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• W2912942154 abstract "Sir: I read with interest the article titled “Not All Breast Implants Are Equal: A 13-year Review of Implant Longevity and Reasons for Explantation,” in which the authors concluded that Biocell (Allergan plc, Dublin, Ireland) textured implants have the shortest time to explantation and the highest proportion of implants associated with implant performance failure compared with saline, smooth gel, and other implants.1 These findings reflect the experience of one explanting surgeon, and I am grateful for the opportunity to share my own experience with Biocell implants. As a private practice surgeon with more than 22 years of experience in breast implantation surgeries, I have worked with a broad range of devices and have found there is a learning curve associated with the successful use of any device, including Biocell implants. Although I did experience higher reoperation rates with Biocell implants for breast augmentation when I initially began to use them in 1996, I was able to greatly improve outcomes by refining my approach in accordance with the five Ps best practice principles: patient selection, preoperative planning, proportional thinking, performance during surgery, and postoperative care.2 Through experience, I found that optimal outcomes with Biocell implants are achieved through appropriate patient selection and biodimensional planning along with strict adherence to good aseptic practice and postoperative strategies (e.g., restricting physical movement for 6 weeks and use of a tight compression bra).3,4 Identification and successful resolution of issues associated with breast augmentation can be attained only through frequent patient follow-up. To that end, I was able to improve 6-month follow-up rates from 57 percent between 2000 and 2009 to 95 percent after 2009, after the implementation of a guarantee program with mandatory follow-up at 6, 24, and 48 months postoperatively that includes free reoperation for a range of complications. Implementation of these practices in my clinic resulted in a reduction of complications that have typically been associated with Biocell implants. For example, the occurrence of partial or total double capsules and the associated rotation and bottoming-out was reduced from 7 percent before 2012 to 0.4 percent over the past 6 years. The five Ps best practices were also followed in 22 patients in Southeast Asia receiving Biocell implants, none of whom required reoperations up to 5.5 years after surgery.5 In my experience, Biocell implants can result in excellent outcomes in appropriately selected patients, especially those with tuberous breasts, low constricted poles, severe asymmetries, and amastia.4 I have also observed that correct use of these implants reduces the occurrence of double-bubble, bottoming-out, and malposition. However, at the same time, it is important to recognize the higher incidence of breast implant–association anaplastic large cell lymphoma associated with these implants. Accordingly, assessing risk factors, educating patients on choices of implants and associated pros and cons, and following patients over time are essential best practices. Therefore, although there is no single perfect implant for every clinical scenario, finding the right implant for the right patient and for the right indications and reasons and using the appropriate surgical and postoperative regimes are keys to success. DISCLOSURE The author consults and conducts research for Allergan, Motiva, and Sientra. Neither honoraria nor payments were made for authorship. Charles Randquist, M.D.AB VictoriaklinikenRösundavägen 4SE-133 36 Saltsjöbaden, Sweden[email protected]Twitter: @victoriaklinik" @default.
• W2912942154 created "2019-02-21" @default.
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• W2912942154 date "2019-03-01" @default.
• W2912942154 modified "2023-10-18" @default.
• W2912942154 title "Not All Breast Implants Are Equal" @default.
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• W2912942154 doi "https://doi.org/10.1097/prs.0000000000005341" @default.
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