Clarification on Rotation Rates of Textured Breast Implants

We have read the article by Maxwell et al entitled “Benefits and Limitations of Macrotextured Breast Implants and Consensus Recommendations for Optimizing Their Effectiveness.” One statement in particular is strongly deserving of clarification. One of the paragraphs in the article begins with a discussion of the reported rates through six years of malposition (including rotation) for the Style 410 shaped cohesive silicone gel-filled implants. That discussion is followed by a statement that “In contrast, in a single-center study by Baeke of various Siltex microtextured implants, rotation rates were as high as 14%.” The authors did not disclose that the cited study by Baeke was not reporting rotation rates for the SiltexTM (imprintedtextured) surface among the available shaped (“anatomic”) cohesive silicone gel-filled implants. They were reporting results on anatomic saline-filled devices (specifically Style 2700 and 2900 implants) that were implanted between 1995 and 1999. The “various” implants used in the Baeke study were 317 anatomical saline-filled devices, including 118 Style 2700, 197 Style 2900, and 2 McGhan Style 163. Rotation rates of anatomic saline-filled devices do not contribute to a discussion of shaped (“anatomic”) silicone gelfilled breast implants. As noted by the authors, “in the 6-year follow-up of the core study of Siltex microtextured silicone gel devices, the rotation rate was 1.1% among patients who underwent primary breast augmentation.” Additional long-term follow-up results are now available from the same large, multicenter, prospective Core Study of Mentor’s (Santa Barbara, CA) MemoryShapeTM Breast Implants for primary augmentation patients, and they indicate a cumulative incidence of rotation by Kaplan-Meier analysis through 10 years of 1.5%.