title: Systematic review of the effectiveness of polyurethane-coated compared with textured silicone implants in breast surgery.
abstract: BACKGROUND
  Silicone gel implants are used worldwide for breast augmentation and breast reconstruction. Textured silicone implants are the most commonly placed implant, but polyurethane-coated implants are increasingly being used in an attempt to ameliorate the long-term complications associated with implant insertion.
  
  
  METHODS
  This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Electronic searches of MEDLINE, EMBASE, the Cochrane Library and www.ClinicalTrials.gov were undertaken in March 2014 using keywords.
  
  
  RESULTS
  Following data extraction, 18 studies were included in the review, including four core studies of textured silicone implants and five studies reporting outcomes for polyurethane-coated silicone implants. There are no clear data reporting revision rates in patients treated with polyurethane implants. In the primary reconstructive setting, capsular contracture rates with silicone implants are 10-15% at 6 years, whilst studies of polyurethane implants report rates of 1.8-3.4%. In the primary augmentation setting, core studies show a capsular contracture rate of 2-15% at 6 years compared with 0.4-1% in polyurethane-coated implants; however, the polyurethane studies are limited by their design and poor follow-up.
  
  
  CONCLUSIONS
  The use of polyurethane implants should be considered a safe alternative to textured silicone implants. It is likely that an implant surface does influence short- and long-term outcomes; however, the extent of any benefit cannot be determined from the available evidence base. Future implant studies should target the short- and long-term benefits of implant surfacing by procedure with defined outcome measures; a head-to-head comparison would help clarify outcomes.
authors.affiliation: University of Manchester, Manchester Academic Health Science Centre, 46 Grafton Street, Manchester M13 9NT, UK; Nightingale Centre, University Hospital of South Manchester, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK.
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Duxbury
authors.affiliation: University of Manchester, Manchester Academic Health Science Centre, 46 Grafton Street, Manchester M13 9NT, UK; Nightingale Centre, University Hospital of South Manchester, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK. Electronic address: James.Harvey@uhsm.nhs.uk.
authors.forename: James R
authors.initials: JR
authors.lastname: Harvey
mesh_terms: D018427:Breast Implants; D020099:Coated Materials, Biocompatible; D006801:Humans; D016462:Mammaplasty; D011140:Polyurethanes; D011474:Prosthesis Design; D020034:Silicone Gels; D013499:Surface Properties
chemical_list: D020099:Coated Materials, Biocompatible; D011140:Polyurethanes; D020034:Silicone Gels
keywords: Breast implants; Mammaplasty; Morbidity; Polyurethanes; Review; Silicone gels