What are shaped implants and what makes them different?

I have just returned from the American Society of Plastic Surgeons meeting in San Diego.  This meeting brings together experts in plastic and reconstructive surgery across the world to discuss the latest advances in our field.  At this meeting, there was quite a bit of buzz regarding the FDA approval of shaped breast implants.  I wanted to hear what other surgeons thought about these new devices.

To this point in my practice, I have been quite happy with round, silicone gel implants.  I think that they give a nice result for the majority of patients, either for breast augmentation or for breast reconstruction.  What do these new shaped implants offer that the round implants do not?  What are the downsides?

Three companies in the U.S. offer these shaped implants: Sientra, Allergan and Mentor.  For the purposes of this discussion, I will be referring to shaped implants in general.  These implants are made of a more cohesive silicone gel than the round silicone implants.  What does that mean?  Well, these are the so called “gummy bear” devices.  They feel firmer than round implants.  Not firm as in hard but firm as in younger breast tissue.

The most obvious difference between these implants and the round implants is their shape.  These implants are shaped like tear drops with more of the volume being in the lower half of the implant.  This is useful for the patient who desires a more “natural-looking” breast, the patient who does not want that much upper pole fullness.  This can be useful in the breast reconstruction patient for whom we would like to try match her opposite, natural breast.  This implant is not for the patient who desires an “augmented” look, one with significant upper pole fullness.

There is a downside to “shape” and that is rotation.  There is the possibility that these implants can turnover in the breast, giving a full upper pole and an empty lower pole.  The numbers presented at this meeting showed that this only happens in a single digit percentage of patients but that still means another procedure to reposition the implant.

These shaped implants are textured while most surgeons are using round implants that are smooth walled.  The texturing is important to keep the implant in position and prevent that rotation.  This texturing does seem to increase the risk of developing a late fluid collection around the implant (months to years down the road).  Although again, the risk is relatively low, this is still something for surgeons and patients to discuss.

There has been some discussion about texturing of the implants decreasing the risk of capsular contracture (scar wall that forms around the implant).  This does seem to be the case when the implant is placed in the subglandular position (above the muscle) but it has yet to be shown when the implants are placed in the submuscular position (under the muscle).  Since most implants are placed under the muscle these days, we are not likely to see a huge decrease in capsular contracture rates due to these implants.

Implant choice is a discussion that needs to take place between the patient and the surgeon.  Both sides must feel comfortable with the choice of implant.  Shaped implants may not be right for every patient but it is a wonderful thing to have another choice in our armament.

If you would like to know more about breast augmentation or the different types of breast implants, don’t hesitate to schedule a consultation.