Extra-Projected Dual Cohesive Silicone Gel Anatomical Implants: Innovation for Breast Augmentation, pp. 273-295
Authors: Egidio Riggio, Plastic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
Abstract: In 2005 a new-concept implant was introduced for breast surgery by Allergan Inc, ―Natrelle 510―, which displays characteristics that implants by other manufacturers do not have. Basic innovations are: the envelope contour and silicone dual gel in one single lumen. Original features are: a) anterior surface composed by smoothly thin borders and contour with upper slope relatively flat and lower pole extremely projected; posterior surface slightly concave along the longitudinal axis; b) single lumen made of firm silicone gel form that is high-cohesive in the posterior part and borders and more cohesive in the anterior-lower part where extra-projection settles. Choosing the 510 implant depends on the breast desired shape and is planned on anatomic features and measurements. The effect can be very attractive and natural. Insertion of larger implants is facilitated and they appear smaller than the real volume. The inner device geometric parameters are analyzed. Surgical strategy involves: 1) planning a restricted pocket, preferably dual-plane-like; placing the device top 1-2 cm beneath nipple; 2) dissecting off the inframammary fold minimally; 3) benefiting from interaction among soft-tissue dynamics, pressure of the firm form-stable gel near the vertex, and counterpressure generated by pectoralis major muscle activity at the upper pole. The inframammary fold could be lowered of 0.5–1 cm when nipple-fold length is 6.5 cm under maximal stretch, in presence of tight skin or large implant. Soft-tissue/implant dynamics can expand physiologically the lower pole skin with time.
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