Alternative Filler Materials and New Implant Designs

Allergan’s silicone gel breast implants

In the USA, women seeking breast implants for augmentation, revision or reconstruction can choose between saline-filled devices and round, silicone gel-filled devices. Form-stable, highly cohesive silicone gel-filled breast implants are marketed in other countries and are currently under review by the US FDA. Allergan has conducted clinical studies to investigate the safety and effectiveness of its round and anatomical (Style 410) devices for US marketing approval. The most frequently reported complications were reoperation, implant removal with replacement, implant malposition and capsular contracture. The FDA approved the round devices in 2006. The weight of the scientific literature suggests that silicone gel-filled breast implants do not increase a patient's risk of cancer, autoimmune disease, reproductive effects or suicide. As differently shaped, cohesive breast implants continue to be introduced, breast implant surgery will become more customized to the patient's biological conditions and desires.

Breast implant surface development: perspectives on development and manufacture

Capsular contracture poses a significant clinical and scientific research challenge for breast surgeons. Some researchers have pointed to the surface features of implant devices as being responsible for the potential tightening and hardening of the surrounding capsule. In this article, the authors review the history and development of breast implant design, specifically the data supporting improvements that have potential to mitigate the incidence of capsular contracture. The literature suggests that development of new implant surfaces designed to reduce a patient's foreign body response will improve the safety profile of implant devices and increase patient satisfaction in the long-term.

Key points in mastopexy

Breasts represent femininity and any change of shape may affect their appearance. Breast ptosis may be caused by several factors, including significant weight loss, pregnancy, long breastfeeding periods, and involution of the postmenopausal breast tissue. Breast ptosis may be associated with breast hypoplasia; thus, in case of a mastopexy with or without the use of implants being indicated, several considerations have to be taken into account: the wishes of the patient, age of the patient, degree of ptosis, parenchymal volume, covering tissue, quality of the tissue, pocket implant, shape and content of the implant, and resulting scars.

Possible future development of implants and breast augmentation

Since the introduction of the silicone gel prosthesis in 1962, breast augmentation has become one of the most frequently performed operations in plastic surgery. As we strive for perfect results, it is important to continue to gather and review data evaluating innovative techniques and devices. Now we even have more options available for breast augmentation, whether we use them in combination or alone. By combining all of the available options (acellular dermal matrix products, silicone implant, fat grafting), we have been able to create "bioengineered breasts" with high patient and surgeon satisfaction. As always in plastic surgery, our concern is with safety; as newer technology and products are introduced to us, patient education, consent, and follow-up remain important.

Indications for extra full projection anatomical cohesive silicone gel implants in cosmetic and reconstructive breast surgery

In 2003, a new extra full projection (EFP) anatomic cohesive silicone gel breast implant was introduced onto the European market. This review presents the early experience of a single surgeon with this new implant over a 29-month period. Between 2003 and 2006, the McGhan Style 410 EFP breast implants were inserted for highly selected indications. Twenty-eight patients received a total of 47 EFP implants. Their age range was 23 to 66 years (mean: 46 years). The implant was used in 6 primary and 7 revisional cosmetic breast augmentation patients. The series included 9 postmastectomy breast reconstructions. In further, 6 patients the implant was used to revise existing breast reconstructions. After a mean follow-up period of 31 months, there were no infections, malrotations, or significant capsular contractures and no patients have required revisional implant surgery. The novel implant was successfully used to address specific challenges in cosmetic and reconstructive breast surgery. These included large skin envelopes in breast augmentation patients declining mastopexy, complicated implant exchanges, and suboptimal prosthetic breast reconstructions. This prosthesis may prove a useful addition to the range of breast implants available, especially when there is an overlap of challenging esthetic problems.

Anatomically shaped breast prosthesis in vivo: a change of dimension?

