SVS, a minimally invasive method for closing diseased veins with pressurized steam, a relatively new method which is becoming more popular amongst physicians who specialize in this area of medicine.
Breast augmentation with round implants
A round implant is one of the models of breast prostheses used in breast augmentation procedures. Other implants used include anatomical implants that have a slightly prolonged shape. The choice between the two types of implants is not easy as they determine not only the shape of the breast but also its functionality.
Round breast prostheses are filled with either saline or silicone. The type of the filler determines the shape and performance of the endoprosthesis after it is implanted inside the body. In 1991 in USA the FDA prohibited the use of silicone implants due to the low quality of silicone and suspicions about the negative effects of the implants on patients’ health. At the time American surgeons were allowed to use saline implants only. In 2005 the FDA allowed the use of round silicone implants. In 2012 only three companies (Sientra, Allergan and Mentor) had an approval for sale of anatomical silicone implants. Therefore, American surgeons are more experienced in the use of round implants. Round implants have been subject to a greater number of clinical studies.
Mentor offers a wide variety of round implants – even wider than the range of available textured implants. The company offers nearly 200 models of textured implants with Siltex coating, filled with silicone Cohesive I and II gel, almost 100 models of smooth implants filled with Cohesive I gel, and 65 models of saline implants. Just to compare – there are only 120 models of anatomical implants with textured surface, filled with Cohesive III gel, and 11 models of saline implants available. The proportions are similar for Eurosilicone. The company offers 59 models under Natural Cohesive Design product line and 80 models under Soft Cohesive Design product line (all products have micro-textured surface), and 80 models with smooth surface under Soft Cohesive Design product line. The anatomical implants offered by Matrix include only 102 models.
Indications and patients’ expectations
Specialists select implant shape depending on patient’s figure. Doctors believe that round implants look better on women with shorter chest in whom the upper part of the breast does not need to be filled. The preferences of the patients are also important. Round implants are selected by women who prefer softer breasts. Round implants ensure a better effect in a lying position by maintaining a nice symmetrical shape.
A lot of plastic surgeons are guided by their patient’s opinion when selecting implant shape. Dr. Alexander G. Nein who works in Nashville, United States, believes that the larger the breasts compared to the prosthesis, the smaller the effect of implant shape on the breasts after the procedure, which is why he prefers round implants. Dr. Richard A. Baxter from Seattle, USA, thinks that round implants are usually softer and require a smaller incision to be made. The cost of the procedure is usually lower than in the case of other implants. According to dr. Maurice Y. Nahabedian in case of round implants it is more difficult to choose the right model to achieve the expected result.
Placement of round implants
The placement of round implants is easier than the placement of other types of implants. The round implants have either smooth or textured surface. The rough surface is intended as a prevention measure against capsular contracture which is a response of the body to the implantation of the prosthesis. Round implants do not entail the risk of prosthesis rotation as the shape of their base is symmetrical.
Round implants are softer because they are filled with a less cohesive and softer silicone gel. The implants easily bend or fold which affects the size of the incision made during the surgery. The round base of the implant makes it easier to place it inside the pocket under the muscle. The shape of the pocket is not as significant as in the case of other implants. The surgery is shorter and its price is lower.
Round implants in manufacturer-funded research
The manufacturers of breast prostheses sponsor a lot of clinical studies. Thanks to such studies we have learnt a lot of about the durability of implants, complications associated with breast augmentation, or the performance of the implants in women with different lifestyles. Thanks to extensive long-term clinical research many companies decided to grant lifetime warranty on their products.
The American Allergan initiated clinical research on round implants filled with silicone gel in 2006, i.e. immediately after they were introduced on the market. The study was entitled “Core Study” and the results were published in Plastic and Reconstructive Surgery. The study covered 700 women who were observed over a period of 10 years. Over that time the risk of occurrence of capsular contracture around the implant after breast augmentation surgery was estimated to be 18.9%, and 24.6% after breast reconstruction. The incidence of capsular contracture was greater in women who underwent subglandular placement of implants (26.3%) compared to those who underwent submuscular placement (15.7%). A leaking implant confirmed by magnetic resonance imaging was found in 7.7% of women. At the end of the study 81.8% of women who underwent breast augmentation surgery still had the implants placed before the initiation of the study. Furthermore, 94.2% were happy or very happy with the results of breast augmentation procedure.
Mentor conducted a nine-year observation of patients to compare the performance of round implants and anatomical implants filled with silicone MemoryGel gel. The placement of round implants entailed a greater incidence of capsular contracture – 11.3% compared to anatomical implants – 3.4%. The compromised integrity of the prosthesis was also more frequent in case of round implants, but the difference became statistically significant only after 8 years of the procedure. Other complications, such as infections or the need to repeat to procedure, were similar for both types of implants. At the end of the study the patient satisfaction index reached 94% for both types of prostheses.
The implants by Eurosilicone were evaluated over a period of 5 years. The study covered women who had a total of 1010 prostheses, 91.4% out of which were round implants, and 8.6% were anatomical implants. According to the results of the study the risk of capsular contracture was estimated to be 10.7%, and the risk of implant rupture – 0.8%. Although the researchers did not present the results divided by implant type, in view of the prevalence of round implants, one may assume that the presented data applies to these implants. The general safety profile was rated as excellent.
Which are better: round or anatomical?
In view of the disagreement as to which type of implants is better researchers have decided to confirm the speculations in research. The results suggest that the advantage of the anatomical implants over the round implants is hard to find. Furthermore, if one does not know what kind of implant a patient had placed, it is even hard to recognise its shape.
A team of specialists from the plastic and reconstructive surgery department at the Royal Hospital in London, the United Kingdom, conducted a randomised blind study that compared the cosmetic effects of placement of round and anatomical implants. In this case randomisation was a random allocation of a type of implant to a patient. The study was blind to prevent the physicians and patients from knowing the type of placed implant. The study covered 60 patients operated by the same surgeon – 33 had round implants and 27 had anatomical implants. 63% of round implants and 49% of anatomical implants were recognised for what they were. Anatomical implants got more positive reviews due to the upper outline of the breast which had natural and aesthetic look. However, the difference was not statistically significant. The study was published in March in Aesthetic Surgery Journal, a prestigious journal published by Oxford University Press.
In other study, dr. Maurice Y. Nahabedian from the Plastic Surgery Clinic at Georgetown University in Washington made an overview of round and anatomical implant placement procedures performed at the clinic. The study covered 69 patients (49 with silicone anatomical implants and 20 with silicone round implants). The results demonstrate that the incidence of complications is similar for both types of implants.