Lessons Learned in Transition from Round to Shaped Implants in Immediate Breast Reconstruction Surgery

Goals/Purpose: Smooth round silicone implants predominate device-based breast reconstruction in the United States; despite their prevalence, complications include bottoming out, superior contour deformity, rippling, and lateral malposition. These complications increase the likelihood of revision surgery and subsequent patient dissatisfaction.  With the resurgence of anatomic textured silicone implants in the United States, we report our success with these devices and tips to optimize outcomes in breast reconstruction surgery. 

Methods/Technique: A retrospective chart review was conducted on a prospectively-collected IRB-approved database of nipple sparing mastectomies (NSM) with immediate breast reconstruction with smooth round silicone implants (Group A) in comparison to textured shaped silicone implants (Group B). Outcomes were reviewed. Changes in operative technique are highlighted (Figure 1).

Results/Complications: Demographics including age, BMI, smoking, and diabetes were statistically equivocal between the two groups. In Group A, 128 NSMs were performed in 76 patients. In Group B, 109 NSMs were performed in 59 patients. 16/128 (13%) received a single-stage operation with permanent implants in Group A and 23/109 (21%) in Group B, p=0.099. 44/128 (34%) had acellular dermal matrix in Group A and 66/109 (61%) in Group B, p<0.0001. 23/128 (18%) breasts had post-operative NAC malposition in Group A and 0/109 (0%) in Group B, p<0.0001. 3/128 (2%) had post-operative NAC ischemia in Group A and 4/109 (4%) in Group B, p=0.362. 29/128 (23%) had post-operative capsular contracture in Group A and 10/109 (9%) in Group B, p=0.0039. 37/128(29%) had post-operative rippling in Group A and 0/109 (0%) in Group B, p<0.0001.  27/128 (21%) had revision reconstruction in Group A and 1/109 (0.9%) in Group B, p<0.0001. Patient/surgeon reported higher satisfaction despite increased firmness in Group B.

Conclusion:  With adaptations in technique, the transition to textured shaped silicone devices for breast reconstruction can be seamless with superior breast contour, greater patient/surgeon satisfaction and decreased complication profile/revision rates.