Most Common Procedures

The most common procedure the plastic surgeons at St. Louis Cosmetic Surgery perform is breast augmentation.  As you can imagine, we-the plastic surgeons-get a lot of questions about breast augmentation and particularly about breast implants.  I thought it would be interesting to look over some of the more recent studies looking at breast implants hoping to answer some of the questions and concerns of our patients.  Over the next few blog issues, I will address different types of breast implants starting with silicone-gel breast implants from the Allergan Company.

Just a short note about the recent history of silicone-gel filled breast implants and the Food and Drug Administration (FDA).  In 1992, in the United States, the FDA issued a voluntary moratorium on the use of silicone-gel implants for cosmetic breast procedures.  It is interesting to note that silicone-gel breast implants were still available for reconstruction and revision breast procedures so the myth that silicone-gel breast implants were “banned” is false.  Restricted-yes, banned-no!  Over the next 14+ years, large numbers of studies and a lot of research was performed resulting in the 2006 decision by the FDA to approve silicone-gel implants from both the Allergan and Mentor companies for cosmetic breast procedures.  Numerous studies are ongoing including some studies that the plastic surgeons at St. Louis Cosmetic Surgery participate in and some of the data used in the studies I will discuss came from our patients.  I cannot thank my patients enough who give their time and trust to us for our studies, doing so to make breast surgery safer and easier for future patients.

In December of 2007, Scott Spear M.D. et al published in a supplement to Plastic and Reconstructive Surgery their study looking specifically at the Inamed (now Allergan) silicone-gel implants.  The study included 940 patients followed for a minimum of six years from the time of their breast surgery.  One-half of the patients were breast augmentation patients, with the other half almost equally divided between breast reconstruction and breast revision procedures.  Approximately 1/3rd of the patients underwent MRI follow-up studies to look for “silent” implant failures.

The overall implant failure rate at the end of 6 years was 3.5 % meaning that 96.5% of the silicone-gel implants were intact.  The group with the highest silicone-gel implant failure rate was the breast reconstruction cohort but this would be expected given that this group of patients has the “harshest” environment for a breast implant to be placed into because of their other medical issues.  The highest complication in all groups was capsular contracture with 14.8% of breast augmentation patients having some increased firmness of the tissues around their implants.  The most common reason for reoperation was to treat capsular contractures with reoperation for size change being second.  Patient satisfaction was over 95% for breast augmentation patients.

The findings of Dr. Spear’s study reflect the data we have seen at St. Louis Cosmetic Surgery though our reoperation rates are lower than in the study and our capsular contracture rates are also lower.  I think it is also fair to say that our patient satisfaction rates match those in this report.  We will be interested in following the data that is to come from this very detailed and important study.

Herluf Lund M.D.

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