Macrolane One Year On

Created on 13th July 2009

Consultant plastic and reconstructive surgeon, Lisa Sacks has been offering Macrolane to her patients for the last year and tells Cosmetic Surgery & Aesthetics Magazine about her experiences

Breast enhancement by injection was the stuff dreams were made of until last year. We could only imagine having firmer breasts that were a cup size bigger without general anaesthetic, hospitalisation or lengthy recovery. More especially resulting in breasts that felt natural, using a product that is safe. This is what Macrolane offers.

Facial filler injections have been used safely and with high satisfaction for nearly a decade. Hyaluronic acid is the first filler not derived from cows, birds or pigs. It is made by bacteria using biotechnology in a form very similar to human hyaluronic acid. This is called Non Animal Stabilised Hyaluronic Acid or NASHA.

Macrolane, using this hyaluronic acid for body volume restoration, was first used in Sweden in 2002, where the early trials were carried out under strict conditions. It was first used in the UK in October 2007, but became more widely available in 2008. We are now entering the second year of our experience with Macrolane. What have we learned?

As appealing as it sounds, we now know that Macrolane is not ideal for everyone who wants it. When it arrived on the market, there was a rush to try it. It was the ‘new' treatment on the menu. Not a firming cream, not silicone stick-ons, not ‘chicken fillets' for inside the bra... but not quite surgery. It seemed too good to be true.

An injectable implant introduced under local anaesthetic without the need for hospitalisation and drawn out recovery, and going home in a bra a cup size bigger than before. There are many happy women who have Macrolane enhanced breasts. We often don't know who they are, because most of them are not telling. It looks so natural. But there are a few who are not so happy.

To put this in perspective we need to go back to basics. Macrolane offers a temporary enhancement of one's breasts. It is the ultimate ‘try before you buy' cosmetic surgery product. It is a procedure not necessarily preformed by a surgeon, but it is done by a doctor trained and certified by the producers of Macrolane to carry it out.

It is essentially an injectable implant and all the same precautions as for any breast implant need to be taken. A full examination and family history needs to be sought. A mammogram just before the procedure is recommended for anyone over 40. Women who have a close family history of breast cancer are not advised to have this treatment. Nor should anyone who is pregnant or trying to fall pregnant, breast feeding, or prone to recurrent infections anywhere in their body.

Women with lots of stretch marks or with large droopy breasts who can hold more than one pencil under their breasts are not ideal either. Anyone who is very thin is not ideal as there needs to be an adequate skin fold thickness (at least 2 cm) to cover the product.

With such a long list of exclusion criteria one may well ask who is appropriate for this treatment: someone who is not too thin, has smallish breasts (A-C cup), with little droopiness, and have no or very few stretch marks. Most importantly, Macrolane can only give one cup size increase at any one treatment. So it is not possible to go from an A to a C cup.

The Macrolane is placed behind the breast gland, and should not leak out from around the periphery. This means that in small breasted thin women, a smaller volume is used in the first treatment. A further top-up can be done after about three months once the skin has stretched a little.

It is recommended that retreatment is done one year later. This can be done with half the original amount injected to maintain the enhancement, or with more, to increase the size a bit more. In one year, it is possible to go up two cup sizes in two treatments.

Macrolane is not a cheap alternative to a breast implant, and in some countries it is even more expensive than an implant. This is because of the convenience of the procedure and the lack of hospitalization. What is really important is to see a practitioner who is not only skilled at diagnosing whether you are ideal for Macrolane, but also someone who can advise you of the alternative treatments if you are not. These may include breast lift, breast implant or the two combined.

It is also useful to have someone who can guide one through the choices about what to do after the first year. Although this treatment is attracting a completely different group of women who would not otherwise want an implant, many change their minds either initially or after the first year of Macrolane.

This really is a very good treatment to add to the armamentarium of what is available on offer to women. It has been used in Sweden for the past six years and there are currently no problems that have been encountered with respect to causing or masking breast cancer. Strict protocols do need to be followed with respect to selecting and screening patients for this treatment. Just as for any other breast surgery.
CS&AM