Best Breast Implant with Minimal Risk of Contracture?
- Asked by confusedincali in San Francisco, CA
- 4 years ago
I am torn between recommendations for primary Breast augmentation: (1) Silicone implants (below muscle through peri-aerolar incision), or (2) Inamed 410 form stable cohesive gel implants. Not sure whether there is a true benefit / substantial minimization of risk (capsular contracture, potential leakage) from using the 410s over silicone.
If there is the slightest evidence from the European experience that suggests the form stable implants significantly reduce the capsular contracture rate or do not need to be replaced, I'd be inclined to go with the new devices. Also, is better to place the gummy bear implants above or below muscle?
Silicone breast implants contract more
There is no good evidence on contracture rates of newer generation silicone gel implants versus those of the older generation. Saline implants contract less than gel implants over time though, so maybe you should consider saline one more time. Contracture is less in the "under the muscle" position for all implants, so I would recommend that. The newer cohesive gel silicone implants are supposed to make removal easier, but we haven't seen them long enough to really know how they will age.
Cohesive gel vs. Form stable gel implants
You are certainly not the only one confused. The current silicone gel implants available made both by Mentor and Natrelle (Allergan/Inamed) are stickier (more cohesive) than the earlier generation models. In addition they are described as having a low gel bleed, which means that on re-operation, the surgeon doesn't encounter a sticky mess. However if the external shell malfunctions, the gel will spread out, either within the scar capsule (intracapsular rupture) or outside it (extracapsular rupture). On the other hand, the form stable or gummy bear gel implants will never leak in such a manner.
My experience with the gummy bear gel implants is limited to three patients. One lady had silent rupture with a cohesive gel implant and wanted to limit future surgery. While she is satisfied with the low maintenance of her implants, she observes that the breasts are slightly less jiggly than her old set of implants and is planning to switch back. She elected to put the gummy bear gels in the previous subpectoral pocket. The other two patients are breast cancer patients and have been pleased with the performance of their reconstructed breasts. In these patients, the implant was placed under the chest muscle and the mastectomy flaps.
The early reports document lower rates of capsular contracture with the form stable implants. Many of the principal investigators are recommending the subfascial plane, which is essentially the subglandular plane (on top of the chest muscle). The manufacturers are still struggling with the FDA, so there isn't a clear release date for the gummy bear gel implants. You should be aware that the gummy bear gel implants do require a larger incision for placement, on the order of 5-7cm, so that should be factored into your decision. Good luck.
There is some data to support a decrease in capsular contracture
I'm not sure when the Allergan Style 410 implants will be approved by the FDA but as the preliminary data is reviewed, there is a decreased incidence of re-operation for a variety of reasons. It may be the implant or it may be an increased vigilance on the part of the operating plastic surgeons in terms of implants handling, antibiotic irrigation, etc. If the smaller incidence of re-operation is appealing to you and you are willing to wait for approval by the FDA, then that sounds like the plan for you.
Best of luck.
Web reference: http://www.medwardsmd.com/plasticsurgery_questions1.html
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