Intra-operative evaluation of textured anatomic implant rotation: a prospective study

Background: Textured implants were developed with the goal of reducing rates of capsular contracture and preventing implant malposition (eg., malrotation). Recent evidence has questioned whether textured implants are as resistant to malrotation as previously reported. Methods: Women presenting to a single healthcare system for removal of textured implants were prospectively enrolled in the study from September 2019 to July of 2022. Patients who underwent removal of an anatomic, textured implant in the operating room were included in the study, while those who did not undergo implant removal, or were found to have a smooth implant, or a round, textured implant were excluded. The degree of implant rotation upon removal of the implant was measured intra-operatively. Implant specific factors, as well as patient demographics, clinical factors, and operative characteristics were collected. Results: A total of 51 patients (80 implants) were included in the study. 45% of implants were malrotated (rotated >30 degrees) and the median degree of rotation was 30. Having more than one previous revision of the breast pocket was predictive of implant rotation (42 degrees) on multivariate linear regression analysis. Patients who presented with a complaint of “aesthetic dissatisfaction” had 2.89 increased odds of having an implant rotated > 30 degrees. Conclusion: Our study found a high rate of malrotation of textured, shaped implants upon explantation.