Abstract
Background
Due to risks of texturization, the use of textured breast implants has been diminishing worldwide and is expected to continue to decline. The crisis with textured devices raises the need to revisit the use of smooth round silicone gel (SRSG) implants and to discuss the results that can be achieved with this alternative. The article aims to exclusively analyze SRSG devices: the changes associated with implant profile and degrees of filling, how these changes correlate to certain aesthetic outcomes, and the predictability and stability of these results over time.
Methods
The experimental component of this study investigated the effect of gravity on various profiles of SRSG implants when their position was changed. The study’s clinical component was a retrospective analysis of primary retropectoral breast augmentation patients with a minimum 1-year follow-up after the procedure.
Results
In the experimental setting upon changing position, the anatomic conformation in higher profile devices was more visible compared with their lower profile counterparts. Clinical results of 92 augmented breasts (46 patients) with various types of SRSG implants revealed a full scope of aesthetic outcomes. Desired results were achieved even in challenging scenarios. Breast shape and upper pole contour were predictable with reliable and stable control over time. The overall complication rate was comparable to other breast implant studies.
Conclusions
With proper device selection and good surgical technique, any aesthetic outcome can be achieved in retropectoral placement while keeping also prioritizing patient safety. Moderate and moderate plus profile underfilled implants are recommended when anatomical results are intended.
Level of evidence: Level IV, Therapeutic.
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References
Clemens MW, Jacobsen ED, Horwitz SM (2019) 2019 NCCN Consensus Guidelines on the Diagnosis and Treatment of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Aesthet Surg J 39(Suppl 1):S3–S13. https://doi.org/10.1093/asj/sjy331
DeCoster RC, Lynch EB, Bonaroti AR et al (2021) Breast implant-associated anaplastic large cell lymphoma: an evidence-based systematic review. Ann Surg 273(3):449–458. https://doi.org/10.1097/SLA.0000000000004365
(ANSM) Andsdmedpds Le marquage CE des implants mammaires texture´s de la marque Allergan (Microcell et Biocell) n’apas e´te´ renouvele´ par l’organisme notifie´ GMED - Point d’information. https://ansm.sante.fr/actualites/le-marquage-ce-des-implants-mammaires-textures-de-la-marque-allergan-microcell-et-biocell-na-pas-ete-renouvele-par-lorganisme-notifie-gmed Accessed 18 Jun 2022
Allergan: Biocell Safety Alert https://www.biocellinformation.com/~/link.aspx?_id=3CD4B20FD4464EF3AD041EB636E053F9&_z=z Accessed 18 Jun 2022
Clemens MW, Knittel CR (2020) Commentary on: is banning texturized implants to prevent breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) a rational decision? A meta-analysis and cost-effectiveness study. Aesthet Surg J 40(7):732–734. https://doi.org/10.1093/asj/sjz374
Heidekrueger PI, Sinno S, Hidalgo DA et al (2018) Current trends in breast augmentation: an international analysis. Aesthet Surg J 38(2):133–148. https://doi.org/10.1093/asj/sjx104
Mallucci P. Is There still a role for textured breast implants? Proceedings: The Aesthetic Meeting 2021; Miami Beach, FL; April 29-May 3, 2021
Bronz G (2002) A comparison of naturally shaped and round implants. Aesthet Surg J 22(3):238–246. https://doi.org/10.1067/maj.2002.124759
Friedman T, Davidovitch N, Scheflan M (2006) Comparative double blind clinical study on round versus shaped cohesive gel implants. Aesthet Surg J 26(5):530–536. https://doi.org/10.1016/j.asj.2006.08.004
Al-Ajam Y, Marsh DJ, Mohan AT et al (2015) Assessing the augmented breast: a blinded study comparing round and anatomical form-stable implants. Aesthet Surg J 35(3):273–278. https://doi.org/10.1093/asj/sju053
Cheng F, Cen Y, Liu C et al (2019) Round versus anatomical implants in primary cosmetic breast augmentation: a meta-analysis and systematic review. Plast Reconstr Surg 143(3):711–721. https://doi.org/10.1097/PRS.0000000000005371
Hamas RS (1999) The postoperative shape of round and teardrop saline-filled breast implants. Aesthet Surg J 19(5):369–374
Rubi CG, Lozano JA, Pérez-Espadero A et al (2017) comparing round and anatomically shaped implants in augmentation mammaplasty: the experts’ ability to differentiate the type of implant. Plast Reconstr Surg 139(1):60–64. https://doi.org/10.1097/PRS.0000000000002896
Spear SL, Mardini S (2001) Alternative filler materials and new implant designs: what’s available and what’s on the horizon? Clin Plast Surg 28(3):435–43
Coroneos CJ, Selber JC, Offodile AC et al (2019) US FDA Breast implant postapproval studies: long-term outcomes in 99,993 patients. Ann Surg 269(1):30–36. https://doi.org/10.1097/SLA.0000000000002990
Mark L, Jewell ML, Bengtson BP, Smither K et al (2019) Physical properties of silicone gel breast implants. Aesthet Surg J 39(3):264–275. https://doi.org/10.1093/asj/sjy103
Tebbetts JB (1996) What is adequate fill? Implications in breast implant surgery. Plast Reconstr Surg 97(7):1451–1454. https://doi.org/10.1097/00006534-199606000-00022
Oliveira ACP, Maino M, Zanin EM et al (2021) Breast implants follow-up: results of a cross-sectional study on patients submitted to mri breast examinations. Aesthetic Plast Surg 45(1):27–34. https://doi.org/10.1007/s00266-020-01962-1
