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Lower Risks, faster Recovery, It is Possible
SIGNIFICANT ADVANCES IN BREAST IMPLANTATION
Polyurethane Covered Breast Implants
Massive reduction in common complications
Tebbetts Surgical Techniques
Significant reduction in recovery – down to 24 hours
Silicone-containing breast implants have been used since 1964. The first polyurethane covered breast implants (PCBI) have been used since 1969 to reduce one of the commonest problems associated with breast implants namely capsular contracture. Silimed have been manufacturing PCBI in Brazil since 1983. These dates give an idea of the reliability associated with PCBI.
PCBI are TGA approved in Australia, which is the Australian Government regulating body. Polyurethane is also used in other medical devices such as pacemakers and blood vessel grafts.
These implants address the two most common concerns associated with implants, which are capsular contracture and displacement or rotation. An added benefit of this is a more rapid recovery. When coupled with newer operating techniques this may be as little as 24 hours, without the use of drains, bras, binding or strapping.
Capsule formation is the body’s response to a foreign material. It is a normal process and problems only arise when the tissue shortens. Scar tissue develops around the implants or other medical device. Over time this may contract. Fibrous scar tissue aligns longitudinally and is therefore able to overlap and shorten.
With implants the first sign is a firmness or hardness followed by an obvious visual change and distortion. Finally the implants may become uncomfortable and even painful. The longer the implants have been in the body the more likely this is to occur. Studies of the incidence of capsule contracture, with conventional implants, vary from about 8% at 3 years to 16% at 8 years and possibly higher. This is the most common reason that implants need to be exchanged. The incidence of contraction for PCBI is quoted as 1% at 15 years.
Polyurethane foam is a 3 dimensional lattice and mesh structure covering a moderately textured breast implant. This structure does not allow the formation of and breaks up the longitudinal scar tissue orientation, therefore preventing contraction. The layer of polyurethane foam is bonded to the implant by a process of vulcanization. This limits delamination and separation.
Implant rotation may occur and this is especially problematic with tear-drop shaped implants.
Implants moving sideways, laterally or rotating have been described. The PCBI have a softer foam surface which has a “Velcro” type effect on the interface with tissue. This adhesive effect limits this rotation of implants and allows a more rapid recovery with less need for strapping or supportive bras. Once the implants are sited, they remain in that position. Downward displacement or “bottoming –out” and lateral displacement are also unlikely to occur.
Issues initially quoted as being associated with PCBI have been extensively studied and been shown to be not valid. There are 60 scientific papers attesting to their safety. The incidence of infection, implant removal difficulty, seroma or fluid collection, rupture and late contracture formation have not been shown to be any different to currently used silicone filled, cohesive gel implants. As mentioned the commonest problem of capsule contracture is significantly less, 16% at 8 years vs 1% at 15 years.
A temporary, localized, itchy rash that occurs in less than 3% of cases is reported. This is most common in the second week and lasts about a week. Resolution of the rash occurs with no long term issues. Symptomatic treatment of the itch is all that is required.
These implants were initially recommended for problematic cases such as repeat or early capsule formation, implant rotation and downward or lateral displacement. A growing number of surgeons recognize the distinct advantage of these implants and are using them first up as their implant of choice. Why wait for a problem to occur and then treat it when it may be possible to reduce the incidence of problem from the start?
The advantages include a capsule contracture rate 10 times less than conventional implants, the higher co-efficient of friction or “Velcro” effect that limits rotation and downward or lateral displacement. The cohesive gel is also slightly softer giving a more natural feel. There is a long safety record over many decades.
Surgical Technique
A very important addition is PCBI combined with advances in surgical techniques and instrumentation, 90% of women return to normal activities within 24 hours of surgery. The techniques are based on a method popularized by Tebbetts. Ninety percent of women can go shopping, return to non-physical work, drive a car, perform light domestic duties without restrictive binding, bandaging or drains within 24 hours of surgery.
The methods minimize tissue trauma and prospectively control bleeding. He reports blood loss of less than a few milliliters per side. Monopolar forcep coagulation is extensively used to achieve this. Accurate pocket dissection and general anaesthesia is required in addition to short acting muscle relaxation.
Procedures are performed in a Day Surgery Centre.
These changes are significant. If your surgeon does not offer these new implants or techniques, find one that does and discus it with them.