Background <p>Almost 20,000 breast implants are being used annually in Israel. The majority of which (approximately 80%) are used for aesthetic breast augmentation and the remaining for reconstructive surgery. The vast majority are silicone-filled implants. Data regarding BIA-ALCL and the possible link to implant texture induced a shift towards different implant selection over the last 5–10 years. As in every change we make in our surgical technique, we should diligently examine the impact on our results over time.</p> Methods <p>We used an anonymous internet-based survey that was sent to active members of the Israeli society of plastic and aesthetic surgery. Questions regarding practice volume, type (aesthetic vs. reconstructive) and surgeon’s experience were asked. Surgeons were asked to specify the brand and type of breast implants they are currently using, did they change their implant selection process and if so, how. The primary survey was done on 2019. Later on the withdrawal of Allergan implants from the market mandated a follow-up survey, which was done on 2023, aiming to examine the effect of implant change on surgical outcomes.</p> Results <p>In the primary survey done and presented in 2019, a significant shift towards less-textured implants was demonstrated, as an expectable reaction to BIA-ALCL concerns. The recent survey demonstrates the effects of these changes on surgical outcomes, as well as complications, seen after 4 years.</p> Conclusions <p>The first part of this Israel survey showed how new evidence influences the evolution of our breast implant selection practice. The second part, shows the impact of this change, and the implication it had on our results.</p> <p>Level of evidence: Not ratable</p>