Nipshagen MD, Beekman WH, Esmé DL et al (2007) Anatomically shaped breast prosthesis in vivo: a change of dimension? Aesthetic Plast Surg 31(5):540–543. https://doi.org/10.1007/s00266-007-0025-3
Tebbetts JB (2000) Patient acceptance of adequately filled breast implants using the tilt test. Plast Reconstr Surg 106(1):139–147. https://doi.org/10.1097/00006534-200007000-00027
Jewell ML (2012) Silicone gel breast implants at 50: the state of the science. Aesthet Surg J 32(8):1031–1034. https://doi.org/10.1177/1090820X12461649
Mahić AP, Grebić D, Čargonja P et al (2020) Silicone gel breast implants: past, present, and future. Acta Med Hist Adriat 18(1):165–176. https://doi.org/10.31952/amha.18.1.10
Charalambous M, Daoud R, Karat I (2020) Technological advances in breast implants. In: Jackson MJ, Phoenix DA, Charalambous CP (eds) 2020: Ahmed W. Academic Press, Advances in Medical and Surgical Engineering. Elsevier Inc., pp 141–147
Lista F, Ahmad J (2013) Evidence-based medicine: augmentation mammoplasty. Plast Reconstr Surg 132(6):1684–1696. https://doi.org/10.1097/PRS.0b013e3182a80880
Yordanov YP (2020) Natural appearance and good control of the breast shape in retropectoral augmentation mammaplasty: achievable without texturization. Aesthetic Plast Surg 44(5):1919–1923. https://doi.org/10.1007/s00266-020-01750-x
Tebbetts JB (2002) A system for breast implant selection based on patient tissue characteristics and implant-soft tissue dynamics. Plast Reconstr Surg 109(4):1396–409. https://doi.org/10.1097/00006534-200204010-00030. (discussion 1410-5)
Hedén P, Montemurro P, Adams WP et al (2015) Anatomical and round breast implants: how to select and indications for use. Plast Reconstr Surg 136(2):263–272. https://doi.org/10.1097/PRS.0000000000001474
Hall-Findlay EJ (2011) Breast implant complication review: double capsules and late seromas. Plast Reconstr Surg 127(1):56–66. https://doi.org/10.1097/PRS.0b013e3181fad34d
Hidalgo DA, Sinno S (2016) Current trends and controversies in breast augmentation. Plast Reconstr Surg 137(4):1142–1150. https://doi.org/10.1097/01.prs.0000481110.31939.e4
Hidalgo DA (2015) Discussion: anatomical and round implants: how to select and indications for use. Plast Reconstr Surg 136(2):273–275. https://doi.org/10.1097/PRS.0000000000001473
Bi S, Liu R, Wu B et al (2020) Breast implants for mammaplasty: an umbrella review of meta-analyses of multiple complications. Aesthetic Plast Surg 44(6):1988–1996. https://doi.org/10.1007/s00266-020-01866-0
Handel N (2011) Managing complications of augmentation mammoplasty. In: Spear SL (ed) Surgery of the breast – principles and art, 3rd edn. LWW, Philadelphia, PA, pp 1447–1472
Pantelides N, Srinivasan J (2018) Rippling following breast augmentation or reconstruction: aetiology, emerging treatment options and a novel classification of severity. Aesthetic Plast Surg 42(4):980–985. https://doi.org/10.1007/s00266-018-1117-y
Nahabedian MY (2019) Round form-stable breast implants: diagnosis and management of complications. Plast Reconstr Surg 2019;144(1S Utilizing a Spectrum of Cohesive Implants in Aesthetic and Reconstructive Breast Surgery):73S-81S. https://doi.org/10.1097/PRS.0000000000005953.
Handel N, Cordray T, Gutierrez J et al (2006) A long-term study of outcomes, complications, and patient satisfaction with breast implants. Plast Reconstr Surg 117(3):757–767. https://doi.org/10.1097/01.prs.0000201457.00772.1d
Codner MA, Mejia JD, Locke MB et al (2011) A 15-year experience with primary breast augmentation. Plast Reconstr Surg 127(3):1300–1310. https://doi.org/10.1097/PRS.0b013e318205f41b
Duncan DI (2008) Correction of implant rippling using allograft dermis. Aesthet Surg J 21(1):81–84. https://doi.org/10.1067/maj.2001.113438
Maxwell GP, Gabriel A (2013) Efficacy of acellular dermal matrices in revisionary aesthetic breast surgery: a 6-year experience. Aesthet Surg J 33(3):389–99. https://doi.org/10.1177/1090820X13478967
Kolker AR, Collins MS (2015) Tuberous breast deformity: classification and treatment strategy for improving consistency in aesthetic correction. Plast Reconstr Surg 135(1):73–86. https://doi.org/10.1097/PRS.0000000000000823
Meara JG, Kolker A, Bartlett G et al (2000) Tuberous breast deformity: principles and practice. Ann Plast Surg 45(6):607–611. https://doi.org/10.1097/00000637-200045060-00006
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The author expresses his gratitude to Borislav Petrov for his assistance in preparation of the figures in accordance with the artwork instructions.
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This is a retrospective descriptive clinical study which does not include any experimental techniques or devices; the identity of the patients is preserved. This study was performed in line with the principles of the Helsinki Declaration of 1975, as revised in 2008.
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The patients have given written informed consent for publication of their pictures and for eventual involvement in a study which is a standard part of the preoperative informed consent process in our clinic.
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Yordan P. Yordanov declares no competing interests.
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Yordanov, Y.P. Smooth round silicone gel implants in retropectoral augmentation mammaplasty: any aesthetic outcome can be achieved without texturization. Eur J Plast Surg 46, 377–386 (2023). https://doi.org/10.1007/s00238-022-02033-1
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DOI: https://doi.org/10.1007/s00238-022-02033-1