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Treating the Breast Mr Taimur Shoaib introduces the modern approaches to breast augmentation surgery Knowledge of surgical procedures is an important part of the skillset of all aesthetic practitioners, whether they are primarily surgical or non-surgical professionals. In an audit performed at my clinic, La Belle Forme in Glasgow, we reported that 22% of our patients who attended initially for a non-surgical treatment subsequently underwent a surgical procedure at our clinic. On average, the patient would wait 18 months after their first encounter at the clinic to undergo surgery. Patients often ask their non-surgical practitioner for advice on which plastic surgeon they recommend for surgical treatments. Non-surgical practitioners may feel that they are seeing a patient who wants a result that cannot be obtained non-surgically will need to refer the patient to a surgical practitioner instead to achieve optimum results. This article will provide non-surgical practitioners with an introduction and understanding of what surgeons are currently doing to maintain patient safety and excellent treatment outcomes for breast augmentation procedures.
Manufacturing breast implants A breast implant consists of a shell and filler material, which can be either silicone or saline. All implants, however, have a silicone shell. Breast implants are made through a mould, or mandrel, which shapes the liquid silicone. The mandrel has a mildly rough texture to hold onto the liquid silicone and this is heated to change its structure to solid
silicone. This action is repeated, creating a few layers in the implant. The layering structure prevents leakage of the filler material from the implant to the breast, and the implant shell is then filled with silicone. Nowadays, the majority of medical-grade silicone in the world is produced by Dow Corning, and is always cohesive gel silicone. Therefore, the silicone cannot leak out of the implant into the surrounding breast tissue, if the implant shell ruptures. The shell of a breast implant is given a roughened texture, and this is performed to reduce the likelihood of the long-term complication of capsular contracture (capcon), where the implant feels hard and distorts the shape of the breast.1,2 Any implant inserted into the body will elicit a reaction in which the body surrounds the implant with scar tissue. This scar tissue is completely normal but may thicken and harden over the years. It is believed that 1% of women every year will develop significant capsular contracture – after five years 5% of women, after 10 years 10% of women, and so on.1
the breast tissue. The reported risk was very low (1:24,000)3 and the disease was not aggressive in most women, with cures discovered from simply removing the thickened capsule.4 ALCL in association with breast implants was first diagnosed at around the beginning of the century but has gained increased attention among plastic surgeons in the past few years.5-7 The association with ALCL was seen with scepticism and surgeons were unsure of the relevance of the association. Practitioners did not know whether the disease and implant were linked; however, over the past few years, studies have shown that these links are correct.8 Implants associated with ALCL have textured surfaces, whilst implants that do not have this association are smooth with no texture.8 Smooth implants, however, have higher rates of capcon.3 This created a problem for surgeons as the decision to use smooth implants and risk capcon rates meant a high proportion of women would need to pay several thousands of pounds for surgery every time they suffer from capcon, or use highly textured implants and run the risk of ALCL. In the past few years, however, a new texture of implant has arisen – the nanotextured implant. The US Food and Drug Administration (FDA) and the International Standards Organisation (ISO) considers this texture pattern to be completely smooth.9 The texture depth, when studied under a scanning electron microscope, is around 16 nanometres or less, but compared with completely smooth implants, the surface areas of comparable implants are the same.9 The nanotextured pattern is made by turning the implant inside out once it comes off the mandrel. The slight roughness of the mandrel creates a pattern on the implant and is used to create the nanotexture. Currently, Nagor and Motiva are two breast implant manufacturers producing minimallytextured implants, which are considered to be smooth walled by the US FDA. The additional advantage of nanotextured implants is the low rates of capcon reported with the Motiva range, which has been out for long enough for reasonable data to be gathered.10-13
Modern techniques Breast implants and ALCL Until a few years ago, many plastic surgeons were using highly textured implants, until these became associated with anaplastic large cell lymphoma (ALCL). This refers to a very rare form of cancer that occurs in the breast lining but does not occur in
In my clinical experience, high quality and long-term outcomes are closely linked to modern techniques in performing breast implant surgery. We understand that implants with bacteria on them will more likely cause long-term problems. Accordingly, myself and many other surgeons now use methods
Reproduced from Aesthetics | Volume 8/Issue 11 - October 2021
