First of all, we have a new player in the breast implant market, the company Sientra. We had the opportunity to participate in the Sientra launch party and got first hand information on the company; it’s philosophy, manufacturing standards, and business ethic. It was a large turnout of plastic surgeons and we were all quite impressed. Sientra is the first new company in over 20 years to be able to successfully break into the breast implant market which has been dominated by two companies, Allergan and Mentor. The best thing about Sientra, is their commitment to sell their silicone implants ONLY to board certified plastic surgeons. Unlike Allergan and Mentor, who sell their implants to other specialties such as dentists, ENT, OB/GYN, Family Practice, and other physicians who have no training to perform breast augmentation, Sientra is committed to Plastic Surgeons. This in turn, translates into patient safety, and patients who receive Sientra silicone implants can rest assured that their surgeon is properly trained. In addition, Sientra implants have the best implant warranty available with an automatic lifetime warranty for rupture and $3600 cash funds available for surgery. Sientra’s implants are also the most cohesive, form-stable implants FDA approved in the United States. We are excited to start using Sientra implants!

Breast reconstruction and complicated breast implant revisions are being successfully handled with ADM. ADM stands for Acellular Dermal Matrix, which is essentially a skin type of substitute. Alloderm and Strattice are examples of ADM and are used widely in many applications. This product works well for complicated breast problems including situations of tissue thinning, rippling, and contour problems, where this product is added to an implant pocket to cover, support, and pad an implant. In addition, it can provide support to the periphery of an implant pocket in the situation of implant malposition. Patients who have experienced recurrent capsular contractures may also benefit from the addition of this material, which is substituted for a section of the capsule to break up the scar and maintain breast softness. Because of the high cost of the product, it best serves patients who have had multiple recurrent complications where other techniques have failed. In the situation of breast reconstruction after treatment of breast cancer, insurance companies handle the cost.

Fat transfer is also a safe and effective option in treating breast or body contour depressions. This involves liposuction of an area such as the inner thigh, preparing the fat, and re-injecting it into areas that are deficient. Touch up procedures may be required in 50% of patients as a result of the potential reabsorption and unpredictability in the “take” of the graft. As an alternative to an implant, larger volumes of fat can be injected for generalized breast augmentation. Although results can be subtle because of variable fatty tissue absorption, we are seeing improved results when simultaneous Brava suction devices are used a few months before the fat transfer procedure. Brava is a breast suction cup type of device, basically a vacuum suction cup that is worn on each breast for at least 12 hours per day, and it causes swelling and improved vascularity to the breast tissue. After a few months of wear, the breast tissue is distended, healthier to accept the fatty tissue grafts, and survival of the newly transplanted tissue is enhanced.

Everyone is hearing about stem cells, and fatty tissue does contain adult stem cells. The simple transfer of fat is not considered a stem cell procedure. The stem cells need to be isolated and concentrated. There are several techniques of stem cell concentration that are currently under investigation. The benefits of stem cells are assumed, yet we are not quite there yet with scientific data showing proof of stem cell benefits in the field of aesthetic surgery. We also need to see data proving the safety of these procedures, before they can be offered to prospective patients. Studies are in progress so be patient!

When it comes to silicone breast implants, and silent ruptures, high-resolution ultrasound may become an accurate method in evaluating the integrity of the implant shell, so that MRI’s may not be required. We will have to wait to see how this evolves with respect to the current FDA recommendation for MRI surveillance of silicone breast implants.

Keller funnels are also being used more frequently for silicone implant insertion. This is a funnel, similar to a cake decorating cone. This guides the implant into the pocket more easily, so the implant itself has less contact with surrounding skin, theoretically decreasing risks for bacterial contamination of the implant, and potentially decreasing risks for scar tissue to develop around the implant (capsular contracture). Other reported benefits to women include significantly reducing force on the implant shell which can prevent a future rupture, shortening incision lengths, and potentially minimizing post operative bruising and swelling. Keller funnels are being used in our practice.

Part 3 of my report will discuss the newest techniques for Body Contouring…

Dr. Hayley Brown MD, FACS
Breast Augmentation Las Vegas Surgeon
Desert Hills Plastic Surgery Center, Henderson and Las Vegas, Nevada

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