Breast Augmentation with Silicone Gel Prosthesis: Smooth or Textured Envelopes?

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1 Breast Augmentation with Silicone Gel Prosthesis: Smooth or Textured Envelopes? São Paulo - Brasil

2 Areola and Breast dimensions Breast Type Access Type of Prosthesis

3 Expectations and Reality

4 No breast implant Artificial breast

5 Envelope Textured Smooth

6 Why? Ashley FL.. A new type of breast prosthesis. Preliminary report. Plast recons Surg 1970; ; 45: Taylor SR, Gibbons DF. Effect of surface texture on the soft tissue response to polymer implants.. J Biomed Mater Res 1983; ; 17: By altering the surface structure of the envelope it is possible to alter fibroplasia and collagen alligment.

7 The textured envelopes present different types of irregularities or rugosity. Depends on the manufacturer the surface may present depressions, nodules, protrusions and may be porous.

8 MENTOR Textured Implant Component Raw Material 1. Shell, inner layer 3. Shell, outer layer 2. Shell, barrier layer Dimethyl Silicone Elastomer Dispersion Diphenyl Silicone Elastomer Dispersion 4. Shell textured layer MED 4750 Silicone Elastomer Patch assembly MED 4750 Silicone Elastomer Gel Silicone Gel: Base and Crosslinker; platinum cure

9 Micro-texture Texture Micro-structure (foam)

10 Texture = Production Micro-texture Micro-structure Regular Irregular The silicone oil is cured and at the same time compressed to a foam mold The oil is mixed with the salt, subsequently dissolves to form the outer irregular surfaces

11 Micro-texture Mentor Perthese Nagor Texture Micro-structure Inamed Polyurethane Silimed Eurosiline Silimed PIP Sabbin Rofil Snow-Lanbem

12 Biocell Siltex M.S.I. Gross texture Polyurethane Fine Texture Anger J. Tissue reaction to the different mammary prosthesis envelopes. In: Toledo LS. Annals of the International Symposium: Recent Advances in Plastic Surgery. São Paulo, Brazilian Society of Plastic Surgery, p

13 Siltex ADHERENCE Biocell With Bleeding!

14 Smooth

15 Siltex (Mentor) Moarines giving rise to gradual elevations,, some end in plateaus

16 Biocell (Inamed) A crystalline material is pre- coated with silicone and disappears after the cure. The width from 200 to 600 µm.

17 Silicone Envelope 1. Silicone = O + C + Si linked to methyl groups = Polymethylsiloxane 2 = OIL CH3 Si O CH3 2. Polymerization and Poly-condensation: RTV (room temperature vulcanization) to obtain macromolecules of large chains A. Acid or Base as a catalyzer B. Solvent (xylene( xylene) 3. It is mandatory to clean up all the debris, particles and the rest of the catalyzers and the solvent = vacuum or high temperature THE HIGHEST QUALITY AND THE BEST SHELL IS CLEARLY RELATED TO THE ABILITY TO CLEAN THE DEBRIS AND TO MAINTAIN BEST QUALITY CONTROL

18 Micro-texture Texture Micro-structure Which one is easier to clean up WITHOUT leaving small particles? Is it possible to take out all the solvent?

19 This is the result of surface shedding on a porous texture (sponge)

20 Silicone fragments after scratching that can result in a granuloma

21 Silicone textured envelope breakdown Batra M, Bernard S, Picha G. Histologic comparison of breast implant shells with smooth, foam, and pillar microstructuring in a rat model from 1 day to 6 months. Plast Reconstr Surg 1995; 95: Copeland M, Choi M, Bleiweiss IJ. Silicone breakdown and capsular synovial metaplasia in textured-wall saline breast prostheses. Plast Reconstr Surg 1994; 94:

22 Silicone inside giant cells Seroma

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25 Thomas Cronin Dacron Mesh Adherence?

26 Polyurethane (Silimed) Polyurethane is comprised by toluene diisocyante and polytetramethylene glygol.. Polyester degradation. After 7 days multinucleated giant formation Polyurethane degradation and disruption TDA

27 rush 1 year post-op. Polyester

28 Capsule Formation?? Soft Permanent Distortion

29 350 cc, round Smooth, Moderate profile Sub-muscular

30 Must stay sub-glandular!

31 300 cc Smooth Gel Moderate profile Sub-muscular

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33 3 year post-op.

34 Polyurethane Subglandular

35 Smooth, Round Moderate profile 300 cc sub-muscular

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37 The capsules around polyurethane and micro structured (foam like) envelopes can be macroscopically thicker and more vascularized. They contain more collagen fibers. Bucky LP, Ehrlich HP, Sohoni S, May JW Jr. The capsule quality of saline-filled smooth silicone, textured silicone, and polyurethane implants in rabbits: a long-term study. Plast Recons Surg 1994; 93:

38 Vascularized area Collagen Vascularized area

39 Stir =MRI

40 Smooth After and Before 1991! 1988

41 Old implants before 1991, most of them were smooth Silicone

42 Envelopes Smooth Textured When and Why to use?

43 Textured Are you expecting adherence and/or less capsule formation? LAW 1 =You must know which texture do you want to use!

44 The textured prosthesis have are more firm because they are more coated. It diminishes the sandglass effect THE INCISON MUST BE LARGER! Textured Smooth

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47 280 cc Contour 2002 pre pos

48 months follow-up

49 4 years follow-up

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51 Contour 550cc

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56 Backer III

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59 Smooth

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63 Post-op 2 months Pre-op Post-op 1 year Fixation

64 275 cc Submuscular Smooth - Round

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66 275 cc Round Smooth Submuscular

67 18 months 3 months

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69 250 cc Round Smooth envelope

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72 275 cc Smooth, Gel Moderate Profile

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74 2 months 12 months

75 2 months post-op

76 12 months Post-op

77 Axillary approach: Always smooth

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79 Dynamic Static

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81 Is it possible with foamtextured?

82 14 months Pre-op. 2 months YOU MUST HAVE A NON ADHERENT ENVELOPE, TO ALLOW MOVING

83 Poland Syndrome: Pectoralis Major agenesy

84 Becker cc cc gel cc saline

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86 225 cc Smooth, gel Moderate profile SUBGLANDULAR

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88 The decision of the surgical technique may be based on the preference of the mobility and natural behavior Think about the type of Prosthesis!!!!

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90 THANK YOU MUCHAS GRACIAS MUITO OBRIGADO תודה MERCI BEAUCOUP DANKE SCHÖN