Plastic Surgery Boca Raton Florida
Becker Breast Implants
561.394.6656
HILTON BECKER CLINIC OF PLASTIC SURGERY
M.D., F.A.C.S., F.R.C.S.
Board Certified Plastic Surgeon
Boca Raton, FL
Email: Hilton@beckermd.com

Dr. Becker's workshop in South Africa


Dr. Becker's wordshop in Japan

Breast Reconstruction using Adjustable Breast Implants

Skin Sparing Mastectomy

Surgical Procedure

Elevation of Pectoral muscle
Adjustable Implant placed beneath muscle
Muscle sutured into position

Acellular Dermal Graft

In immediate breast reconstruction, obtaining complete pectoralis major muscle coverage of an implant or expander can be a problem. As shown in this schematic, AlloDerm® can be used to cover and support the implant/expander at the lower breast pole. Technically, this can be accomplished in a number of different ways.

Alloderm Surgimend Neoform

Acellular Grafts

Acellular Dermal Graft

Acellular Dermal Grafts - Anatomical Pocket

Adjustable Implants

Becker 50/50 Implant
Standard value used in saline implant
Spectrum value

Adjustable Implant Misconceptions

Types of Adjustable Implants

Single-lumen saline implant (Spectrum)

The adjustable saline implant functions exactly like a normal saline implant, with the added advantage of volume increase and decrease capabilities.

Empty implant with fill tube
Implant with fill tube and injection port
Implant with fill tube and injection port removed

Double-lumen saline-gel implant (Becker-Mentor)

Model implant names of the double-lumen saline-gel implant are as follows: Becker 50/50, Becker 25/75 and the Contour Profile Gel (CPG) Becker Implants. The Becker 50/50 is composed of 50% gel in the outer chamber and 50% saline in the inner chamber. The Becker 25/75 is a double-lumen implant with 25% gel in the outer chamber and 75% saline in the inner chamber. The CPG Becker is an anatomically shaped implant with 35% gel in the outer chamber and 65% saline in the inner chamber. These implants are mostly used in reconstruction surgery. However, in selective cases they are useful in treating complications of the breast following breast implant surgery.

75% Saline / 25% Gel
50% Saline / 50% Gel
0-10% Saline / 100-90% Gel
65% Saline / 35% Gel

Adjustable Gel Spectra

The Spectra adjustable gel implant is a dual-lumen gel implant. However, it has a small inner chamber that can be filled with saline. Gel percentage in the Spectra can range from 100% to 80% of total volume. The implant can be placed in the patient with or without any saline in the inner chamber. If the size is satisfactory, then the fill tube is removed. The implant for all intents and purposes is then a gel filled implant. If, however, further volume is needed, the inner lumen can be filled to the desired volume before the fill tube is removed. If increased projection is desired, the inner lumen can be overfilled. Projection can thus be increased without decreasing the base diameter. The firmer pressure of the overfilled inner chamber aids in projection but without creating undue firmness, due to the presence of the soft gel. The ability to alter implant size and projection at the time of surgery eliminates the need to discard an implant that does not have the correct dimension. In addition, in the event that the desired gel implant is not available, the Spectra adjustable gel implant can be an ideal alternative because of its flexibility.

It was developed by Dr. Becker in 2006. Visit www.adjustablegelimplant.com to find out more.

The adjustable gel implant represents a totally new concept in breast implant design. It was developed by Dr. Becker in 2006.

The implant is essentially a gel implant, the inner lumen may be left empty or filled up to 20% for enhanced projection. This is the first adjustable implant that does not require any saline to be added if necessary and has greater volume flexibility.

Another unique feature is that scalloping is not seen on overexpansion.

Leakage Rate

Filling Volumes

325cc empty
325cc optimal
275cc min
390cc max
  • The limits set by the manufacturers are constrained by the FDA.
  • It is often necessary for saline implants to be filled beyond the manufacturer’s recommended limits in order to achieve the desired result or to provide patients with optimal satisfaction.
  • When given the ability to select the volume post-operatively, patients most often choose higher levels or beyond.

Over Expansion

Each saline implant size has a recommended minimum volume, temporary over-expansion volume, and final volume. The manufacturer’s recommended fill ranges have been determined not by clinical use, but rather by placing implants on a flat surface and progressively filling them until wrinkling was minimal, and then filling until scalloping occurred. These volumes represent the minimal and maximal recommended fill volumes. However, clinically, it has been noticed that a wider fill-volume range can and has been used.

