Algorithm and techniques for using Sientra's highly cohesive shaped silicone gel implants in primary and revision breast reconstruction.

With the recent availability of shaped silicone gel implants for breast reconstruction, many plastic surgeons are inquiring as to when and how these devices should be used. Questions about indications, algorithms, and techniques have become prevalent. This article reviews the author's experience using Sientra's highly cohesive shaped silicone gel devices for breast reconstruction. A total of 31 patients had prosthetic breast reconstruction procedures using Sientra's shaped silicone gel implants. Bilateral reconstruction was performed in 16 women; thus, a total of 47 breasts were reconstructed or revised. Sientra's 3 shaped implants included the classic-base, round-base, and oval-base devices. Reconstructions occurred immediately following mastectomy, on a delayed basis following mastectomy, and for revisional purposes following a previous reconstruction using a nonshaped device. Mean follow-up for the 31 patients was 7.9 months. There were a total of 3 complications that occurred in 3 patients (9.6%) and in 3 breasts (6.4%). These included an infection in 2 breasts (4.3%) and device exposure due to incisional dehiscence in 1 breast (2.1%). No patient developed a grade 3 or 4 capsular contracture, seroma, or device malposition/rotation. Reoperation was necessary in 3 of 31 women (9.7%). Sientra's highly cohesive shaped silicone gel breast implant has been useful for controlling breast shape, contour, and position for breast reconstruction or revision following mastectomy. Breast projection has been maintained, and malrotation has not been observed within the follow-up period. Adverse events have been few, and patients have been pleased with the surgical outcomes.