Building a Better Breast
WHY YOU SHOULD CARE
Innovation in the breast augmentation market brings us RFID chips in implants and inflatable breasts.
By Zara Stone
If you had told Ethan Winner 10 years ago that he’d spend his days getting paid to look at photos of women’s breasts, he’d have laughed at you. But that frat-boy dream came true in a most unusual way.
It started when his wife chose to get breast implants, and none of the fancy doctors the couple consulted could show her what her new assets would look like. The 48-year-old executive recruiter from Los Angeles thought that was lame. Given all the available imaging technology, why couldn’t his wife stand in front of a green screen — or something — as the good doctor ran through the options?
The experience inspired Winner to create Illusio, an augmented reality app that shows a potential customer how well various implant iterations would work with her body type. Think 3-D Photoshop but done to a medically accurate degree. Here’s how it works. Wearing a modesty strap around her chest, the prospective implant recipient stands in front of her doctor’s iPad. The surgeon uses the Illusio app to modify the patient’s virtual bust, molding her body to reflect the parameters of various breast shapes, sizes and orientations while the patient views the results on a separate screen that acts as a virtual mirror. Illusio licenses its software only to professionals; it’s one of those “don’t try this at home” situations, because amateurs don’t know how to factor in gravity, scarring and other indignities of the flesh.
Today there’s generic [breast] shapes and sizes. We want to create them specific for each person.
Dr. Nolan Karp, NYU Langone Medical Center
Winner is just one of a growing number of innovative entrepreneurs and inventors who are trying to cash in on the booming market for aesthetic procedures, which analysts predict will grow at an annual rate of 10.8 percent through 2020. Breast modifications are expected to contribute half of that total. “There’s been limited investment and innovation in this category, [and] the market leaders are no longer the technology leaders,” says Establishment Labs CEO Juan José Chacón-Quirós. In 2015 Establishment Labs raised $28 million to develop its Motiva implant, which has a nanotech surface to increase biocompatibility and an embedded RFID chip that stores the product’s serial number, the name of the manufacturer, insertion date and volume data, all of which is accessible via an external scanner and synced to mobile apps. So far, 180,000 women in more than 60 countries have the implant, which currently is not FDA-approved.
Pairing an implant with an app may seem extreme, but it’s actually low on the innovation totem pole. How about 3-D-printed nipples made from skin cells as part of reconstructive surgery, forgoing the need for tattoos and asymmetry concerns? Or the AirXpander AeroForm, a temporary implant that’s used to stretch breast skin and pectoral muscles after a mastectomy and prior to more permanent implants? The DIY-minded patient uses a remote control to inflate the AirXpander with carbon dioxide over a period of weeks or months, thereby eliminating multiple trips to the clinic for injections of increasingly voluminous saline solutions.
Then there’s GalaFLEX, FDA-approved in 2014, a biological polymer mesh that acts as a sort of internal bra to provide support for breast tissue. FDA-approved Mentor implants are well-suited for women who worry about buyer’s remorse — the size is adjustable for up to six months post-op. They’re adjusted through a removable tube that’s accessed by injecting the original incision.
One reason that breasts are so attractive to investors is that elective surgery is not covered by most health plans, so it’s an immediate cash win. “What interests business guys is that they don’t have to deal with insurance companies,” says plastic surgeon Dr. Nolan Karp from NYU Langone Medical Center. “Venture people are taking what we have and making an incremental improvement.” Karp is excited about using new technology to create a better patient experience; he thinks 3-D modeling helps creates realistic expectations. His latest project (still in the research phase) uses 3-D printing and scanning to create custom breast implants. “Today there’s generic shapes and sizes,” he says. “We want to create them specific for each person.”
That’s an easy sell, given that everyone wants to feel unique. “It’s about expectations,” Winner says. “Women have them, and doctors have them. The difficulty is not the surgery; it’s taking the guesswork out of what the patient wants.” Around 20 percent of implant patients have breast revisions, mostly because they didn’t have an accurate idea of what their new body shape would look like.
Not every surgeon is enthusiastic about the new options. “Everyone is trying to make a better implant,” says Los Angeles plastic surgeon Dr. Elliot Hirsch. “But there’s not a one-size-fits-all approach. You have to customize your treatment to meet the needs and goals of the patient.” New York plastic surgeon Dr. Barry Weintraub agrees: “This is surgery, not changing a battery.” Weintraub calls the AirXpander AeroForm remote-control activation “gimmicky” and “not going down a smart road.” He also considers imaging programs like Winner’s to be potentially misleading. “You could show someone anything you want,” he says, “but if you can’t produce it in the operating room, what have you really done?”
But this could all end well. Scientists at Brown University have spent four years creating a polymer-based breast implant that deters cancer cells with a bed-of-nails-like design — it turns out that malignant cells don’t adhere to a spiky surface. A cup-size boost and no cancer? Let’s toast the next Series DD round!