The use of textured breast implants for breast reconstruction was associated with increased risk of breast cancer recurrence, a single-institution, retrospective cohort study in JAMA Surgery found.1

“Larger, multi-institutional analysis is critical to confirming the findings,” wrote Michael Cassidy, MD, and Daniel Roh, MD, PhD, of Boston University School of Medicine, Massachusetts, in a corresponding editorial.2 They noted that these preliminary data reported are both “alarming” and “intriguing.”

The study included 650 women, of whom 613 had cancer in 1 breast and 37 in both, resulting in 687 cases for analysis. Women underwent total mastectomy at Samsung Medical Center in South Korea and had tissue expanders placed to create space for implants and a second operation was later done to remove the tissue expanders and insert smooth or textured implants. Overall, 39.9% of cases had a smooth implant and 60.1% had a textured implant.

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A multivariate analysis showed that use of textured breast implants was associated with significantly worse disease-free survival (DFS) compared with use of smooth breast implants (hazard ratio [HR], 3.054; 95% CI, 1.158-8.051; P =.02).

“This association was driven by a higher incidence of distant recurrence in the textured group,” explained Drs Cassidy and Roh.

A total of 28 cases had breast cancer recurrence, which included 10 distant recurrences, all of which were found in cases with textured implants. The number of local and regional recurrences did not differ significantly between implant groups.

Multivariate analyses of subgroups showed that use of textured implants was associated with worse DFS for cases with ER-positive breast cancer (HR, 3.130; 95% CI, 1.053-9.307; P =.04) and cases with invasive carcinoma (HR, 3.044; 95% CI, 1.152-8.039; P =.03).

“Given the association of textured implants with ALCL [anaplastic large cell lymphoma], 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,” Drs Cassidy and Roh wrote.


  1. Lee K, Kim S, Jeon BJ, et al. Association of the implant surface texture used in reconstruction with breast cancer recurrence. JAMA Surg. Published online October 7, 2020. doi:10.1001/jamasurg.2020.4124
  2. Cassidy MR, Roh DS. Is it time to abandon textured breast implants for breast cancer reconstruction? JAMA Surg. Published online October 7, 2020. doi:10.1001/jamasurg.2020.4141