Should I replace my textured implants with smooth, round implants? If so, should they again be sub muscular? (photos)

 I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

I appreciate your concern and agree that the textured Sientra implants should be replaced with round, smooth Sientra implants. This will avoid the possibility of BIA/ALCL from developing due to the textured surface. And yes, the submuscular space is the ideal "pocket" for you.
Your photos show that you have ptosis with "bottoming out" of the prostheses. Ideally, a mastopexy small reduction can be done at the same time to give you the ideal shape and safer implants. Ask you plastic surgeon about this place. Good luck!

That is an excellent question and I can understand your concern. The FDA has updated their website with more information on BIA-ALCL since the first time the data was reported, and while this T cell lymphoma has been found way more often associated with textured implants, there were still cases reported following smooth implants. (Per the FDA website, based on info as of Sept 2017, of 414 reported cases of BIA-ALCL, 272 of these specified the surface of the implant, and 242 of these were textured. This means there were still 30 of those 272 cases that had smooth implants.) There is no current recommendation to change out textured implants for smooth ones, and if this was your only concern then you don't necessarily need to change them out, unless for you personally you would not be able to get peace of mind without doing so. In looking at your photos, it appears you have bottoming out of your implants, with displacement of your inframammary fold. In this case you would benefit from a full breast lift, with reconstruction of your inframammary fold back at it's higher position, and if you are going in for that procedure, you can use that as a time to change to smooth round implants. I would recommend leaving the implants behind the muscle. I would suggest seeing a board certified plastic surgeon in consultation, one who is experienced with breast implant revisions, since a full history and exam is the only way to get true advice or recommendations.

You
are an excellent candidate for explantation using The Bellesoma Method.  The implants are removed, your breast tissue
is reshaped creating upper pole fullness, elevated higher on the chest wall and
more medial to increase your cleavage. 
Vertical scars are avoided, nipple sensation and the ability to breast
feed are maintained, if not injured during your previous surgery.  At the same time or later, fat transfers can
be performed if additional volume is desired. 
I do not recommend repeat implants since your skin is already stretched
very thin. 
Best Wishes,
Gary Horndeski, M.D. 

The risk of BIA-ALCL is between 1 in 3000 and 1 in 10,000. This makes it a rare chance, but a possibility. The general recommendation is not to change the implants but to follow closely for any changes. It is definitely possible to change the implants to smooth and keep them under the muscle.

It's a great question. So far, the only people at risk of BIA-ALCL are those with textured implants. Risk ~1:2,000. The American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgeons  recently released a consensus report. At this time they do not believe that women with textured breast implants should have them replaced unless there are other indications for surgery. I would stay in contact with your plastic surgeon for up-to-date information as more is learned about BIA-ALCL. 

Hi Mrs.DEBI take it your concern is really regarding the textured surface and should you replace them or not?  This is a personal question and there may not be a single "right" answer.The ALCL is a cancer that seems to be associated with the scar tissue capsule around the implant.  There are very few cases of ALCL vs. Millions upon millions of implants so we as doctors and researchers can't make inferences with great certainty. What we know is that the ALCL seems to occur more with the textured implant than the smooth.  ALCL tends to be a slow growing and not very aggressive tumor that has a very successful treatment rate.  The tumor develops after around 7 years of implantation.That all said, It looks like you will need significant work on the capsule to get optimal cosmetic results.  On the other hand, you could just get an implant exchange without modifying the pocket if you are happy with your appearance.  If not, you may even do well with a lift if you are healthy.If you decide to change out the implants, by all means go under the muscle where the current ones are, for many reasons.So really to get to the heart of your question.  The chances of getting ALCL is very unlikely and has a long latency period before it shows up.  You have to decide for yourself how worried you are about it.  Statistically, if you were to develop ALCL, you would be around 75 or so.  That said, if you feel like you have a "ticking time bomb" in your chest, get them out.All the best.sek

In my practice I prefer and recommend the use of round smooth implants placed in a partial subpectoral position for nearly all of my patients. I would not however recommend removal of all textured implants especially ones just placed two years ago. It's also unclear how much risk reduction for BIA-ALCL you would accomplish by changing your implants to smooth at this point. Cases of the disease have been discovered in patients with smooth implants who had a history of previous textured implants leaving it unclear to me whether being aggressive is warranted. Clearly the risk of BIA-ALCL is still felt to be relatively small and observation for the formation of seromas, swelling or lumps is probably all that is warranted at this time.As an individual you should discuss your particular case with your plastic surgeon to get the best guidance. Best wishes,Jon A. Perlman, M.D., FACSDiplomate, American Board of Plastic SurgeryAssociate Clinical Professor of Plastic Surgery Geffen/UCLA Medical CenterExtreme Makeover, ABC TV plastic surgeonBeverly Hills, Ca.

Dear Mrs. DEB,Hello and thank you for your excellent question.  You may want to look into the Bellesoma Breast Lift technique - it provides an exceptional breast lift, upper pole fullness, relief from neck and back pain, and no vertical breast lift scar. It uses a woman’s OWN breast tissue to produce an internal suspension technique, without the need for a breast implant. It does not disturb the nipple, areola, or breast glands, so sensation and the ability to lactate is preserved. It uses 3D scanning of your breasts and body to design a procedure specifically designed for YOU, and you alone. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. If you have any questions, call our office for assistance. Good luck!

Best,

Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

Texas “Top Doc” 2017, 2018

RealSelf100

America’s Top Plastic Surgeons, Consumer’s Research Council, 2010 - 2018

From your photos, it appears that you have a little bit of animation, which comes from scar that formed when your implants were below the muscle.  Otherwise, you appear to have a very good result from your Sientra implant breast augmentation and there is certainly no reason to change your implants from that stand point. 
When one considers breast implant associated, anaplastic large cell lymphoma or ALCL, a lymphoma that can occur around any type of implant, not just breast implants, it is true that that the incidence is higher with textured implants, but that incidence is still very low.  In addition, the incidence is even lower with the less aggressive textures like Sientra implants.  In fact, Sientra, (US manufacturer) and Silamed (international manufacturer) have had only a couple of cases of ALCL worldwide as compared to other implant manufacturers who have a more aggressive texture surface.  Patients with smooth walled implants are not immune to developing ALCL either so changing implants will not protect you.

I would recommend that you leave your Sientra implants in place and simply be vigilant you’re your breasts.  ALCL usually occurs 7 to 12 years after the implants were placed and the presentation is normally one side becomes very swollen.  Treatment is very successful if the diagnosis is made correctly. 

Sientra recently increased their warranty to 20 years and provides financial support if you have a problem.  With most manufacturers you have to pay to get something similar in terms of a warranty and they only go for 10 years, so Sientra’s warranty amounts to a free 20 year insurance policy for any problems with your breast implants.

In short, you have a good result with, by far, the best breast implant on the market.  Even though they are textured, they are still very safe.  Your chances of having other life threatening problems  in the future are significantly higher than your chance of developing ALCL.

I hope that helps.

Best regards.