Breast Implant Stability in the Subfascial Plane and the New Shaped Silicone Gel Breast Implants

Abstract

The author presents his experience with breast augmentation using a next-generation, form-stable, anatomically shaped silicone gel breast implant. Rotation is a potential complication for anatomically shaped breast implants. Anatomically shaped saline implants have been reported to have a rotation rate as high as 14%, while lower rotation rates of 1-2.6% for anatomic cohesive gel silicone implants have been reported. Currently, these implants are limited in the United States to US FDA-approved clinical trials. The author reviews the appropriate surgical techniques to prevent rotation when using these devices. A recent innovation, placement of the superior pole of the implant underneath the superficial fascia of the pectoralis major muscle, is described. Primary and secondary breast augmentations in 241 procedures using the Allergan Style 410 implant resulted in a 0.0% rotation rate. Overall, the anatomic form-stable silicone gel breast implants, when placed sub fascially, improve common complications such as capsular contracture and implant rupture with improved aesthetic outcomes and patient satisfaction.

Hallazgos ecográficos normales y complicaciones de implantes mamarios en Colombia

“…Cuando se deshidratan, los implantes de solución salina se lobulan más, se encogen y se doblan, lo que facilita su rotación. Los implantes de gel cohesivo, por ser más rígidos, mantienen su forma y rotan menos (13). Se han descrito técnicas quirúrgicas, como colocar el polo superior o la mitad superior del implante debajo de la fascia superficial del músculo pectoral mayor en vez de subpectoral o retroglandular, para minimizar esta complicación (14).…”

“…Los marcadores en la superficie anterior del implante en el polo inferior están hechos para el monitoreo intraoperatorio por palpación, para asegurar una posición adecuada (14). Cuando un implante es redondo y se rota, por su forma más simétrica, no cambia mucho su apariencia clínica, pero un implante anatómico sí varía clínicamente al rotar y parece deformado (11,13). La rotación puede ser sintomática o asintomática, con deformidad y asimetría, y puede requerir corrección quirúrgica (14).…”

“…La textura de los implantes es variable y así también la formación de la capa de adhesión. Los implantes texturizados con poros más grandes disminuyen la posibilidad de rotación (13,14). Los bolsillos quirúrgicos grandes, seromas o hematomas periprotésicos, masajes y ejercicio pueden favorecer la rotación (12).…”

Implant-based multiplane breast augmentation—a personal surgical concept for dynamic implant–tissue interaction providing sustainable shape stability

“…At the same time, this approach avoided the dissection of the pectoralis muscle. Despite these inaugural methods, breast augmentation has been constantly challenged by the fact that predictable long-term results without capsular contracture cannot be achieved in all patients [5]. Partly this is due to the fact that, in submuscular augmentation, using the standard method an unnatural move or even frozen aspect together with muscular animations or waterfall deformity may lead to an unfavorite result [6].…”

Clinical Trial Outcomes of High- and Extra High–Profile Breast Implants

“…Inappropriately large implant pocket sizes or excessive postoperative activity may prevent the development of connective tissue integration between a textured implant surface and the surrounding breast tissue, thereby allowing subsequent malrotation. 1,13,14 The lack of definitive clinical data on risks and benefits of high-and extra high-profile breast implants relative to moderate-or low-profile implants has led to calls for data from clinical trials. 2 In response, we report on the riskbenefit profile for high-and extra high-profile breast implants by analyzing risks of CC, moderate to severe malposition, and secondary surgery relative to moderateor low-profile implants in patients registered in pooled long-term clinical trials.…”