Polyurethane breast implants: pros and cons

Polyurethane breast implants are not new, yet they keep giving rise to discussion and can unsettle patients. Many patients rightly ask themselves whether these implants offer them an advantage or whether there are also disadvantages. This article aims to provide clarity.

Dr. Handl is a specialist in plastic and aesthetic surgery with extensive experience in breast surgery with breast implants in Vienna. He stands for safety and sustainability in plastic surgery. Many international patients travel to Vienna specifically to be treated by Dr. Handl. Dr. Handl has many years of experience in performing various breast operations, including breast augmentations, breast reductions, breast lifts and breast reconstructions. His responsible approach to breast implants shows in the fact that he always thinks in the interests of his patients.

Breast implants have existed for many decades, and continuous development offers patients increasing safety and steadily improving quality. The polyurethane-coated implant is not a recent innovation and has been on the market for years. The temporary ban was based on the mistaken assumption that these implants could cause breast cancer. Today they are approved and have met the legal requirements for approval as a medical device of the highest class.

Polyurethanes are plastics that contain urethane groups. They are produced by the polyaddition of polyhydric alcohols with polyisocyanates. These plastics are very widely used and are found in a wide variety of industries. This group of plastics has also found its way into medicine, which ultimately led to the development of breast implants with a corresponding coating.

A weighty argument often put forward for these implants is the reduced risk of capsular contracture, which patients are unfortunately all too often made afraid of. A capsule normally forms around every breast implant as a natural foreign-body reaction; in rare cases, this can lead to capsular contracture with problems such as hardening of the breast. However, patients can develop capsular contracture with coated implants just as with any other implant. Current clinical studies show that the implant surface plays a smaller role in the development of capsular contracture than other factors. So the question is: at what price do you reduce the risk of capsular contracture?

For many plastic surgeons, the polyurethane breast implant represented a “carefree package”. Because of the lower rate of capsular contracture, many surgeons and patients readily accepted the disadvantages of these implants. As a plastic surgeon who also thinks about the future, however, you have to address the disadvantages clearly.

The reduced risk of capsular contracture and the lower tendency of these implants to rotate come at a price. As a plastic surgeon, you have a responsibility towards your patients and must also think about their future. The coated implants have the property of “growing into” the human body. The plastic foam literally grows together with human tissue, so the rejection reaction (capsular contracture) can be reduced. However, this growing together of implant and tissue also has disadvantages.

Problems: migration – revision – allergy

Potential migration of particles: with these implants, small particles of the coating may come loose and spread into the surrounding tissue. This can lead to inflammation and require further surgery to remove the particles.

Difficulties with revision: because of the adhesive effect of the coating, revision procedures can be more complex. Removing or exchanging the implant often requires additional surgical steps to release the adhesion and remove the implant safely.

Potential allergic reactions: some patients may have allergic reactions to the coating. Although this is rare, it is still a potential risk that should be taken into account.

Breast implants today usually come with a lifetime guarantee (which is also a relative statement). The responsible plastic surgeon always has the task of also thinking about the ageing of the body and the changing stages of the patient's life. Dr. Handl takes time for every patient and can point to many years of experience. Removing these implants is a much more complex operation, something many patients were not always aware of when they originally chose their implants.

Removing polyurethane breast implants

Because the tissue grows so firmly onto the implant, it can often only be removed with greater collateral damage. Often it is also no longer possible to completely remove the coating that has spread in the body, which can lead to long-term problems. “That is why polyurethane breast implants should not be the first choice,” says Dr. Handl. You can read more about breast implant removal on the corresponding page.

With the right indication, the polyurethane breast implant certainly has its place. If a woman has had a breast augmentation with normally coated implants and develops capsular contracture, which is rare in itself, it can be an alternative. After comprehensive information about the potentially difficult later removal, it can help this group of patients achieve an aesthetic result.