title: Textured surface breast implants in the prevention of capsular contracture among breast augmentation patients: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Capsular contracture is a common complication associated with the use of breast implants. Numerous randomized controlled trials addressing the efficacy of textured surface breast implants in reducing capsular contracture have yielded nonuniform results. This meta-analysis addresses the use of textured breast implants in the prevention of capsular contracture.
  
  
  METHODS
  MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases were searched to identify all randomized controlled trials involving the use of textured versus smooth breast implants. The results of these trials were meta-analyzed to obtain a pooled odds ratio of the effect of textured surfacing on capsular contracture rates. In addition, subgroup analyses were performed based on implant type (saline or silicone gel), type of surface texturing (Siltex or Biocell), placement (subglandular or submuscular), and length of follow-up.
  
  
  RESULTS
  Eleven trials were reviewed. Four were excluded because they failed to meet a priori inclusion criteria. The remaining seven trials were meta-analyzed. Only three of these studies found significantly lower rates of capsular contracture with the use of textured implants. However, when all seven studies were pooled, the odds ratio was found to be 0.19 (95 percent confidence interval, 0.07 to 0.52), indicating a protective effect for surface texturing on the rate of capsular contracture. Submuscular placement was the only subgroup in which significance was not achieved. However, this subgroup consisted of a single study, which was dramatically underpowered.
  
  
  CONCLUSIONS
  The results of this meta-analysis demonstrate the superiority of textured over smooth breast implants in decreasing the rate of capsular contracture.
authors.affiliation: Department of Surgery, Division of Plastic Surgery, Dalhousie University.
authors.forename: G Philip
authors.initials: GP
authors.lastname: Barnsley
authors.forename: Leif J
authors.initials: LJ
authors.lastname: Sigurdson
authors.forename: Shannon E
authors.initials: SE
authors.lastname: Barnsley
mesh_terms: D001940:Breast / Q000473:pathology*; D001941:Breast Diseases / Q000209:etiology / Q000517:prevention & control*; D019928:Breast Implantation / Q000009:adverse effects / Q000295:instrumentation*; D018427:Breast Implants / Q000009:adverse effects*; D005260:Female; D005355:Fibrosis / Q000209:etiology / Q000517:prevention & control*; D006801:Humans