Market-Driven Plastic Surgery: Trend or Tragedy?

Posted on September 11, 2009 under General Plastic Surgery

Patients sometimes come to our Denver plastic surgery practice asking for a “quickie face lift” or a particular kind of lipo like “Smart” lipo that they have heard about on TV or the internet or at another physician’s office. It’s normal to want the newest thing, because technology has brought us great things.

I was one of the first to jump all over the iPhone, but I confess that I’m not the first to take on new, market-driven procedures, and here’s why: good plastic surgery practice is based on research and proof that a new way of doing a procedure is based on checks and balances, studies on thousands of patients, and general agreement by other plastic surgeons that this change is positive and longer-lasting or in some quantitative way, better than the way it was previously performed. However, this goes against the public’s desires: they want a new technique that seems better, and they want to find a surgeon who will do it.

Note to consumers: Plastic surgery techniques change slowly. The techniques employed by board certified plastic surgeons are based on years of research and evaluation to make sure that what we deliver to our patients is both safe and effective. Even with all the research and effort to make these changes, they are usually  small, subtle advances; little differences that help someone get the best result.

Advice to consumers: Find a surgeon who’s not just up-to-date on the best technologies, but does a better job than others. Check their photos. Check their testimonials. Perform due diligence. And, if a surgeon doesn’t meet with you until the day of surgery, it’s bad medicine. Run. Quickly.

THE BOTTOM LINE: It doesn’t matter what you call a procedure. A rose by any other name is still a rose. It matters how you look after it’s performed. The proof is in the results. Legitimate results aren’t based on the latest procedures, but the best hands and minds in the plastic surgery business.

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Gummy Bear Implants: The Same, but Different

Posted on September 11, 2009 under Breast, Breast Augmentation

Patients occasionally ask us about “Gummy Bear” implants: what are they? Are they safer? Are they better? Can I have them? Should I have them?

It’s normal to want the latest, greatest thing—after all, Americans are hot for innovation, and both of us are committed to investigating and validating the latest and best technologies, devices and techniques for use in our practice. However, just because something is “new” doesn’t mean it’s “better”. Let’s briefly compare current silicone-gel implants with this new “gummy bear” implant.

What is a gummy bear implant?

The phrase “gummy bear” is a consumer-friendly name for an implant that is a “form stable cohesive gel”. They are firmer than current silicone implants and are pre-shaped in a tear-drop profile meant to look “more natural” in the breast.

Who makes them and what is their medical name?

  1. Mentor – Contour Profile Gel (CPG) implant
  2. Inamed/ Allergan – The style 410.
  3. Silimed/ Sientra – Silimed cohesive gel implants.

Are they safer? Are they better?

Safety: Current silicone implants are quite safe, and if they rupture (which is rare), any extruded silicone generally remains in the pocket surrounding the implant itself, unless the breast sustains significant trauma. Gummy bears are, literally, like their candy-referenced name: when sliced, nothing comes out. Therefore, you might say the 410’s are safer than silicone-gel in the same way a Prius getting 50 mpg is a better car than a Civic getting 46 mpg, ie, silicone-gel implants are safe or we couldn’t use them; it’s not as if the 410’s will replace an unsafe implant.

  • Longevity: Studies show that the form-stable gel implants have a lower rupture rate compared with standard silicone gel implants. Assuming the same outer shell, this would suggest that the 410’s would last longer.

  • Speed of Recovery: The recovery won’t be easier or more rapid compared with current implants; it will be the same.

  • Postoperative discomfort: as with speed of recovery, it will be the same.

  • Cost: as with any new product, they may initially be more expensive than current silicone-gel implants. We’ll have to wait and see if they become competitively priced with silicone-gel.

  • Appearance: Although most women seeking breast augmentation wish to have larger breasts, most still wish them to appear as close to “nature” as possible, ie, not obviously implants. The firmness of the 410’s may make them look slightly less natural when the women lies on her back or side. Their tear-drop shape may look more natural than silicone when she is upright. We think the “feel” of silicone gel implants may be preferable, as the gummy bear implants are firmer and, therefore, feel less like normal breast tissue.

Are they better? We don’t know yet. They are extremely popular in Europe and Asia, some very good breast surgeons prefer them and we’ve seen some very nice cases in the literature. Once they are accepted as primary implants we’ll have a better idea about performance.

Can you have them?

Gummy bear implants (we use the 410’s) are available in our office as replacement implants, not yet for primary (first-time) augmentation. They are also approved for breast reconstruction and repair of breast deformities as replacement implants.

After they are approved, we might or might not prefer Gummy Bear implants over silicone-gel implants, depending on our assessment about their aesthetic result—in other words, if they actually look better or perform better than the current cohesive gel implants we’re using now.

THE BOTTOM LINE: Suggesting that the gummy bear is safer simultaneously suggests that the current silicone gel implants are not safe. They are, or we wouldn’t be using them. Gummy bears are a different option that may become the standard. Time will tell.

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