Breast Revision Surgery Testimonials

This is out of the Aesthetic Surgery Journal March 2019.  “Physical Properties of Silicone Gel Breast Implants.” Yawn.  Not a catchy title, but important things to know.  With the options for silicone gel implants exploding, how do you choose?

There are some things which are not addressed here:

• the width and projection of the implant, which give you the profile of implant (low, medium, high profile)
• the volume of the implant (measured in ccs, which ranges from 120-600)

The study:

• They looked at 4 manufacturers: Sientra, Mentor, Allergan, and Establishment labs
• They did bench testing to look at
  • form stability– does the device retain its dimensions when you move from horizontal (lying down) to vertical (standing up)?  The less it changes, the more they have shape retention.
  • dynamic response to the gel– when you compress it, what is the gel cohesivity, resistance to gel deformation (stiffness), and energy absorption (softness)?
  • Shell thickness, tested in five regions of the implant.
• They tested 3 textured shaped implants, 6 textured round implants, and 8 smooth round implants.  They tested 6 of each type.

Findings:

• Form stability:
  • SHAPED SILICONE GEL BREAST IMPLANTS: Natrelle 410 implants containing Truform 3 gel retained significantly more of their original dimensions than Mentor MemoryShape and Sientra Textured Shaped implants.
  • TEXTURED ROUND SILICONE GEL IMPLANTS: Inspira (Allergan) implants with Truform 3 gel, followed by TruForm 2 gel.
    • Sientra had the lowest form stability in height,
    • Mentor had the lowest form stability in projection
    • Inspira Truform 1 gel had lower form stability in the upper pole.
  • SMOOTH ROUND SILICONE GEL IMPLANTS: Inspira Truform 3 gel was equal to Motiva ProgressiveGel Plus
    • Inspira Truform 2 gel was equal to Motiva ProgressiveGEl Ultima
    • Sientra implants with High Strength Cohesive Plus gel did in the middle
    • Mentor implants Cohesive 1 implants had lowest form stability in each dimension
• Gel Material Properties
  • Allergan Natrelle 410 implants with TruForm 3 had significantly higher gel cohesion, resistance to gel deformation, and lower energy absorption complared to Mentor MemoryShape or Sientra Textured shaped implants
    • Truform 3 had higher retention of all 3 properties than Truform2 or Truform 1
  • In general the gel properties of the implants varied “significantly across devices.” The order of gel cohesion:
    • Natrelle 410 or round with TruForm 3 gel
    • Mentor textured shaped with Cohesive III gel
    • Sientral with High Strength Cohesive gel
    • Motiva with ProgressiveGel Ultima
    • Mentor with Cohesive 1 gel
    • Inspira with TruForm 1 gel
• Shell thickness
  • Allergan shell thickness was consistent in all textured implants regardless of shape
  • Natrelle 410 and Mentor MemoryShape had the same mean shell thickness.
  • Sientra textured were thinner
  • The round textured implants, Inspira implants were thicker than Mentor implants or Sientra implants

So what does this all mean??

In their discussion, the authors talk about these differences may affect performance of the breast implants in clinical settings.  If you have more form stability, you will retain the breast implant shape better.  The more cohesive the gel in the breast implant means more form stability, which determines shape retention.  The shell thickness may also have an effect.

What does this mean to you?

After reading this, or skimming this, or just skipping all of the above and reading my summary here, you may think- aha! I need to do a form stable implant with the highest cohesive gel so my implant retains its shape as much and as long as possible.

Not so fast.

The more cohesive the implant, the firmer the breast feels. I have patients who think their implant has a capsular contracture because the implant feels firm.  They don’t have capsular contracture. They are just feeing the firmness of the high cohesive silicone gel itself.

The higher cohesive gels also keep the upper pole of the breast fuller, which for those who want a more cleavage, augmented look is great.  But for those who want a more subtle, natural look having a really full upper pole looks like they had a breast augmentation- and they don’t want that.

