The Renaissance of the Smooth Breast Implants - How to Obtain Any Aesthetic Outcome with Round Devices WHEN Banning the Texturization?
Many authorities and medical professionals worldwide keep expressing concerns regarding the safety profile of breast implant texturization and its relation to the development of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Currently in global databases there has not been a confirmed case of smooth device only. Due to the recognition that texturization increases malignancy risk, the use of textured devices have been diminishing and are expected to continue to decline. In Europe texture devices still seem to be more popular in comparison with the United States and Canada. Nevertheless, the crisis with texture implants worldwide raises the need for recall and further clarification on how smooth round silicone gel implants to be properly used in retropectoral breast augmentation when given outcome is aimed.
Goals/Purpose:
The purpose of the present study is to demonstrate how do the smooth round silicone gel breast implants change their shape and how a plastic surgeon could properly handle the implants’ characteristics - projection, degree of filling and softness of silicone gel, in order to obtain any desired surgical outcome by using those devices in retropectoral placement in accordance with the patient anatomy.
Methods/Technique:
The study was designed in two parts. In the first one, an experimental model was invented in order to investigate how the shape of the round silicone devices changed when put vertically in regards of the implant projection and degree of gel filling. The devices were fixed on a specially created holder which permitted to observe the shape changes that occurred. From practical point of view it was interesting to compare how the experimental findings corresponded to the clinical results of augmented patients. That’s why in the second part of the study a retrospective analysis was conducted recruiting patients with primary subpectoral breast augmentation with smooth round silicone gel implants. Photodocumentation and clinical records of those cases were meticulously analyzed. Breast features were evaluated pre- and postoperatively and a minimal follow-up of 12 months was established. Special attention was paid to the control of the upper pole fullness. The changes of the breast contour over time were meticulously investigated.
Results/Complications:
The experimental model clearly demonstrated the shape changes of smooth round silicone gel implants that happened when switched from horizontal to vertical position. When put vertically, due to the gravity an underfilled implant tended to form a more anatomical shape with less pronounced upper pole convexity in comparison with a fully filled one which still maintained its upper pole fullness regardless of the gel cohesiveness. That observation was also registered in high-projecting devices where the anatomic conformation was even more visible. A remarkable finding was registered regarding the orientation of the implant surface wrinkles as they indicated the cohesive gel distribution inside the shell: the wrinkles were orientated more vertically in the underfilled devices. That observation could help to predict a rippling effect depending on the degree of filling.
The outcomes of 21 augmented patients (42 breasts) was identified and explored. The clinical results corresponded with the experimental observations and the full scope of aesthetic outcomes that could be obtained by using smooth round devices was revealed. Desired anatomic correction and natural appearance of the breast was achieved even in thin patients and in women with tuberous breast deformity. The upper pole contour and fullness showed to be predictable with reliable and stable control over time in all the patients when proper implant selection had been made.
In retropectoral placing in vivo compression forces of the pectoralis major muscle and overlying soft tissue further impacted the implant shape, affecting its upper half especially when the dual-plane technique with underfilled implant was applied. Those forces in combination with gravity made round silicone implants become more or less anatomical when put in the patient body. The shape change was particularly noticeable when a moderate-projecting or low-projecting underfilled device was used depending also on the gel firmness and plasticity. In fact, what one appreciates on a clinical setting is the final cumulative outcome of the above-mentioned forces, implant properties, and patient anatomy. The skillful handling all those variables is the main reason why results obtained by using round and anatomical implants can be practically indistinguishable even for experienced plastic surgeons as stated in some previous studies.
Conclusion:
It has been demonstrated both experimentally and clinically how smooth round silicone gel breast implants to be accurately used in breast enhancement surgery. By properly selected device and good surgical technique any outcome of a retropectoral breast augmentation could be obtained in daily practice: from well-shaped breast with aesthetically appealing linear upper pole and tight, convex lower one to excessive fullness and augmented appearance. Any of those results is fully achievable with no concerns regarding the potential risk of BIA-ALCL as a main issue of implant texturization.