The fuzzy logic behind Brazilian breast implants
Many patients want to know about "furry" Brazilian implants which are being promoted heavily and marketed in Australia by both cosmetic and plastic surgeons. Having used these implants under their correct name as polyurethane implants and having been involved with this implant for over 30 years, I feel qualified to comment on some of the myths leading information that is turning out in the media, the Internet, printed media and magazines.
The implants have been recently introduced.
Not true. They were first introduced in the 1970s and were called the Ashley implant.
Dr Ashley was a plastic surgeon in Los Angeles.
The foam is incorporated into the body.
That is the problem. It degenerates with time and its by-products and the process of degeneration is chronic inflammation. There have been serious worries about the by-products of the implant in the past and whether it could have been carcinogenic or not. After the implant foam has degenerated, the body is exposed then to a plain underlying gel implant.
Foam implants do not move.
That is true and that is a problem. They are fixed, unlike real breasts which move.
They are glued in place and give a "headlamp" like appearance.
Capsular contraction is reduced.
Not really. Because of the chronic inflammation, the scar tissue is delayed from forming. Eventually when the foreign body reaction dissolves the foam, the old silicone implant is exposed and capsular contraction then occurs. There is a honeymoon period. Dr Ben Cohney reviewed his cases of this type of implant with the 1980s version of the polyurethane implant and they ended up with a high rate of capsular contraction. Removing the capsule and putting in a new implant is really difficult because the foam has broken off and is nearly impossible to remove and it is a real chore to try and clean it up.
- There is a bigger scar and a big incision is necessary to insert the implant. If you are pushing or shoving the implant in, it is probably breaking and fracturing the polyurethane which is unadvisable. You cannot put this implant through the armpit or the bellybutton.
- It is generally placed under the breast tissue alone which with time the breast tissue degenerating the implant will show and this gives an obvious "boob job" especially in the upper pole.
- Texture products are more palpable than smooth and the furry Brazilian is a textured implant.
- This implant is not FDA approved in the United States, the biggest market where still saline implants have a very high percentage of utilization because of the long-term satisfaction that can be achieved with surgeons who know how to use the implant.
- KY jelly is used by some surgeons to insert the implant but there are serious questions as to whether this off label use of KY jelly and KY jelly may have products in it that we do not know whether that is a good thing for them to be introduced around an implant or into a body cavity.
- The most fuzzy of logic is the one about the reduction of breast capsular contraction. In single series by surgeons over the last 20 years, smooth walled saline implants put under the muscle or in a partial subpectoral pocket, have a rate of capsular contraction as low as less than 2%. So why would one want to change from using the safest of all of implant fillers, intravenous saline? Our body is 50% saline.
The polyurethane implant has a place in the very established most difficult cases of capsular contraction which these days is fortunately not so common, due to the fact that people are not getting injections of silicone into their breasts and the new cohesive gel implants are not giving quite as much trouble in the long run of causing bad capsular contractions. I have used foam implants but only in these very selected cases which is the only indication, not in a primary operation. I see no place for it in the primary breast augmentation.
Surveillance of saline implants is virtually nil as if they fail or they break, then one knows instantly. Saline breaks at the same rate as any gel implant but the surveillance necessary in a gel implant is much greater as one is not sure if it is broken, leaking or rotated and in these cases, special tests which are expensive need to be performed to evaluate the patient and are often inconclusive.
If the aesthetic result from polyurethane was superior to that of saline, one might be convinced, but it is not!. See these pictures of results after polyurethane in the literature, which is still referred to by the doctors promoting polyurethane. The result shows the upper pole is visible. Also, in the second case, the breasts are asymmetrical and that is the best results these doctors could show in a ten year follow up.
Finally, beware of any product and beware of any surgeon who promotes any new product and be aware that many of these surgeons are paid by the manufacturer or get special deals by the manufacturer. Ascertain the surgeon's disclosures of why he is promoting this implant so strongly. I have no disclosures myself regarding breast implants. All I have is an experience of over 30 years and operating on over 6,000 women for breast implants and for this reason, I feel obliged to alert women considering breast implants to have an open mind and not necessarily choose the newest and most sexy sounding implant, especially if it is being highly marketed by surgeons enthusiastic to get you on the operating table.