All of the brands have variations in cohesiveness- hence the confusing lingo above with different levels of cohesive gel. It seems that Allergan TruForm 3 gel is the most stable.  (Of note, this study was done by Allergan consultant doctors, and in the critique of the study, it was noted an independent study supporting these findings would be nice.)

When you meet with your doctor, ask to feel the different cohesive gels.  They should have samples of each.  I think it is useful for you to feel it- you will know which you like the best. I use primarily Allergan implants.  I can have you feel and squeeze an implant with TruForm 1, 2, or 3 type gel.

I saw Dr. Greenberg for explant of my Breast implants this past April. I had planned on visiting with at least 3 Dr’s before I selected one, but after my consultation, I just knew she was right for me, she felt like a big sister, even though I am older than she is. Dr. Greenberg is a straight shooter, she does not candy coat anything, so if you’re a really sensitive person that get’s their feelings hurt, then hmmmmm….. I personally want someone to talk straight with me, be real with me about where I am and what my results will be.,I love the Surgery Center that she uses, it’s small and cozy, and everyone there was super nice.I am so happy now, I LOVE LOVE LOVE my little boobies, she did an amazing job!!!! After my surgery she was available for any questions I had,always getting back to me right away. Justine, her front office gal is awesome as well. Bottom line, she did EXACTLY what I asked her to do, unlike the male PS that I had my implant surgery with all those years ago. I’m back to feeling like myself again! Totally forgot to mention that after the implants were out, she gave me a lift, this is what I wish I had done in the first place! Awesome boobies now!!! Love!

– Meg T. August 3, 2016

As promised, an update now that I’ve had a procedure. Dr. Greenberg has helped me with some very serious keloid scars and we are in the process of revising them by redoing the incisions. She’s been super meticulous in doing a test section first and observing it for months, and soon we’ll do more because the small section she revised has healed much better than the scars from the original operation done by another doctor.  Beyond that, I have so appreciated her professionalism, compassion and commitment to fixing scars left by another doctor’s surgery. The surgeon I saw before Dr. Greenberg was dismissive and minimized my very reasonable discontent with the results of the surgery he did, and to have Dr. Greenberg validate my feelings about how my scars look and show genuine care in doing what she can to improve them has meant a lot. Numerous times she’s said, “You’re too young to settle for this result. Let’s see what we can do to make this better.” And that’s been such a relief after two years trying to talk myself into accepting wide, raised and long scars.

– Lauren J. January 21, 2016

Dr. Greenberg is as good as it gets! She is super kind and very sweet! She is an amazing surgeon! If I could, I would give her more stars! Dr. Greenberg spends time listening to you and always give her expert opinion. I consider her an “ARTIST”! She managed to fix my breast augmentation and return me to my natural self! I was told what she did, could not be done by many other surgeons! But she did it! I could not be more pleased with the results!

– Liz M. May 20, 2014

How lucky was I to have a sister that had surgery by Dr. Greenberg. I was able to go directly to a great plastic surgeon that has had me smiling since my surgery July 11, 2011. I want to tell everyone about her skill and talent and how I was so fortunate to have her as my surgeon. I had 40 year old breast implants that were ruptured and Dr. Greenberg removed them and gave me a lift too. My breasts have never looked so wonderful and I know that if others were to see my before and after pictures her already busy office would be over flowing. Dr. Greenberg is so focused on her patients getting the very best results that I am telling all my friends about her. I live in Mill Valley but I am so glad that I made the drive to Palo Alto. I have 2 woman coming to my home tomorrow because they are considering a breast reduction and a lift. My friend told them about my surgery and that I was thrilled with the results. I hope that I can refer her business because I want other woman to be as satisfied and get the best care possible like I did by Dr. Greenberg.

– Sandy R. August 28, 2011

She performed some corrective surgery from a procedure I had done many years ago. I know I should have had the correction done sooner, but then I may not have found Dr. Greenberg who did such an outstanding job. The results are beautiful and natural. It was the best money I have ever spent. Thank you Dr. Greenberg!

M.F., Revision Breast Surgery, Belmont, CA