A few weeks back I promised to continue discussing some of the evolution in contemporary breast reconstruction. Most of that post had to do with past. This one's about the future. The future is the cohesive gel implant with or without a latissimus flap. This is for a couple reasons.
1. As I mentioned earlier, no one is going to subsidize the more labor-intensive reconstructions (ie. TRAM flaps, Free TRAMS, and the various perforator flaps - DIEP,SIEP,Ruben flaps,etc..)
2. The form-stable cohesive gels can look great with very little work, even in patients with thin skin flaps following mastectomy
Seen above is a cut section of the Inamed 410, a textured and anatomic-shaped implant that's fairly far along in the FDA approval process. It uses a silicone gel filler that's cross-linked much more then the traditional gel implants. This gives it the "gummy-bear" feel that patients have described it as.When the shell is cut or ruptures, the filler goes nowhere. This completely eliminates the migratory silicone gel that can cause some local issues in the breast or enlarged axillary lymph nodes. The safety data coming in on the 410 style blows away the currently FDA approved saline and silicone implants already sold. (NOTE: Mentor Corp. also makes a high-cohesive gel, the CPG, which is slightly behind Inamed's 410 in the approval process)
It's been used continuously since 1994 in Europe, and is the most popular style of implant for both reconstructive and cosmetic breast surgery in the world. Surgeons in other countries are amazed at the fact that the United States is still debating about 30 year old implant designs while they've already moved beyond that.
An excellent summary of the 410 cohesive can be found here