Something New: ‘Gummy Bear’ Implants and ADM Placement Surgery
‘Gummy Bear’ Implants
It may be a bit of a stretch to label form-stable silicone gel implants (popularly known as ‘gummy bear’ implants) as ‘new.’ Beginning March 2012, the US Food and Drug Administration (FDA) had approved the use of ‘gummy bear’ implants for breast augmentation. The go signal came after medical aesthetics company Sientra gathered 1,800 women over an 8-year period for clinical trials using the implants and proved that they were safe and effective.
The term ‘gummy bear,’ coined by Marina del Rey, Calif. plastic surgeon Grant Stevens, points to the implant’s claim to novelty. Unlike its earlier counterparts, such as saline and silicone implants, the ‘gummy bear’ implant is known for retaining its shape even when cut in half or when a rupture occurs.
But while some, such as Dr. Stevens, see similar properties between the implant and the popular snack, the FDA and Sientra itself discourage such a label. In an interview with ABC News, the company’s CEO Hani Zeini expressed that comparing the ‘medical device to a piece of candy triviliazes it.’
To date, there are three licensed manufacturers and distributors of the implants: Sientra, Allergan, and Mentor. Thicker at the bottom and tapered towards the top, implants are designed to look like tear drops. The shape allows for a more natural look. The silicone gel used has a thicker consistency than the one found in ordinary silicone implants.
There’s also less wrinkling or rippling, which is a common problem especially when smooth implants are used. Patients have cited additional firmness, especially for those who chose ‘gummy bears’ for their secondary procedures. Because it is textured, the implant lowers the risk for capsular contracture – that is, scar tissue that forms around implants which cause them to harden.
Just like any medical device, this type of implant also comes with its own issues. Should rotation occur, its irregular shape may bring about distortion more noticeable than, say, its round counterpart. A longer incision is also necessary to ensure proper placement either above or below the pectoral muscle. Though rare and common to all implants, there are still cases of infection, bleeding, and rupture post-surgery. According to the American Society of Plastic Surgeons, however, this particular variety is ‘thought to be less likely to break.’
ADM Placement Surgery
Acellular dermis matrix? Sounds overly complicated. Yet, it is a relatively new procedure – introduced in 1994 – that makes breast reconstruction a touch simpler. These matrices are culled from human, pig (porcine), or cow (bovine) skin, sometimes from the lining around the heart. Cells are removed from the tissue (hence, the name), which is then attached to the chest muscle or along the inframammary fold. It acts as a sling of sorts and supports the lower part of the implant. Among the most preferred matrix options: AlloDerm, DermaMatrix, and Tutoplast which are donated human tissue; Strattice which is sourced from porcine dermis. Before cosmetic use, ADM has been utilized in burn and abdominal wall reconstructions.
What exactly does the extra piece of skin do for the breast? It eliminates the need for weeks-long expansion of the pectoral muscle and breast skin to create a pocket of suitable size in which the implant can be inserted. When patches of human, porcine, or bovine skin are stitched along the muscle or on the underside of the breast, there is also better coverage for implant edges.
Surgeons have reported that ‘rapid early expansion (using acellular dermis) has led to improved cosmetic outcomes,’ as cited in Medscape.
Also, despite the matrix being foreign to the chest area, there are no issues regarding the repopulation and revascularization of the implanted tissue. Patients are assured of healthy integration of their cells into the matrix.
Despite the numerous conveniences ADM offers, most surgeons still opt for traditional implant surgery. The added tissue support eliminates the need for expansion, but not the need for secondary procedures. Subsequent surgeries generally don’t require a complete overhaul, merely corrections or improvements after a few years to ensure that implants and pockets are in their best form.
Macmillan.org.uk – New methods in breast reconstruction (acellular dermal matrices)
BreastRecon.com – Direct-to-Implant reconstruction
Medscape – Breast Reconstruction with acellular dermis – John YS Kim, MD; James Neal Long, MD
ABC NEWS – Gummy Bear Breast Implants – David Wright and Brandon Baur (Nightline)
PlasticSurgery.org – What’s Hot: Gummy Bear Implants – Earl Campbell, MD