silicone breast implants complications

 Every year, about 400,000 people receive silicone breast implants in the United States. According to data from the U.S. Food and Drug Administration, a majority of those implants needs to be replaced within 10 years due to the buildup of scar tissue and other complications.

A team led by MIT researchers has now systematically analyzed how the varying surface architecture found in these implants influences the development of adverse effects, which in rare cases can include an unusual type of lymphoma.

“The surface topography of an implant can drastically affect how the immune response perceives it, and this has important ramifications for the [implants’] design,” says Omid Veiseh, a former MIT postdoc. “We hope this paper provides a foundation for plastic surgeons to evaluate and better understand how implant choice can affect the patient experience.”

The findings could also help scientists to design more biocompatible implants in the future, the researchers say.

“We are pleased that we were able to bring new materials science approaches to better understand issues of biocompatibility in the area of breast implants. We also hope the studies that we conducted will be broadly useful in understanding how to design safer and more effective implants of any type,” says Robert Langer, the David H. Koch Institute Professor at MIT and the senior author of the study.

Veiseh, who is now an assistant professor at Rice University, and Joshua Doloff, a former MIT postdoc who is now an assistant professor at Johns Hopkins University, are the lead authors of the paper, which appears today in Nature Biomedical Engineering. The research team also includes scientists from Rice University, Johns Hopkins, Establishment Labs, and MD Anderson Cancer Center, among other institutions.

Surface analysis

Silicone breast implants have been in use since the 1960s, and the earliest versions had smooth surfaces. However, with these implants, patients often experienced a complication called capsular contracture, in which scar tissue forms around the implant and squeezes it, creating pain or discomfort as well as visible deformation of the implant. These implants could also flip after implantation, requiring them to be surgically adjusted or removed.

In the late 1980s, some companies began making implants with rougher surfaces, with the hopes of reducing capsular contracture rates and making them “stick” better to the tissue and stay in place. They did this by creating a surface with peaks extending up to hundreds of microns above the surface.

However, in 2019, the FDA requested a breast implant manufacturer to recall all highly textured breast implants (about 80 microns) marketed in the United States due to risk of breast implant-associated anaplastic large cell lymphoma, a cancer of the immune system.

A new generation of breast implants that dates back a decade, having a unique and patented surface architecture that includes not only a slight degree of surface roughness, with an average of about 4 microns, but also other specific surface characteristics including skewness and the number, distribution, and size of contact points optimized to cellular dimensions, was designed to prevent those complications.

In 2015, Doloff, Veiseh, and researchers from Establishment Labs teamed up to explore how this unique surface, as well as others commonly used, interact with the surrounding tissue and the immune system. They began by testing five commercially available implants with different topographies, including degree of roughness. These included the highly textured one that had been previously recalled, one that is completely smooth, and three that are somewhere in between. Two of these implants had the aforementioned novel surface architecture, one with a 4-micron roughness and one with a 15-micron roughness, manufactured by Establishment Labs.

In a study of rabbits, the researchers found that tissue exposed to the roughest implant surfaces showed signs of increased activity from macrophages — immune cells that normally clear out foreign cells and debris.

All of the implants stimulated immune cells called T cells, but in different ways. Implants with rougher surfaces stimulated more pro-inflammatory T cell responses, while implants with the unique surface topography, including 4-micron average roughness, stimulated T cells that appear to inhibit tissue inflammation.

The researchers’ findings suggest that rougher implants rub against the surrounding tissue and cause more irritation. This may offer an explanation for why the rougher implants can lead to lymphoma: The hypothesis is that some of the texture sloughs off and gets trapped in nearby tissue, where it provokes chronic inflammation that can eventually lead to cancer.