Experience with high-cohesive, form-stable silicone gel implants (Allergan and Mentor) throughout the past 14 years has convinced one European cosmetic surgeon of their unique benefits for breast augmentation surgery.
"With all modern implants — and assuming the surgeon has good technical skills and maintains sterility — problems with infection, bleeding and capsular contraction should not be a major issue," says Dr. Randquist, Victoriakliniken, Stockholm. "Nevertheless, the highly cohesive form-stable implants, anatomical and round, have allowed me to conquer some challenging situations in breast augmentation that I could not address adequately before. I believe the form-stable implants are predictable and clearly superior in certain regards, and I believe the data I have collected over the years proves this point."CUSTOMIZATION, PREDICTABILITY Since the anatomical implants are available in a variety of heights, projections and sizes and because of their highly cohesive material, the form-stable implants provide the surgeon with increased opportunity to customize the procedure.
Consequently, early results are more predictable and better. Because the implants are textured, long-term outcomes are superior, as well, Dr. Randquist says.
"When a smooth implant is put into a relatively large pocket, depending on the quality of the woman's tissue and size of the implant there may be bottoming out, asymmetries and less control over time. In contrast, my data show that using the textured cohesive implants, a preoperative planned breast shape depending on volume of breast tissue and shape of implant can be achieved after surgery and stay maintained after one year, five years or 10 years," Dr. Randquist says.
The form-stable implants also provide better results in breasts with a lower constricted pole because the implant is firm and better able to shape the surrounding tissue than a softer material. Some critics of form-stable implants cite firmness as a negative feature, arguing that it imparts a less natural feeling to the breast. Greater firmness to the touch on the table does not mean the implant feels unnatural once it is in the body, however, and besides, there is already natural variation in breast firmness among women that depends on the amounts of fatty and glandular tissue present, Dr. Randquist says.
"Better shape is one of the primary reasons why women seek augmentation, it is not all about volume, and the form-stable implants meet this goal better than other devices," Dr. Randquist says. "When placed into a precise pocket, it can act like a controlled tissue expander, adding volume where needed. This is a benefit for augmenting breasts with a lower constricted pole that has not been possible before using any other type of implant."
VARIATIONS, ASYMMETRY Since the anatomical form-stable implants can vary in three dimensions — in contrast to two-dimensioned, round implants — they have benefits for use in flat-chested women with limited glandular tissue.
"In this situation, the form-stable implant allows me to shape the breast into what I consider an aesthetically superior appearance, and it gives me an opportunity to individualize the results in a way that has not been possible before," Dr. Randquist says.
The form-stable implants also have a unique role for addressing asymmetry, which Dr. Randquist says is present in almost all women to some degree and is usually related to rib cage configuration and bone structure, rather than a consequence of differences in the amount of tissue present between breasts. The increased versatility for varying projection and width available using an anatomical form-stable implant enables asymmetry to be addressed in a way not possible with other prosthetic devices, he says.
"One-third of all of my augmentation patients receive two different implants because of the unique potential the form-stable implants give me to minimize asymmetry," Dr. Randquist says. "With these devices, I am even able to solve minor differences between breasts as I strive for perfection."