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Breast augmentation

A breast implant is a prosthesis used in cosmetic surgery to enlarge the size of a woman’s breasts (known as breast augmentation) or to reconstruct the breast (for example, after a mastectomy, or during male-to-female sex reassignment surgery). There are four types of breast implant:

Breast implant diagram

Breast implant diagram

      • Saline-filled, which have a silicone shell filled with sterile saline liquid. These implants are currently the only type available in the United States, but future regulation may make more available.
      • Silicone gel-filled, which have a silicone shell filled with silicone gel. In the 60 countries where silicone implants are available, they are used in approximately 90% of implant operations. The implantation of silicone gel-filled breast implants is currently illegal in the US.
      • String implant, a third, much less common type of implant, is a method of achieving extreme breast sizes, initially developed by Dr. Gerald W. Johnson, M.D.P.A., using polypropylene (PPP). String implants are unique in that they cause the breast to continue expanding after surgery, and are preferred by those women who choose to have the largest breasts possible, including many adult entertainers. String implants were eliminated years ago by the FDA due to the complications brought about by continuous growth after implantation.
      • Tissue engineered implant, a new form of implant currently in development. The principle is that cells are taken from tissue artificially grown from human stem cells, which are then combined with an appropriate scaffold material to produce a Tissue Engineered Breast Implant.[1] The advantage of this method is that there is no risk of leakage or rupture, and the size can remain stable for the lifetime of the patient, a contrast from the silicone or saline filled implants which typically reduce by approximately 40%.

History

Saline-filled breast implants

Saline-filled breast implants

Implants have been used at least since 1865 to augment the size of women’s breasts. The earliest known implant occurred in Germany in which fat from a benign tumor was removed from a woman’s back and implanted in her breast. In following years the medical community experimented with implants of various materials, most commonly paraffin. The first use of silicone as breast-implant material may have been by Japanese prostitutes in the period immediately following World War II, who would directly inject silicone into their breasts.

Silicone gel-filled breast implants

Silicone gel-filled breast implan

Houston plastic surgeons Thomas Cronin and Frank Gerow developed the first silicone breast prosthesis with the Dow Corning Corporation in 1961 and the first woman was implanted in 1962. The implant was made of a silicone rubber envelope or sac filled with a thick, viscous silicone gel.

Since then developments have focused on making the implants last longer, feel better and excite less fibrous tissue in the capsule around the device. A capsule tends to make the implant feel hard, look distorted and unnatural and may cause pain. Bacteria, leaking silicone and time are the main factors in capsule formation. Saline implants can also form capsule. Capsule rates have fallen with newer textured implants, thicker shells which leak less, and thicker ‘cohesive’ gels.

Risks and controversy

In the United States, implants made from silicone gel were restricted by the Food and Drug Administration because of growing concerns about the safety of such implants. More than one million women had availed themselves of the implants at the time of the ban, and the subsequent litigation led manufacturers to agree to a settlement of USD$4.25 billion. The degree of risk associated with silicone-gel breast implants is still a matter of debate within the scientific community. Currently silicone implants are available in the US only in the setting of controlled trials but they are widely used in the rest of the world where health authorities have not accepted that they pose an unacceptable threat.

Breast implants

Breast implants

Grade IV capsular contracture in the right breast of a 29-year-old woman seven years after subglandular placement of 560cc silicone gel-filled breast implants.

The health hazards of breast implants have been debated greatly in recent years. Some people believe that breast implants cause such illnesses as autoimmune disease, although both the AMA and FDA have found there to be no evidence of this. [2] However, documented problems with breast implants include asymmetry, visibility, palpability, rupture, deflation, infection, scarring and hardening of the implants or ‘capsule’. [3]

It is noteworthy that implants, especially silicone implants, can impede radiography-based mammograms. Specific techniques have been developed to ensure that all breast tissue is imaged in the woman with implants. This requires taking extra images. It is interesting that the rate of breast cancer in women with implants is less than in matched non-augmented women.

Photograph of grade IV capsular contracture in the right breast of a 29-year-old woman seven years after subglandular placement of 560cc silicone gel-filled breast implants

Grade IV capsular contracture in the right breast of a 29-year-old woman seven years after subglandular placement of 560cc silicone gel-filled breast implants

Since the breast is an erogenous zone, particularly for those with small breasts, breast augmentation can have the effect of reducing sexual pleasure by reducing sensitivity. However self-esteem may be improved after augmentation. Few women regret having augmentation mammoplasty

According to the American Society of Plastic Surgeons, breast augmentation is the most commonly performed cosmetic surgical procedure on women in the United States. In 2002, 236,888 women in the U.S. underwent breast augmentation. [4] According to the National Institute for Women, one in four silicone implant recipients must undergo surgery, within 5 years, to correct implant problems.

As well as medical concerns, breast implants have been the subject of social controversy. Among some women they are seen as empowering and an exercise of control over the body; others see them as voluntary subjugation of the body to men’s desires and a step backwards for women’s empowerment. Some have compared breast implants to Chinese foot binding and female circumcision. Despite this, the social acceptability of breast implants seems to be increasing in most Western countries, although there remains a gulf between their portrayal in the media and in everyday life.

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