Use of textured breast implants for postmastectomy reconstruction led to a small but significant increase in breast cancer recurrence as compared with smooth-surface implants, a retrospective study from South Korea showed.
Overall, 4% of 650 women had some form of disease recurrence during a median follow-up of 52 months after receiving breast implants. The 5-year locoregional recurrence-free survival (LRRFS) rate was 95.9% among women who received textured implants and 97.8% in those who had smooth implants, a nonsignificant difference, reported Sa Ik Bang, MD, PhD, of Sungkyunkwan University and Samsung Medical Center in Seoul, and colleagues.
As shown in their study online in JAMA Surgery, the 5-year disease-free survival (DFS) rate was significantly lower with textured implants: 93.3% vs 97.8%.
In a Kaplan-Meier survival analysis, LRRFS did not differ by implant surface type, but DFS remained significantly lower in the textured-implant group at 3, 4, and 5 years.
“Textured implant use could be associated with a lower DFS and high risk for recurrence than use of a smooth implant,” the researchers concluded. “This association may be valid regardless of other factors, including tumor stage and ER [estrogen receptor] status. Further investigation is required to verify these results.”
The results added to the well-documented risk of anaplastic large-cell lymphoma (ALCL) associated with breast implants, which have been blamed for 733 cases of ALCL and 36 deaths worldwide as of early 2020. The accumulation of adverse data makes a case for discontinuing use of textured implants, according to the authors of a commentary that accompanied the article by Bang and colleagues.
“Given the association of textured implants with ALCL, and now the suggestion that they are associated with increased risk for breast cancer recurrence, surgeons who choose textured implants should counsel their patients with breast cancer about their possible consequences,” wrote Michael R. Cassidy, MD, and Daniel S. Roh, MD, PhD, both of Boston University School of Medicine. “Many reconstructive surgeons across the world have already abandoned the use of textured implants altogether.”
The sudden emergence of the breast implant-associated (BIA) ALCL, and its possible relationship with implant-surface texture, focused more emphasis on implant safety, Bang and co-authors noted. Patients have raised concern about whether the implants might also be associated with breast cancer recurrence when used in reconstruction procedures after mastectomy, the team added.
No clinical studies had examined the association between breast implants and breast cancer recurrence. Chronic inflammation associated with an implant or the surgical procedure has been hypothesized as a potential trigger for BIA-ALCL.
Clinical and preclinical studies showed that surgery-induced inflammation could have implications for local residual or dormant tumor cells, including the potential to trigger tumor regrowth and metastasis, the authors continued.
To examine the issue, Bang and colleagues retrospectively analyzed data for patients whose breast cancer treatment included use of an implant during reconstruction procedures performed at Samsung Medical Center in Seoul from 2011 through 2016.
The researchers identified 650 patients who received a total of 687 implants, which had textured surfaces in 413