Patients undergoing breast augmentation have a large spectrum of outcomes that they would like to achieve, both in size and shape¹. For those patients who want a round appearing breast with maximal definition of the implant, augmentation with an ultra high profile implant (Allergan, style 45) can be useful. There has been a suggestion that ultra high profile implants can cause an increased rate of complications compared to the same sized implants of a lower profile². A retrospective review of our patient data over the last 5 years was performed comparing complication rates between the patients undergoing primary and revisionary cosmetic breast procedures with ultra high profile implants (Allergan, style 45) and moderately high profile implants (Allergan, style 20). Patients undergoing breast reconstruction after mastectomy were excluded.
A total of 1150 implants were placed in 560 patients with 42% being ultra high profile implants. The range in volume was from 160 cc to 650 cc with a mean of 320 cc. The total number of complications was 14% with nipple sensation loss and capsular contracture being the most common. There was no difference in complication rate between the moderately high profile and ultra high profile implants. The complication rate was also evaluated with respect to implant volume, low (less than 300 cc), moderate (301-425 cc) and high (450 cc or greater). The rate of complications was higher only in the highest volume category and the complication rate is on par with national averages³. We conclude that ultra high profile implants do not cause an increase in the rate of complications compared to lower profile implants, and their use is safe.
Since the introduction of the silicone breast implant in 1960, there have been multiple modifications of the implants, not only to improve longevity and safety, but to improve a surgeon’s ability to match the patient’s desired outcome to her anatomy. There are now four differing profiles of silicone breast implants on the market in the U.S. that allow further refining of the shape of the breast following breast augmentation. There is a definite group of women who want a high, round appearing breast. Further, they will even tell me that they want a “fake” appearance. Utilizing the ultra high profile implant allows the surgeon to achieve that goal in those patients and making them happy.
From January 2007 until December 2012, a total of 1150 silicone implants were placed in 560 patients. 42% (483) were ultra high profile (style 45) and 58% (667) were moderately high profile (style 20). The range of implant volume was from 160 to 650 cc with a mean of 320 cc. The style 20 mean was 330 cc and the style 45 was 310 cc. The total number of complications was 14%.
There are a significant number of women who desire a round appearing breast with a significant amount of definition. The use of a ultra high profile implant (Allergan, style 45), works well in this situation. There was a recent article that called into question the safety of the ultra high profile implant, stating that “the potential occurrence of negative tissue consequences from high- and extra-high-profile implants in primary breast augmentation and breast augmentation re-operation cases is well known to experienced aesthetic breast surgeons.” Having used ultra high profile implants for over 12 years, the author has not seen these “potential complications”. There are other groups of patients that benefit from the use of ultra high profile implants other than those who wants a round appearance. These include: wide chest width patients in whom an implant with the same width as the chest wall would make the patient have an excessively wide appearing breast, patients with very thick skin and breast tissues that require additional projection to create an attractive breast, and those patients undergoing circumareolar mastopexy which, by its nature, diminishes breast projection.
The complication rates using moderately high profile and ultra high profile implants were on par with national averages. There appears to be no increase in complications with their use. The implication that there are “potential” complications and “un-correctable” complications are not supported by this study or any other study. The complication rate does go up with the larger implant volumes. For some patients who are trying to achieve the “round look” by increasing the volume of the implant might be better served with a smaller ultra high or moderately high profile implant.
The moderately high profile and ultra high profile silicone implants have the same complication rate as lower profile implants and are safe to use. Their use is beneficial to a number of patient groups to obtain the most aesthetically pleasing post-operative result for those patients. Surgeons should feel comfortable in their use.