BACKGROUND

In addition to the already existing round cohesive gel-filled breast prostheses, anatomically shaped breast prostheses were introduced in 1990 to provide a more natural shape to the augmented or reconstructed breast. To date, however, it is unclear whether the anatomic configuration of the prostheses is maintained after subpectoral implantation. Recently, a three-dimensional (3D) magnetic resonance imaging (MRI) technique became available, offering a precise visualization of the prosthesis in vivo. Using this 3D MRI technique, this study aimed to compare the shape of commercially available round and anatomically shaped silicone gel-filled breast prostheses before and after implantation.

METHODS

Using 3D MRI, 6 conventionally round and 12 symmetrically shaped silicone gel-filled prostheses were scanned in vitro. Scans were made in vivo 6 weeks after subpectoral implantation of these prostheses in nine patients. The in vivo 3D images were compared with the in vitro 3D images.

RESULTS

Overall, a 3.5% decrease in projection was found on the in vivo images, as compared with the in vitro images. On the craniocaudally oriented images, a slight lateral shift of the cohesive gel was observed in the majority of the prostheses. Inamed Style 510 prostheses showed the best in vivo preservation of their configuration.

CONCLUSIONS

The results show that both the round and the anatomically shaped silicone prostheses in vivo largely maintain their original in vitro configuration after subpectoral implantation.

[Plastic surgical body form correction. Part II: Face-lift, periorbital surgery, and breast augmentation and reduction]

The demand for a younger appearance is increasing as the average age of the population increases. Extensive anatomic studies in recent years have improved for facial and breast reconstruction the understanding of anatomic structures and the basis of the aging process. Numerous new surgical techniques have resulted. This understanding of the anatomy of aging and the diversity of surgical methods have made the attainment of naturally young facial appearance more easily possible, in which repositioning of the tissue plays a more important role than lifting. In the past, plastic surgery of the eyelids aimed primarily at hiding the aging process, not at true anatomic restoration. Modern techniques in this field aim more toward redistribution of fatty tissues and the anatomic restoration of aging structures. In this way long-term results are stabilized and secondary stigmata can be avoided. New concepts have also been established in breast surgery that allow more natural results, particularly in augmentation. Although no single method may be designated as superior, there still exists an optimal technique suited to every patient's anatomy and personal wishes.

Breast Augmentation

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Understand the different variables that are inherent to breast augmentation. 2. Identify certain breast shape characteristics that make one approach more advantageous than others. 3. Take into account certain patient characteristics to develop a logical surgical plan for breast augmentation.

SUMMARY

The optimal technique for breast augmentation has always been debated, and numerous variables fit the needs of the variously shaped patients in our population. The purpose of this article is to present the advantages and disadvantages of the various techniques available in breast augmentation so that, in conjunction with the patient's physical examination, a sound surgical plan can be developed for aesthetic augmentation of the breast.

Voies de recherche pour la mise au point de nouvelles prothèses mammaires

Despite the improvement of breast implant quality across the last decade, the perfect implant does not exist. Therefore research should manage to improve those implants. In this article we have tried to identify different directions to investigate for better prosthesis: improvement of the shell, the filling and the form. Moreover, other targets as fat transfer or other permanent soft tissue filler also need further experimental and clinical investigation.

Early experience with an anatomical soft cohesive silicone gel prosthesis in cosmetic and reconstructive breast implant surgery

Recently, an anatomic breast implant filled with soft cohesive silicone gel was introduced by Mentor Medical Systems onto the European market. This study reports the early experience of a single surgeon with this implant. All patients who received a Contour Profile Gel (CPG) implant from March 2001 to October 2002 were studied. Patient satisfaction with breast shape and consistency was assessed using linear analogue scales with a maximum score of 10. Thirty-five patients received CPG implants for cosmetic (10 patients, 20 breasts) and reconstructive (25 patients, 31 breasts) surgery purposes. Patients were satisfied with their breast shape (mean score: 8.3). Eighty-five percent of the breasts were rated as soft (score >/=6). No serious esthetic complications such as implant malposition or significant capsular contracture were observed. Anatomic soft cohesive gel implants provide excellent results in selected cases. They are well accepted by patients and not associated with an increased rate of complications.