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April
09-17-2004, 08:40 AM
1. While anatomic implants intuitively seem like they'd be better...86% of plastic surgeons use smooth round implants. Basically a round implant becomes teardrop or anatomical when its in your body especially if the implant is under the muscle

2. Many dancers want a "fake" look...to do this the implant should be over the muscle. That is always going to lead to more rippling. Less with gel than with saline but the new cohesive gels will be even better but theyre not available.

3. The gels which are available now (for patients with "problems" with saline implants, lifts, or those replacing current gel implants) don't require a larger incision. The cohesive gels do require a larger incision (around 6 cm vs 3 cm)

Hope that helps.
Plastics Doc



I agree that a regular silicone or saline implant takes on a teardrop shape inside the body, but for certain women (like women who have sag or women who want really "fake" looking implants) they don't provide enough projection. High profile implants can give this projection with the more pronounced or "fake" look. Depending on which type of implant is used, an anatomical implant can also give more projection, with a more natural slope than high profiles.

I do not agree that over the muscle implants create a faker look. I personally have had under the muscle implants switched to over the muscle (same size and shape), and I can definately say that they looked more fake when they were under the muscle. They were higher, they were more pronounced (I think having the muscle in between my own tissue and the implant added more projection), they moved unnaturally when my pecs were flexed (which is more than you would think, happened at work, at the gym, during sex!), and they felt firmer. I think high profiles placed under the muscle have the "fakest" look.

Lastly, cohesives ARE available; you just have to be in a study to get them. Anyone can call the manufacturers (Inamed, Mentor, and Silimed) to find out which studies are still open and where are the nearest PSs who are participating in the studies. I believe the Silimed study is still enrolling. I personally have Mentor CPGs (an anatomical, cohesive silicone, textured implant) and I LOVE them. They look and feel incredibly natural!

Nichole
09-17-2004, 08:50 AM
Plastics Doc, I saw one ps in Chicago, but then decided against the cohesive gel. I would be interested in speaking with you and seeing your work.

Plastics Doc
09-17-2004, 08:51 AM
Obviously, you're entitled to your opinion... I think in the vast majority of patient with round, softball-stuck-on the-chest implants the implants are over the muscle. They are about 4x more likely to have significant capsular contracture compared to under the muscle. I don't think theres much debate about that.

Also, the Mentor and Inamed cohesive gel studies have been closed for a while now. Silimed has a cohesive gel implant but, the company is foreign (French) and they have not been willing to stand behind their product the way Inamed and Mentor have (both American companies). So if you go that route keep your fingers crossed.

Plastics Doc

April
09-17-2004, 09:14 AM
I'm not advocating over the muscle placement, I just am pointing out from personal experience that different people=different results. What works for someone might not work for someone else.

I had under the muscle saline implants and developed Baker Grade III contracture within the first month, I also had under the muscle textured cohesive silicone implants and developed Baker Grade II contracture within the first two months. Now I have OVER the muscle textured cohesive silicone implants with NO excessive contracture (3 months post-op), go figure! I think that I have very developed pec muscles, that were leading to excessive bleeding and movement of the implants during the healing stages that was actually CAUSING the contracture. That's just my opinion, though, and hopefully the contracture won't return, fingers crossed!

Also, I think the softball stuck on the chest has more to do with how much breast tissue the patient starts out with than what placement is used. A woman with A cups who gets implants is going to look a lot faker with over the muscle placement than a woman with C cups who gets over the muscle.