Capsular contracture and Microthane implant- KIES-U Breast augmentation Korea

1:40 AM

Following “Trend”.... "Safety, Certification" are unconsidered

Current selection for implant depends on whether the product is “new or not”. The customers are less interested in types such as “smooth” and “anatomical” therefore the clinics use the term “new product” in order to gain more interests.

Microtextured product is not a new one. It was produced by Arion in France more than 10 years ago. Eurosilicone, Sebbin, Motiva and Bellagel followed after and the product has been popular in Korea.

Let’s look back about 6 years ago, when anatomical implant was first certified in Korea about 2011.
Everyone was talking about the anatomical type ever since.

Those who did not have any knowledge about breast augmentation somehow related “breast augmentation” and “anatomical implant” together.

There was a reason for its presence and its value was great for those who needed it. This applies to all type of products.

A general storyline was “Anatomical implant = Natural looking breasts” which appealed to the general because the people thought that it would just provide natural looking breasts. Of course, anatomical type was more expensive than the round type.

However, such process is not appropriate. What you see cannot be the judgment for what happens in the future, the effectiveness and complications that may come up.

Our population is small and so is our country, therefore there is a “wave” of customers going into a certain “hit item”. In this case, it was the anatomical type implant.

Such trend lasted for about 3 years.
Anatomical implants have its defects as well. When a product is used for a long time, people tend to find out the defects and the prices tend to go down.

As the prices went down, the clinics that used this implant did not find it appealing. They all looked for highly priced new product that could fulfill the high expectation of the customers.

This resulted in the microtextured product that we have today. (Sebbin, Motiva, Bellagel, Eurosilicon, etc)

Soon the popularity of microtextured products will settle down, and there will be a new product in the market.

Today, I do not want to share about a “new product” but something that has been in the market for a long time. And during this time, this product has resulted in some good outcomes. However, the surgical procedure is rather difficult.

The name of the product is Polyurethane foam coated breast implant.
The inner substance of this product is silicone as well. Just the outside has been coated with polyurethane.

1. Is polyurethane safe?

There has been a report that TDI from polyurethane caused cancer in animal testing which led to recall of its products from BMS in 1991.

FDA soon studied for cause of cancer on human body soon after.

In 1995, FDA announced that the polyurethane implant from BMS had very rare chance of causing cancer. This certified the safety of polyurethane implants. But the company did not manufacture the polyurethane implants.

There was a huge class action on silicone breast implants at the time in US. The largest medical product company, Dow, went into bankruptcy due to this class action.

But, this was a witch hunt. Soon after, people found out that the silicone gel did not have any influence on the health of the people.

Polyurethane, too, does not have any effect on health. FDA clarified this as well. It also was studied that polyurethane has very low incidence rate of complications such as capsular contracture, collapse, damage, bleeding, infection, etc.

2. Why is the incidence rate of capsular contracture low?

Many are interested about capsular contracture. We need some explanation on why polyurethane implants have low incidence rate of capsular contracture.

There is no clear understanding of the cause of capsular contracture but we do not the process of it. We see it as a resistance to foreign substance. Macrophage, one of infection cells, plays the main role. The infectious cells surround the implant heavily, and release substances that the fibroblast get attracted to.

When fibroblast gather, it generated collagen that grows into same direction making strong and tough capsule. This is the start of the capsular contracture.

But polyurethane has a surface that is not smooth but sponge net-like structure.
The infectious cells fill up the net-like structure therefore they cannot grow into one direction. The collagen grows into all different direction.

The capsule formed cannot be strong or tough but is very weak. This is why the incidence rate of capsular contracture on polyurethane implant is low.

3. What happens to the patients who use polyurethane implants after a long period of time?

Polyurethane is a type of coating material. The coating dissolves into the capsule after 2 years. The coating cannot be visually seen after 5 ~ 9 years.
The polyurethane disassembles therefore the capsular contracture starts to form when the polyurethane disappears.

Dr. Don Parsa from University of Hawaii released a report of 30 year study on polyurethane implants. The earliest period where the capsular contracture was found was after 9 years of its usage. After 9 years, the incidence rate of capsular contracture increases year by year however, there was not one case of capsular contracture within the first 9 years.

Although the polyurethane coating cannot be seen visually, it does not mean that the coating has been completely disappeared.

You can see it through the endoscope. The polyurethane remains on the capsule. The invisible polyurethane must have resisted the formation of capsular contracture for 30 years.

Dr. Parsa stated that incidence rate of other complications such as collapse, inflammation, and etc is also lower on polyurethane implants.

4. Why is the usage rate so low for polyurethane implants?

All the readers might feel the same. If this product is so good then why don’t the doctors use it?

There are various reasons, but first, technically the polyurethane is more difficult to use than the silicone type. The surface texture is very rough therefore it is difficult to put in the implant. (We can use funnel to put in the implant which makes the process easier) The price is relatively expensive as well.

But I think the more important reason is the habit of the doctors. Silicone implants have more variety and there are many producers and many promotions for the product. But polyurethane implant has low level of awareness and it came into the market rather late therefore it is not the “core product” in the hospitals.

There are many doctors who think that there are other products that can be used rather than the polyurethane implant.

However the incidence rate of capsular contracture on polyurethane is 1/20 of silicone implant. Of course there has been many developments in silicone implants to lower the incidence rate of capsular contracture, but the capsular contracture itself is a scare to all patients. This shows how much great a value the polyurethane implant has.

5. Rumors on microthane implants

Microthane implant is the only product that improved on the problems on silicone implants. There has been numerous trials in 60~80’s with no success. Microthane product is the only successful product.
Microthane is the only product with 30 year research data as well.

Also, FDA is certified that there needs to be no concern on if the product caused any form of cancer.

There are rumors that microthane implant is difficult to remove, but this is not the case with the doctors who have actually done it. There are saying that the incidence rate of capsular contracture is low, but high for inflammation or seroma. This rumor comes from those doctors who have never even touched the microthane implant once.

Those who have only touched the silicone implant think that the microthane implant would feel hard, but this is not the case. Microthane implant feels very soft and good. There is no feeling of foreign substance.

As a cosmetic surgeon who conducts breast augmentation, I hope that more people use polyurethane coated breast implant.

The product has been certified for a long time and it has value for those patients who need reconstruction due to capsular contracture.

This is all for today. Thank you.

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