I just returned this last weekend from the Atlanta Breast Symposium, one of the annual major meetings in Plastic Surgery. Atlanta is one of the places where many milestone advances in Plastic Surgery came from including flap based reconstructive surgery, the TRAM flap & latissimus breast reconstruction procedures, and endoscopic plastic surgery. At one point in the early-mid 1970's there existed a cadre of talent at Emory University's Plastic Surgery department that will never be rivaled.
A few observations from the meeting:
- the form-stable shaped "gummy bear" implants from Inamed (Inamed 410 implant), Mentor (Mentor CPG implant), & others (Silimed, Euro-Silicone) are going to dramatically affect our results for the better in breast reconstruction surgery. A number of international presenters showed results that cannot be achieved with round "normal" silicone implants as were just approved by the FDA.
- the silicone-istas are ready to pounce on any failure of compliance with the FDA instructions to demand that approval be withdrawn for silicone implants.
- we're struggling with how to address the increasing use of radiation in breast cancer patients when we plan reconstruction. There continues to be wide variability in different cities in who gets radiated and how much the side affects are.
- subglandular implant placement seems poised for a comeback. Contemporary "low bleed" implants appear to have significantly lower chance of capsular contracture as compared to older implants when placed above the muscle.
- using smaller implants continues to be identified as the single most important factor in reducing complications and reoperations.
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4 comments:
of course a successful operation with a satisfied patient produces good results, but are there any aesthetic differences between the two types of implants?
There are definately differences in the appearance b/w the form stable silicone & traditional silicone implants. In particular, the tapered appearance can give much more natural results results of the upper breast. We're also documenting dramatically lower capsular contracture rates and almost zero ruptures with devices like Inamed's 410. These generation of implants are much more then just a subtle evolution in design, but rather they reinvent many of the concepts involved with planning operations and results.
There are still many patients and physicians who will use traditional smooth round implants as the results produced are desired (round, full upper pole) by many patients.
Even though we have known the improved outcomes with smaller implants for quite a while, it is nice to see it in print. Patients frequently want larger than is wise at least in my neck of the woods.
Joe,
I think the onus is on us as Plastic Surgeons to better communicate why appropriate sized implants based on a patients' anatomy should be performed. Ignoring high reoperation rates for breast surgery (many of which are ultimately due to the dimensions & weight of oversized implants) is going to potentially cause problems with continued access to silicone & saline implants by the FDA.
I'm a firm believer in Drs. John Tebbetts & Pat Maxwell's ideas on biodimensional planning as the key for long-term minimizing of reoperations.
Thanks for the comment. Your "Truth in Cosmetic Surgery" blog was my initial inspiration for Plastic Surgery 101.
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