Each saline implant size has a recommended minimum volume, temporary over-expansion volume, and final volume. The manufacturer’s recommended fill ranges have been determined not by clinical use, but rather by placing implants on a flat surface and progressively filling them until wrinkling was minimal, and then filling until scalloping occurred. These volumes represent the minimal and maximal recommended fill volumes. However, clinically, it has been noticed that a wider fill-volume range can and has been used.

The limits set by the manufacturers are constrained by the FDA. It is often necessary for saline implants to be filled beyond the manufacturer’s recommended limits in order to provide patients with optimal satisfaction. When given the ability to select the volume post-operatively, patients most often choose higher levels or beyond.

According to a study done by Greenwald, et al.,at the University of South Florida in Tampa, Florida, saline-filled breast implants can be safely filled far beyond manufacturer’s recommendations with regard to the mechanical properties of the Silastic polymer implant shell.

Adjustable breast implants provide unique post-operative versatility. Implant adjustability allows for more effective management of numerous conditions that would otherwise require surgical intervention.

Filling Adjustable Implants Beyond Manufacturers Recommended Fill Volumes

A total of 138 patients[264 implants] undergoing breast augmentation mammoplasty with Smooth Round Spectrum® implants were evaluated post-operatively. Follow up ranged from 2 months to 5 years , with an average of 2 years. In order to determine the effects of over-expansion, the incidence of leakage was assessed, as well as the possibility of causing increased firmness of the breast implant.

The surgeon assessed patients to see the effects first-hand. A questionnaire was submitted to patients, inquiring as to their satisfaction with their breast implants, as well as their perceived softness of the breast and whether they experienced bothersome wrinkling.

Results

Out of 264 implants:

  • 108 implants (40.9%) were overfilled.
  • 5 implants (1.9%) were underfilled.
  • 151 implants (57.1%) were filled to optimum volume.
  • There was no evidence of increased leakage in the over-expanded group.
  • There was only one leakage – interestingly this implant was not overfilled.
  • The leakage rate was 0.37%, which is lower than that of regular saline implants.
  • This lower leakage rate is attributed to less fold floor failure, due to overfilling, as well as decreased valvular leakage, due to superior quality of the spectrum valve over the diaphragm valve.
  • No patients in the over expanded group complained of increased firmness.

A large percentage of augmentation patients initially feel that they are too large; however, as time passes, the implants settle, and patients get used to their new size, they request further filling of the implant.

Conclusions

By exceeding the recommended fill volume, the authors were able to use the implant to its maximal potential, with increased patient satisfaction. The authors were able to correct problems and avoid complications that would not have been possible without deviating from the manufacturer’s recommended fill volumes. Non-validated restrictions on fill volumes severely limit the efficacy of adjustable implants.

Preventing Circulatory Compromise

In the reconstruction patient, it is often necessary to place the implant under-filled, in order not to compromise the circulation to the skin flaps. This is particularly beneficial in patients undergoing augmentation mastopexy, to prevent wound problems and possible nipple necrosis.

Following bilateral mastectomy and insertion of Becker implant
Note compromised circulation.
Final Result
Final Result

It is often necessary to over-expand implants in order to iron out irregularities, to alter implant position, and to treat impending capsular contractor. In the treatment of capsular contracture after release of the capsule, over-expansion and splinting of the capsule has been found effective in reducing recurrence of contracture.

Before
Following mastectomy
Early post operative result
Implant over expanded
Volume reduced

In the treatment of breast implant problems, it is extremely beneficial in many instances to deviate from the manufacturer’s recommended fill volume, especially in cases where capsular repair is done such as in the treatment of symmastia. In these situations it is important to avoid tension on the repair site in the healing phase; therefore, implants are kept under- filled until repair has taken place. Two to three weeks later, the implant can then be filled to the desired volume.

In the treatment of the breast cancer patient, during irradiation is it sometimes necessary to deflate the implant, in order to allow the radiation beam access to the target area.

Before surgery
Following Right mastectomy and
Left prophylactic mastectomy
Following radiation
Following radiation
Final result

Ideal Breast Reconstruction

One stage immediate breast reconstruction using local tissue makes your post-operative breasts look as good or better than before the mastectomy.