JAIME ANGER, MDPortuguese

A NEW BREAST IMPLANT:  THE ANATOMICAL COHESIVE GEL IMPLANT.

The use of breast prosthesis is well defined in plastic surgery. The silicone implant is indicated in breast augmentation, in  breast reconstruction following cancer treatment ands when a large amount of breast tissue removal is necessary

The first implants were made with a silicone envelope and silicone sponge inside. Since then many modifications were done. The envelope became thinner and the sponge was changed for silicone gel. The result was a more natural touching and providing a better cosmetic result very close to a normal breast. Nowadays two type of implants are used : the smooth and textured envelopes. Each one is related to a medical need. It depends on the anatomical position to be located and the breast contour. There arte also two types of implant material filling: saline and gel.

IMPORTANT: The technological advances and the personal medical experience provides a better result and a very low rate of complications. 

Today the tips of the surgical technique are related to the aesthetic natural contour and the softness of  touching.. The scars are also important but they are now smaller and can be located in non-visible regions.

We avoid the access trough the breast tissue in order to maintain the mammary ducts and the nerves:  The periareolar access is not the best choice when the indication is the sub-muscular positioning. The trans-umbilical access doesn't allow us to use gel implants.

The inframammary fold and the axillary approach are the first choice. With the videoscopy assisted procedure  it is possible to use minimal scars.

The axillary access results in the most aesthetic scar. The procedure is technically more difficult and depends on the doctor's surgical experience. The technique is based in a 2,5 cm incision in a axillary horizontal fold. Gel implants under 300 cc are easily introduced. The best choice is to put under the muscle. The cosmetic result is better and the incidence of tissue reaction is lower.

     Sometimes it is indicated to maintain the implant in fromt of the pectoralis major muscle. For this special conditions it's better to use the anatomical implants. They don't show a round artificial contour.

    Other important point is the cohesive gel that prevents the leakage of the silicone if   a envelope rupture occours.