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Past, Present and Future: Breast Implants


After a checkered past – consisting of liquid silicone injections and use of various implantable sponges – modern breast augmentation began with the development of the first silicone gel implants in the early 1960s. These were smooth bags made of an outer solid silicone shell, pre-filled with silicone gel and placed under breast tissue above the pectoralis muscle (sub-glandular).

Early results were encouraging, but as time went on various limitations become evident – the most notable was that a certain percentage of the implanted breasts (up to 40%) became unacceptably firm due to capsular contracture. The human body forms a layer of scar around any foreign body put into it; and when the scar tissue around a breast implant gets too thick, the breast may become hard and look distorted.

In efforts to improve augmentation results, surgeons began placing implants under the pectoralis muscle (sub-muscular) and the rate of capsular contracture decreased, but the operation became more involved.

Other efforts to improve breast augmentation have focused on implant design modification and alternative filling materials. An early attempt to modifying the outer shell of implants was to coat them with polyurethane foam. Due to incompatibility, this was eventually abandoned, but paved the way for the current generation of textured implants, with a “rough” outer shell. Texturing the outer shell seems to further decrease the rate of capsular contracture. In some cases, especially women with thin skin and little breast tissue, textured implants can cause visible rippling of the skin.

Saline was introduced as a filling material because unlike silicone, should the implant leak, saline is easily absorbed by the body. Saline was, and is, still considered a safe alternative to silicone filled implants and design modifications have improved the life span of saline implants – currently estimated between 10-20 years. Soy-filled implants were briefly introduced in the mid 90s as an alternative to saline or silicone, but have largely been abandoned amid concerns over local inflammatory problems in instances when the implants leaked.

Due to the more natural feel of silicone over saline, the majority of implants used until 1992 were gel. At that time, however, the FDA pulled gel implants off the market amid concerns of possible health risks. Since that time, the FDA has reviewed several studies concerning silicone gel and systemic health risks, and has recently concluded no apparent link exists. As a result, silicone gel implants have again become available on a restricted basis subject to strict guidelines.

Due to current restricted use of silicone, the most common implants today are smooth, round saline, and a more recently introduced textured, anatomical or “teardrop” shaped saline implant. Anatomical implants are shaped to provide a more natural look to the augmented breast. However, many women still prefer the natural feel of silicone, which is now also designed in a textured, anatomical shape. The future of breast augmentation may include a reintroduction of the softer gel implant in the USA.

Two implants are currently available in Europe that will undergo FDA clinical trials beginning in late-1999. The first is an anatomical-style cohesive gel implant. The gel is a silicone gel variant thicker than previous gels. This will not migrate should the outer shell fail and does not cause rippling. The second new implant is the Novamed hydrogel implant. This is a pre-filled implant with a saline-based polymer gel said to interfere less with mammograms, feel softer than saline, and be completely excreted from the body without difficulty, should the implant leak.

Regardless of implant size, shape or filler, the keys to an optimal result and a satisfied patient are realistic expectations and an understanding of the risks, benefits and alternatives of augmentation surgery.

To view Before and After photos of Breast Augmentation surgery, Click Here.



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