texturization of the shell of the implant. Specifically, we attempted to document the differences in macrotextured surface technology (such as Biocell) and microtextured surface technology (such as Siltex). While I believe the content of our article stands on its own merit, I do appreciate the comments regarding the differences in a saline-filled textured implant versus a gel-filled (or, more specifically, a form-stable gelfilled) implant. Notwithstanding the above, it is important that readers are well aware of the findings of Danino et al2 regarding implant positional stabilization when comparing a Biocell (macro) textured surface saline implant with a Siltex (micro) textured saline implant. They documented that the macrotextured surface promotes an “adhesive effect” (within the pocket), while a microtextured surface does not. This
adhesive property of a macrotexture allows for tissue adherence with the desired goal of “implant immobility with softness.” Such is not the case with microtextured surfaces. These findings are especially important with regard to the use of anatomically-shaped breast implants.
Disclosures Dr Maxwell is a consultant and royalty recipient for Allergan, Inc (Irvine, CA); a consultant for LifeCell Corporation (Branchburg, NJ); and a consultant and stockholder for the GID Group (Louisville, CO). Dr Scheflan is a consultant and speaker for Allergan, Inc, Canfield Scientific (Fairfield, NJ) and TEI Bioscience (Boston, MA). Dr Spear is a consultant and speaker for Allergan, Inc and LifeCell Corporation. Dr Hedén is a consultant and speaker for Allergan, Inc. Dr Nava declares no potential conflicts of interest with respect to the research, authorship, and publication of this article.
REFERENCES 1. Maxwell GP, Scheflan M, Spear S, Nava MB, Hedén P. Benefits and limitations of macrotextured breast implants and consensus recommendations for optimizing their effectiveness. Aesthet Surg J. 2014;34(6):876-881. 2. Danino AM, Basmacioglu P, Saito S, et al. Comparison of the capsular response to the Biocell RTV and Mentor 1600 Siltex breast implant surface texturing: a scanning electron microscopic study. Plast Reconstr Surg. 2001;108(7): 2047-2052.
Dr Maxwell is a Clinical Professor of Plastic Surgery at the Loma Linda School of Medicine, Loma Linda, CA. Dr Scheflan is a plastic surgeon in private practice in Tel Aviv, Israel. Dr Spear is a Professor and Chairman of the Department of Plastic Surgery at the Georgetown University Hospital, Washington, DC. Dr Nava is a plastic surgeon and Head of the Plastic Unit of the IRCCS Foundation at the National Cancer Institute, Milan, Italy. Dr Hedén is an Associate Professor of Plastic Surgery at Akademikliniken, Stockholm, Sweden. Corresponding Author: Dr G. Patrick Maxwell, Maxwell Aesthetics, 2020 21st Ave S, Nashville, TN 37212, USA. E-mail: [email protected]
Response to “Clarification on Rotation Rates of Textured Breast Implants”
Aesthetic Surgery Journal 2015, Vol 35(5) NP124 Published by Oxford University Press on behalf of the European Society of Cardiology 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US DOI: 10.1093/asj/sjv031 www.aestheticsurgeryjournal.com
G. Patrick Maxwell, MD; Michael Scheflan, MD; Scott Spear, MD; Maurizio B. Nava, MD; and Per Hedén, MD, PhD
We appreciate the comments offered by Drs Wixtrom and Canady regarding our article, “Benefits and Limitations of Macrotextured Breast Implants and Consensus Recommendations for Optimizing Their Effectiveness.”1 Texturization of the surface of breast implants was originally developed in an effort to minimize capsular contracture. An additional benefit was to stabilize the position of the breast implant. While there are many factors that contribute to the stabilization of a breast implant—including patient selection, preoperative planning, operative technique, postoperative care, the surface area of the base dimension of the implant, the filler to shell ratio, and the character of the fill material—the focus of our article was on the texturization of the shell of the implant. Specifically, we attempted to document the differences in macrotextured surface technology (such as Biocell) and microtextured surface technology (such as Siltex). While I believe the content of our article stands on its own merit, I do appreciate the comments regarding the differences in a saline-filled textured implant versus a gel-filled (or, more specifically, a form-stable gelfilled) implant. Notwithstanding the above, it is important that readers are well aware of the findings of Danino et al2 regarding implant positional stabilization when comparing a Biocell (macro) textured surface saline implant with a Siltex (micro) textured saline implant. They documented that the macrotextured surface promotes an “adhesive effect” (within the pocket), while a microtextured surface does not. This
adhesive property of a macrotexture allows for tissue adherence with the desired goal of “implant immobility with softness.” Such is not the case with microtextured surfaces. These findings are especially important with regard to the use of anatomically-shaped breast implants.
Disclosures Dr Maxwell is a consultant and royalty recipient for Allergan, Inc (Irvine, CA); a consultant for LifeCell Corporation (Branchburg, NJ); and a consultant and stockholder for the GID Group (Louisville, CO). Dr Scheflan is a consultant and speaker for Allergan, Inc, Canfield Scientific (Fairfield, NJ) and TEI Bioscience (Boston, MA). Dr Spear is a consultant and speaker for Allergan, Inc and LifeCell Corporation. Dr Hedén is a consultant and speaker for Allergan, Inc. Dr Nava declares no potential conflicts of interest with respect to the research, authorship, and publication of this article.
REFERENCES 1. Maxwell GP, Scheflan M, Spear S, Nava MB, Hedén P. Benefits and limitations of macrotextured breast implants and consensus recommendations for optimizing their effectiveness. Aesthet Surg J. 2014;34(6):876-881. 2. Danino AM, Basmacioglu P, Saito S, et al. Comparison of the capsular response to the Biocell RTV and Mentor 1600 Siltex breast implant surface texturing: a scanning electron microscopic study. Plast Reconstr Surg. 2001;108(7): 2047-2052.
Dr Maxwell is a Clinical Professor of Plastic Surgery at the Loma Linda School of Medicine, Loma Linda, CA. Dr Scheflan is a plastic surgeon in private practice in Tel Aviv, Israel. Dr Spear is a Professor and Chairman of the Department of Plastic Surgery at the Georgetown University Hospital, Washington, DC. Dr Nava is a plastic surgeon and Head of the Plastic Unit of the IRCCS Foundation at the National Cancer Institute, Milan, Italy. Dr Hedén is an Associate Professor of Plastic Surgery at Akademikliniken, Stockholm, Sweden. Corresponding Author: Dr G. Patrick Maxwell, Maxwell Aesthetics, 2020 21st Ave S, Nashville, TN 37212, USA. E-mail: [email protected]
