versión impresa ISSN 1983-5175
Rev. Bras. Cir. Plást. (Impr.) vol.26 no.3 São Paulo jul./set. 2011
Implante? Prótese? Inclusão?
César Augusto Arrunátegui Carvallo
Plastic surgeon at Hospital Belvedere, Belo Horizonte, MG, Brazil
The author discusses the indiscriminate use of various terms to designate a single artifact and suggests the adoption of only one signifier. Although no publications deal specifically with the meaning of the terms "implant", "prosthesis" or "inclusion", apart from what is found in ordinary lexical and medical dictionaries, such terms are commonly and interchangeably used to designate a single artifact. According to the author, it is beneficial to select and utilize only the term that best conceptualizes the object designed for correcting lack of breast volume in specialty terminology. The use of a single term will facilitate scientific paper writing; therefore, the author proposes the use of the term "implant" to indicate the artifact placed inside the mammary gland.
Keywords: Breast implantation. Breast implants. Mammaplasty. Prostheses and implants.
O autor discute o uso indiscriminado de vários termos para designar um único artefato e sugere a adoção de apenas um significante. Embora não se encontrem publicações que tratem especificamente do significado dos termos implante, prótese e inclusão, a não ser o que se encontra nos dicionários léxicos e médicos comuns, esses termos têm sido usados rotineiramente para designar um único artefato. O autor considera ser possível incluir na nomenclatura da especialidade o termo que melhor conceitue o referido objeto destinado à correção da falta de volume mamário. O uso de um único termo facilitaria a redação de trabalhos científicos, e, por esse motivo, o autor propõe o uso do termo implante para o artefato colocado dentro da glândula mamária.
Descritores: Implante mamário. Implantes de mama. Mamoplastia. Próteses e implantes.
Currently, there is no consensus among plastic surgeons on the use of an appropriate term to describe "silicon skin", an object currently filled with high-cohesion silicone gel. The program of the 12th International Symposium of Plastic Surgery, held on March 18-20, 2011 (São Paulo, SP), exemplifies such situations in a single round table conference held on March 19, in which the following instances could be observed:
Round table: Inclusions of silicone implants
1. My experience with polyurethane-coated prostheses
2. Experience with anatomical prostheses
3. Study of histology, immunohistochemistry... in capsules of breast implants
4. Endoscopic transaxillary surgery
5. Mastopexy with prosthesis inclusion
6. Breast implant: durability versus warranty
7. Tactic for choosing the ideal prosthesis
As seen above, the following terms are often used to refer to the same artifact intended to increase mammary gland volume: "inclusion", "prosthesis", "implant", or simply "silicone".
It is also interesting to note the various terms used in the official scientific program of the 24th Midwest Plastic Surgery Congress, held from March 31 to April 2, 2011 (Brasilia, Distrito Federal), which widely deals with topics on breast surgery: the same artifact is referred to as a breast implant, silicone augmentation, implant inclusion, or prosthesis inclusions. Lack of consensus on this issue is clearly evident.
Aiming to unify the terminology of such a widely used object, the author researched commonly used terms in dictionaries and found the descriptions given below:
Replacement of an organ, or portion thereof, with an artificial substitute1.
Replacement or substitute for a missing part: an arm, one or more teeth1.
Any device that helps or increases a natural function (such as hearing or vision)1.
Replacement of an organ or body part by an artificial part2.
Artificial organ or body part such as an eye, leg, or denture2.
Replacement of a part of the body by an artificial part. It is a branch of Medicine, particularly in surgery or dentistry. For example, a person may lose an arm or a leg in an accident. An artificial limb will perform the functions of the missing part. The artificial limb also receives the name of prosthesis, such as artificial teeth, fixed or movable dental bridges, and implanted by dentists. Factories manufacture artificial body parts made of wood, plastic, or stainless steel3.
A device implanted in the body to address the absence of an organ or to restore an impaired function4.
Substitute manufactured for a sick or absent part of the body5.
