Journal time! This month October 2012 issue of the Plastic and Reconstructive Surgery Journal had an interesting article “The Effect of Silicone Gel Bleed on Capsular Contracture: A Generational Study,” by Drs. Moyer, Ghazi, and Losken out of Atlanta.
The basic question: are the new generation of silicone gel breast implants better with regards to gel bleed?
First, lets back up.
- What is gel bleed? Gel bleed is when the silicone inside of the implant “bleeds” out of the shell. The thought is this bleed causes the capsule to thicken, forming a hard breast
- What is a capsule? A capsule is a scar your body forms around a foreign object. When the capsule is thin, you can’t feel it. When it is thick or contracted, it make the implant feel hard, can cause shape distortion, or can cause malposition of the implant. When someone has a “hard implant” it isn’t the implant which is hard- it is the capsule around the implant you are feeling.
- What are generations of gel implant? Implants have been around since Dow Corning made the first one in 1962. Since that time they have been refined, with the goal to make the internal gel more cohesive and crosslinked to lower the rates of gel bleed and minimize leaking if there is a problem with the implant shell.
So did it work? Are the newer more crosslinked cohesive gel implants better?
This was an interesting study, done in a pig model. They implanted each with eight 50cc custom gel implants. Treatments were done on the shell to simulate the older, more porous shells. Then in the second phase, they used the cohesive gel implants (3/4th generation) and the super cohesive gel (5th generation). Half of the implants were punctured to simulate a rupture.
Capsules were removed at 1 month and 3 months and analyzed with histological slides with different strains.
Findings?
- gel bleed correlated with the stiffness of the capsule
- the more bleed, the stiffer the capsule
- the worst implants were the high bleed second generation implants (these are not used anymore)
- the best implants were non ruptured third and fourth generation implants
- histology slides showed a layer of muscle cells in the contracted capsules, which was not present in soft capsules
Great study. Interestingly, they state the fifth generation of supercohesive gel implants are hypothesized to have a lower inflammatory result if ruptured. (The theory is these supercohesive implants when ruptured won’t leak, as the more viscous gel inside won’t leave the implant, so they will have less inflammation. ) The data from this study does not support this. When squeezed, ruptured implants of the 3rd, 4th, and 5th generation of implants showed equal amounts of leakage of the gel.
For more information, you can go to October 2012 PRS.