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Dr. Jejurikar's Blog

Much like everything else in life, technology and techniques are constantly changing in plastic surgery. With the advent of new products, plastic surgeons can refine and improve the procedures they offer patients. This is particularly true with breast augmentation, which has evolved considerably in the past few years. So, what’s new you ask?

The biggest changes involve improvements in breast implant gel and breast implant shells. Although silicone implants have been around for years, not all silicone implants are the same. The earliest silicone implants consisted of a mostly liquid silicone covered by a relatively wispy shell. Not surprisingly, these implants tended to leak, either from the breast implant shell rupturing or from silicone gel bleed, which occurred when silicone gel would leak through the breast implant shell to the surrounding tissue. When this happened, patients were plagued with severe pain, not to mention hard and deformed breasts. The problems were so bad that the Food and Drug Administration (FDA) removed silicone breast implants from the United States market in 1992. The implants remained available elsewhere in the world, however, and scientists and plastic surgeons worked diligently to improve them. The first change consisted of making the silicone gel material within the implant more cohesive, meaning the gel became stickier and thicker. The other substantial change involved improving the implant shell so that the implants were less likely to rupture and less likely to leak. The results of these changes were an improving safety profile throughout the world. Because of this, as well as numerous clinical trials conducted in the U.S., The FDA allowed silicone gel implants back on the market in 2006.

Since then, breast implant technology has continued to improve. In 2013, the FDA approved the first of the cohesive gel implants that are most commonly used today. These are commonly called gummy bear implants, because they feel remarkably like the candy. Safety data from these implants are promising because, not only do these implants give the best aesthetic results for patients, but they are less likely to result in capsular contracture than other commonly used silicone and saline implants. Depending on the feel desired by patients, implants manufactures have even varied the cohesivity of implants. Allergan, for instance, offers a relaxed, soft touch (intermediate) and more cohesive implants. These options not only allow plastic surgeons to get better results than ever before, but to customize these results more than ever before to the preference of their patients.

Other big advancements have come in the fight to prevent capsular contracture, which is one of the worst complications that can happen with breast augmentation. Capsular contracture essentially is pathologic scar tissue build up around a breast implant, resulting in painful, hard and deformed breasts. Usually, surgery is required to fix this problem when it develops, so prevention is obviously of paramount importance. It’s thought that capsular contracture is the result of subacute bacterial infection.

The Keller Funnel is a device most plastic surgeons believe will reduce the incidence of capsular contracture. The Keller funnel essentially functions as a condom for breast implants; the implant is completely sheathed in the funnel as it passes through the skin into the breast pocket. Once in the appropriate location, the breast implant can be squeezed out of the funnel into the breast, never having touched the patient’s skin. With no skin contact, the chances of contaminating the implant with even a small number of bacteria is reduced, theoretically diminishing the likelihood of capsular contracture.

Another way to reduce the incidence of capsular contracture is through antibiotic solutions which bathe the breast pocket and the implant prior to insertion into the patient. Compelling data has demonstrated that the combination of three antibiotics (cefazolin, bacitracin, gentamycin), with the addition of an iodine containing solution markedly reduce bacterial biofilm around implants. This should also lessen the likelihood for bacterial colonization of a breast implant, thereby lessening the likelihood of capsular contracture.

Finally, preoperative doctor-patient communication has been significantly improved with the advent of three-dimensional imaging. Dr. Jejurikar finds that it’s relatively simple to create an accurate 3D rendering of a patient and then use that rendering to point out relevant anatomy to patients. Patients can see differences in size and symmetry from all angles and then better understand the rationale behind using different sized implants or recommending a breast lift. In addition, it is possible to simulate a breast augmentation on these 3D models with varying sized implants, tremendously helping with the process of preoperative implant selection.

Obviously, innovative technology and implants must be used in concert with good surgical judgment and technique. If you’d like to learn more about breast augmentation consult with Dr. Jejurikar, please do not hesitate to contact our office to set up a consultation. If you’d like to submit photos prior to your consultation to create your every own 3D rendering, follow this link.

 

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