Poly-urethane coated (PUC) implants have recently been back in the spotlight following the halt on Silimed implant use in Europe and this review is timely in assessing the perceived benefits of these prostheses. This review was adherent to the PRISMA guidance using the best available databases. However, a major flaw is that studies preceding 1993 were not included. There are studies prior to, and during the ban on PUC implants in Europe, preceding 1993 and these are at least level 2/3 evidence studies. In addition, silicone studies of the 1980s and 90s significantly add to the natural history of our understanding of capsular contracture. This study highlighted, again, that follow-up reporting for primary augmentation patients is poor. Nonetheless, early complication and capsular contracture rates were less in PUC implants. Interestingly the authors suggested this might because of inferior reporting practices in PUC implant cohorts. For example, the authors compare the haematoma rates to those seen in reconstructive breast surgery, which clearly are a group of patients with different complication profiles. Moreover, using this rationale, it is just as likely complication profiles may be under-reported in primary silicone implant cases. The authors quite rightly highlight the current evidence base is poor, particularly for the long-term, but it appears PUC implants are a safe alternative to silicone implants. 

Systematic review of the effectiveness of polyurethane-coated compared with textured silicone implants in breast surgery.
Duxbury PJ, Harvey JR.

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Daniel B Saleh

Newcastle Hospitals, UK.

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