In our reconstructive experience, particularly with thinner patients and implants placed in the prepectoral plane, we have found that Responsive implants are often unable to provide sufficient maintenance of upper pole projection and can have high rates of visible rippling and wrinkling. As a result, we primarily use SoftTouch and Cohesive implants in the reconstructive setting, which address both of these issues and provide durable results (with the limited follow-up we have thus far).
As with outcomes data following primary augmentation with Inspira cohesive implants, data on use of the implants in the reconstructive setting are limited. However, some of the most recent articles on prepectoral reconstruction include outcomes with these implants as part of larger studies (albeit with short follow-up). Recent studies have shown good outcomes demonstrated by low rates of complications, safety in both the previously irradiated breast and following postmastectomy radiation therapy, and clinical applicability in challenging patients.16,17
Particularly in the reconstructive setting, we have found the extensive matrix of different implant volumes, projections, and cohesivities within the Inspira line to offer significant value when compared with other implant types. Although there is a trade-off of increased firmness with increased cohesivity (Fig. 5), the ability with more cohesive implants to provide improved upper pole projection with decreased possibility of rippling due to the higher fill ratio has a major benefit in the postmastectomy setting. Additionally, having multiple profiles (typically moderate, full, or extra-full for reconstruction) available in the higher cohesivity gel allows for greater flexibility and options for patients to help them achieve their desired outcome, particularly in the setting of unilateral mastectomy when trying to achieve symmetry with the nonmastectomy breast.
One potential downside of highly cohesive implants, particularly in higher projection, larger volume implants, is the possibility of implant malposition/flipping in the anterior–posterior direction. Although it has not been well-studied yet, the cause is thought to be a mechanical one related to the “top heavy” nature of higher projection, more cohesive implants, which can rotate from back-to-front in the implant pocket, causing a visible deformity of the breasts and a flattened appearance to the implant. Anecdotally, it has been seen more often in the reconstructive setting, but this is likely related to increased ease of identification following mastectomy as compared with augmentation, where native breast tissue is still present in front of the implant and, thus, it may not be identified as frequently. Careful pocket control and consideration for intermediate cohesivity for larger volume, high-profile implants have been suggested as strategies to minimize the risk of this type of implant malposition. Fortunately, when it does occur, patients can typically “flip” the implant back on their own with simple maneuvers.
Women undergoing primary breast augmentation or implant-based reconstruction can achieve excellent outcomes with Inspira implants with a wide range of options available for patients. Appropriate patient assessment and preoperative discussion of goals and expectations is essential to optimize outcomes.
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