Insertion of inert elements in intact tissues of a host, such as artificial teeth, heart valves, etc1.
Regressive derivation "to implant"2.
Material that is implanted in the body: have a dental implant6.
Act or effect of implanting = implant7.
Substance or object inserted into the body for prosthetic, therapeutic, or aesthetic purposes7.
Material removed from the individual, from others, or artificially produced, which is inserted or grafted into an organic structure in order to be part of it8.
An implant consisting of a silicone rubber bag containing a silicone gel; used in breast augmentation5.
Act or effect of including. [Antonym: exclusion]1.
A microscopic technique by which the object to be studied is first surrounded by an easily selectable mass, which immobilizes it1.
Act or effect of including2.
Penetration of one thing into another2.
Impregnation of a liquid substance in a tissue, which solidifies and enables it to be cut into thin sections for microscopic examination2.
State of an included thing3.
Act or effect of including. (Latin: inclusio). Cover, understand, involve6.
Act or effect of including7.
The process by which a strange or heterogeneous structure is placed in another tissue5.
Any external device used to immobilize or assist limbs or spine movements4.
A support, splint, or orthopedic device5.
Medical device, implantable or not, used in humans as a substitute for a function or anatomical structure9.
Although applying the correct meaning to terms used in plastic surgery does not affect operative results, it is ideal for surgeons to use suitable, accurate terminology, thus unifying scientific presentations and facilitating understanding.
The artifact placed by women between the bra and the skin to correct breast hypoplasia, which is removable at any time, should be considered a prosthesis; however, the artifact placed within the mammary gland should be considered a breast implant, which indicates that it is "permanent" or is intended to be permanent.
The term "prosthesis" is old and familiar and has always described a "removable artificial leg", "false teeth", "glass eye", and an external "device for breast augmentation", especially after mastectomy.
While other medical specialties use the term "prosthesis" in an unclear manner, this does not necessarily mean that it is not possible to unify terms in plastic surgery. In the case of hair, it seems that the expression "hair transplant" is more acceptable compared to "hair implant."
In dentistry, the so-called "dental implant" should be referred to as a "dental exo-implant", since one part of the artifact is permanently placed inside the bone (the metal pin), and the other part, which is also permanent, is located outside of the body (the tooth). Although the term "orthosis" is used exclusively in orthopedics, it is important to highlight that its ambiguous meaning gives rise to the same misunderstandings that occur with the terms mentioned above.
Definitions in dictionaries are not exact nor precise regarding the meanings of terms; therefore, plastic surgeons need to have good will and good intentions in order to unify their expressions in a positive manner.
Therefore, the author recommends the use of the term "prosthesis" in plastic surgery to describe any object that can be affixed and removed at any time. The term "implant" should be used to describe an artifact or device that is placed inside the body, permanently or with that intention, such as breast, nose, chin, or ear implants.
The term "inclusion" is not suitable for plastic surgery and should be abandoned.
However, the meanings of these terms, according to various dictionaries, are not absolute, and considering that languages are constantly evolving, it is appropriate to give more specific meanings to terms used in plastic surgery.
This reasoning can also be applied to Spanish and English and their corresponding translations.
The author suggests the use of the term "prosthesis" to describe all objects that can be placed within and removed from the body at any time and the term "implant" to designate an artifact that is placed inside the body, permanently or with that intention. The word "inclusion" should be abandoned, since it is the least applicable term to describe the desired purpose of a medical artifact.
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César Augusto Arrunátegui Carvallo
Rua Afonso Costa Reis, 65 - Belvedere
Belo Horizonte, MG, Brazil - CEP 30320-450
Submitted to SGP (Sistema de Gestão de Publicações/Manager Publications System) of RBCP (Revista Brasileira de Cirurgia Plástica/Brazilian Journal of Plastic Surgery).
Received: April 27, 2011
Accepted: May 23, 2011
Study conducted at Hospital Belvedere, Belo Horizonte, MG, Brazil.