Highly cohesive breast implants are getting a lot of play in the media and at the meetings I attend. I’ve also noticed a real push from the breast implant manufacturers to persuade us to use these in our practice. They even have a cute, catchy nickname: gummy bear implants. But the question in the minds of many plastic surgeons and their patients is: Can you tell the difference in the shaped and round implants when you look at breasts? In other words, does this difference make a difference?
Last week I was at the meeting of the American Society of Aesthetic Surgeons in San Francisco. (I know, thankless job, but someone has to do it.) There were several sessions on breast implants and one was specifically on the difference between round and shaped implants.
At the beginning of the session, the audience of about 250 Board-certified plastic surgeons were shown 20 sets of patient photographs. We were then asked to vote electronically on whether the implants used were round or shaped. So, how good were we – the experts – in telling the difference between the two? Drum roll please…..We got it right 46% of the time. We would have had as good or better odds by tossing a coin.
As an aside, I can remember the adage that “to make a difference, a difference must make a difference.” Otherwise why bother with it, particularly if what you are doing is working well. But, I digress.
Why round is not always round
Most of the breast implants that are currently in use, and have been used in the past, are round. This is true for both saline and silicone implants. But, round implants are not always round – gravity changes the shape of implants. So when someone is standing upright, there is more fill at the bottom of the implant than at the top. When you think of this it makes sense. But when you are lying down, the breast is round. In this way round implants mimic what the normal breast does. And, silicone breast implants always do this a bit better than the saline implants.
The shape of the future?
As the newer silicone breast implants have come along (as in 5th generation, or highly cohesive, or “gummy bear”) there has been the ability to make an implant that is not round but is always shaped, or sloped no matter what position you are in. Sometimes these are referred to as “anatomic implants.” These are the implants that all the plastic surgery pundits are pushing (with some help from the manufacturers).
The bottom line
Bottom line here is that most people cannot tell the difference in shaped and round implants in most patients. Thus, for most of my patients I will use round implants. They cost less, are softer, and have no risk of malrotation. But there are some patients in whom the shaped implants may be a better choice. Just how many of my patients will profit from these is still something that I am working on. But in terms of breast reconstruction after mastectomy, these are certainly a better implant.
So I will resist the urgings of all the experts to use only shaped implants. I guess if I was a paid consultant I might think differently. When I think a patient will benefit from these implants or if a patient specifically requests them, I will certainly use them. Otherwise I will stay with the round implants and, as they say, dance with the date who brought me.
All the best,
David B. Reath, MD
P.S. If you are think about having a breast augmentation, you should check out our 37-page eBook A Girlfriend’s Guide to Breast Augmentation. It’s a free download.
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