Tradeoffs in Implant Selection for Reconstructive Surgery and Adjuncts Utilized to Maximize Aesthetic Outcomes

Area of Science:

• Plastic Surgery
• Biomaterials Science
• Reconstructive Surgery

Background:

• The wide array of US Food and Drug Administration-approved cohesive gel implant options can overwhelm surgeons and patients during the selection process.
• This review focuses on the comparative advantages of commonly used silicone cohesive gel implants and adjuncts, especially within the context of breast reconstruction.

Purpose of the Study:

• To evaluate the clinical impact of various cohesive silicone gel implants and adjuncts on aesthetic results and complication profiles.
• To guide implant selection in breast reconstruction by analyzing the merits of different implant types and associated surgical techniques.

Main Methods:

• A comprehensive literature review was performed using PubMed.
• Articles were selected based on their assessment of cohesive silicone gel implants and adjuncts concerning aesthetic outcomes and complications in breast reconstruction.

Main Results:

• Analysis of how implant shape, cohesivity, and texture influence breast aesthetics and complications in implant-based breast reconstruction (IBBR).
• Review of adjuncts like fat grafting and acellular dermal matrix (ADM) in IBBR, particularly for prepectoral approaches.
• Exploration of future advancements in IBBR, including nanoscale surface modifications for implants.

Conclusions:

• In the absence of evidence favoring shaped implants over round ones for aesthetics, a risk-benefit analysis favors smooth, round cohesive silicone implants.
• Smooth, round implants with variable cohesivity offer aesthetic benefits without the drawbacks of textured shells, proving advantageous in modern breast reconstruction.
• The selection of smooth, round cohesive silicone implants aligns with advancements in bioengineered breast aesthetics and patient outcomes.