Abstract
Background
Smooth, round, silicone implants predominate device-based breast reconstruction in the USA; despite their prevalence, complications can include bottoming out, superior contour deformity, rippling, and/or lateral malposition. This complication profile increases the need for revision surgery and subsequent patient dissatisfaction. With the resurgence of shaped, textured, silicone implants in the USA, we report the senior author’s success with these devices and outline a strategy to optimize outcomes in breast reconstruction surgery.
Methods
A retrospective chart review was conducted on a prospectively collected IRB-approved database of nipple-sparing mastectomies (NSMs) with immediate breast reconstruction with smooth, round, silicone implants (Group A) in 2011 in comparison to textured, shaped, silicone implants (Group B) in 2012. Changes in operative technique were highlighted and extrapolated. Outcomes were reviewed.
Results
In Group A, 128 NSMs were performed in 76 patients. In Group B, 109 NSMs were performed in 59 patients. Thirteen percent of patients in Group A had direct to implant reconstruction as compared with 21% in Group B. Patients with textured, shaped implants were more likely to have acellular dermal matrix (61 vs 34%, p < 0.0001) than those with smooth, round implants. Patients who had smooth, round implants were more likely to have postoperative nipple malposition (18 vs 0%, p < 0.0001,) and rippling (29 vs 0%, p < 0.0001.) Patients with textured, shaped implants had fewer operative revision reconstructions as compared with those with smooth, round implants (36.71 vs 12.8%, p < 0.0001) Based on these results, our technique has evolved and has eight key technical modifications.
Conclusion
With a few adaptations in surgical technique, the transition to textured, shaped, silicone devices for breast reconstruction can be seamless with superior breast contour and reduced complications/revision rates.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Similar content being viewed by others
References
Full Plastic Surgery 2012 Statistics Report—ASPS website http://www.plasticsurgery.org/Documents/news-resources/statistics/2012-Plastic-Surgery-Statistics/full-plastic-surgery-statistics-report.pdf
Small KH, Kelly KM, Swistel AJ et al (2014) Surgical treatment of nipple malposition in nipple sparing mastectomy deviced-based reconstruction. Plast Reconstr Surg 133(5):1053–1062
Cárdenas-Camarena L, Encinas-Brambila J (2009) Round gel breast implants or anatomic gel breast implants: Which is the best choice? Aesthet Plast Surg 33:743–751
Spear SL, Seruya M, Clemens MW, Teitelbaum S, Nahabedian MY (2011) Acellular dermal matrix for the treatment and prevention of implant-associated breast deformities. Plast Reconstr Surg 27:1047
Namnoum JD, Largent J, Kaplan H, Oefelein M, Brown M (2013) Primary breast augmentation clinical trial outcomes stratified by surgical incision, anatomical placement and implant device type. J Plast Reconstr Aesthet Surg 66:1165–1172
Zienowicz RJ, Karacaoglu E (2007) Implant-based breast reconstruction with allograft. Plast Reconstr Surg 120:373
Stevens WG, Harrington J, Allzadeh K et al (2012) Five-year follow-up data from the U.S. clinical trial for Sientra’s U.S. Food and Drug Administration-approved Silimed® brand round and shaped implants with high-strength silicone gel. Plast Reconstr Surg 130:973
Maxwell GP, Van Natta BW, Murphy DK, Slicton A, Bengston BP (2012) Natrelle style 410 form-stable silicone breast implants: core study results at 6 years. Aesthet Surg J 32(6):709–717
Hammond DC, Migliori MM, Caplin DA, Garcia ME, Phillips CA (2012) Mentor contour profile gel implants: clinical outcomes at 6 years. Plast Reconstr Surg 129:1381
Nipshagen MD, Beekman WH, Esmé DL, de Becker J (2007) Anatomically shaped breast prosthesis in vivo: a change of dimension? Aesthet Plast Surg 31:540–543
Discussion SR (2012) Five-year follow-up data from the U.S. clinical trial for Sientra’s U.S. Food and Drug Administration-approved Silimed® brand round and shaped implants with high-strength silicone gel. Plast Reconstr Surg 130:982–983
Dent BL, Small K, Swistel A, Talmor M (2014) Nipple-areolar complex ischemia after nipple-sparing mastectomy with immediate implant-based reconstruction: risk factors and the success of conservative treatment. Aesthet Surg J 34(4):560–570
Huston TL, Small K, Swistel AJ, Dent BL, Talmor M (2015) Nipple-sparing mastectomy via an inframammary fold incision for patients with scarring from prior lumpectomy. Ann Plast Surg 74(6):652–657
Cordeiro PG, McCarthy CM (2006) A single surgeon’s 12-year experience with tissue expander/implant breast reconstruction: part I. A prospective analysis of early complications. Plast Reconstr Surg 118:825–831
Serletti JM, Fosnot J, Nelson JA, Disa JJ, Bucky LP (2011) Breast reconstruction after breast cancer. Plast Reconstr Surg 127:124e–135e
Woods JE, Mangan MA (1992) Breast reconstruction with tissue expanders: obtaining an optimal result. Ann Plast Surg 28:390–396
Hedén P (2010) Form stable shaped high cohesive gel implants. In: Hall-Findlay EJ, Evans GRD (eds). Aesthetic and reconstructive surgery of the breast, vol 24, pp 357–386
Stevens WG, Harrington J, Alizadeh K et al (2015) Eight year follow up data from the us clinical trial for Sientras FDA approved round and shaped Implants with high-strength cohesive silicone gel. Aesthet Surg J 35:s3–s10
Stevens WG, Calobrace MB, Harrington J (2016) Nine year core study data for sientras FDA approved round and shaped implants with high strength cohesive silicone gel. Aesthet Surg J 36:404–416
Calobrace MB (2015) Teaching breast augmentation: a focus on critical intraoperative techniques and decision making to maximize results and minimize revisions. Clin Plast Surg 42:493–504
Hammond D (2014) Techniques and results using memory shape implants in aesthetic and reconstructive breast surgery. Plast Reconstr Surg 34:s16–s26
Cárdenas-Camarena L, Encinas-Brambila J (2009) Round gel breast implants or anatomic gel breast implants: which is the best choice? Aesthet Plast Surg 33(5):743–751
Lee KT, Mun GH (2016) Updated evidence of acellular dermal matrix use for implant-based breast reconstruction: a meta-analysis. Ann Surg Oncol 23(2):600–610
Hanwright PJ, Davila AA, Hirsch EM et al (2013) The differential effect of BMI on prosthetic versus autogenous breast reconstruction: a multivariate analysis of 12,986 patients. Breast 22(5):938–945
Fischer JP, Cleveland EC, Nelson JA et al (2013) Breast reconstruction in the morbidly obese patient: assessment of 30-day complications using the 2005 to 2010 National Surgical Quality Improvement Program data sets. Plast Reconstr Surg 132(4):750–761
Atisha DM, Alderman AK, Kuhn LE, Wilkins EG (2008) The impact of obesity on patient satisfaction with breast reconstruction. Plast Reconstr Surg 121(6):1893–1899
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical Standards
We declare that this article was composed with the highest ethical standards and that the Institutional Review Board of Weill Medical College (New York, New York) approved all study procedures in accordance with state and federal guidelines.
Rights and permissions
About this article
Cite this article
Imahiyerobo, T.A., Small, K.H., Sackeyfio, R. et al. Transition from Round to Shaped Implants in Immediate Breast Reconstruction: Our Preferred Approach and Clinical Outcomes. Aesth Plast Surg 41, 284–292 (2017). https://doi.org/10.1007/s00266-016-0738-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-016-0738-2