The History of Breast Augmentation
Breast augmentation colloquially known as the "boob job" is the most common surgical procedure performed by plastic surgeons.This past Friday I performed my first breast augmentation on a patient in which I was the primary surgeon, rather than assisting a more senior surgeon. I'll present her in another post once her post-operative images are available. In the consult we talked at length about where to place the incisions, whether to use a mesh, and of course different implants. But how did we get to these implants.
In 1895, an Austro-Hungarian surgeon by the name of Vincenz Czerny performed what is generally accepted as the first breast augmentation. After performing a partial mastectomy for breast cancer, he transferred a lipoma (a benign fatty growth) from the patient's trunk to her breast to correct the asymmetry.
Around the same time there are reports of women injecting paraffin oil into their breasts. This began a trend with other products being injected from petroleum jelly (Vaseline) to epoxy resin. In the 1940's, Japanese prostitutes experimented with using liquid silicone. All of these liquid injectables caused various forms of complications. In the most benign cases they would form masses with firm breasts or contour irregularities. But it could quickly become worse with some patients developing infections that occasionally led to losing the entire breast. Due to these complications, the liquid breast augmentations began falling out of favor by the late 1950's.
The 1960's saw the emergence of the first generation of breast implants. In 1962, Cronin and Brauer developed the first silicone implant with the Dow Corning company. This implant had a smooth shell and was filled with moderately viscous gel. The implant itself had an anatomic, tear drop shape with the lower half more filled than the top half. To keep it from flipping it had patches in the back that could be sewn in.
The first generation implants suffered from a high capsular contracture rate. Capsular contracture is when the tissue the body uses to wall off the implant becomes a tight scar. This can be as mild as a firmer implant to a deformed, painful capsule (grading system below). The second generation sought to reduce capsular contracture by making a round implant with a thinner shell and less viscous gel. This also had the added benefit of creating an implant that was more deformable and thus could be inserted through a smaller incision. However, the thin shell led to a higher implant failure rate. The less viscous inner gel easily dispersed and made removal very difficult (example to the right).
Around this time, lawsuits began developing alleging the silicone implants were inducing autoimmune diseases. Many large settlements were won, and by the early 1990's Dow Corning filed for bankruptcy protection due to the mounting lawsuit losses. The FDA enacted a moratorium on aesthetic use of silicone implants while studies could be performed. The silicone implants were still available for use in breast reconstruction. To date, multiple large studies have found no link between silicone implants and autoimmune disease. The moratorium was lifted in 2004.
Following the second generation, silicone implants developed progressively thicker and multi-layered shells as well as a thicker and more cohesive gel. The implants currently referred to as the "gummy bear" implant are the most cohesive. If you were to cut one of these implants, the gel would hold its form, similar to a gummy bear. The video below shows an example of a more cohesive gel a step below the gummy bear implants. The implant has a break in the shell. In earlier generations the gel would have flowed out, but with this gel it flows out under pressure but reverts when the pressure is removed.
Other varieties of silicone implants include anatomically shaped. These have more volume in the lower half and less in the upper half. This is to recreate the natural slope of the upper half of the breast rather than create the convex surface seen with traditional implants. The shaped implants are all textured. The texturing allows the body to grasp the implant preventing rotation of the anatomically shaped implants.
Several years after the first silicone implant, the French developed the saline implant. Dr. Arion created the inflatable device in 1965. By inserting it deflated, a smaller incision could be used to place the implant in the breast. These first devices suffered from a high rupture rate of almost 80% in 3 years. Similar to silicone implants, progressive generations of saline implants developed thicker and multi-layered shells. Due to the moratorium on silicone implants in the 1990's, saline implants
gained popularity. The trans-umbilical approach was created specifically for saline implants.
Today saline implants have become the minority again, being used almost exclusively in the United States. Nationwide and worldwide, silicone implants are the dominant implant. The choice of saline implants is usually financially related, costing around 50-70% of the silicone equivalent. Regardless of the implant chosen modifications and improvements are always being made. The current trend is using fat liposuctioned from other areas of the body to augment the breasts. Almost as if we've come full circle to Dr. Czerny's initial procedure.
In 1895, an Austro-Hungarian surgeon by the name of Vincenz Czerny performed what is generally accepted as the first breast augmentation. After performing a partial mastectomy for breast cancer, he transferred a lipoma (a benign fatty growth) from the patient's trunk to her breast to correct the asymmetry.
Around the same time there are reports of women injecting paraffin oil into their breasts. This began a trend with other products being injected from petroleum jelly (Vaseline) to epoxy resin. In the 1940's, Japanese prostitutes experimented with using liquid silicone. All of these liquid injectables caused various forms of complications. In the most benign cases they would form masses with firm breasts or contour irregularities. But it could quickly become worse with some patients developing infections that occasionally led to losing the entire breast. Due to these complications, the liquid breast augmentations began falling out of favor by the late 1950's.
The 1960's saw the emergence of the first generation of breast implants. In 1962, Cronin and Brauer developed the first silicone implant with the Dow Corning company. This implant had a smooth shell and was filled with moderately viscous gel. The implant itself had an anatomic, tear drop shape with the lower half more filled than the top half. To keep it from flipping it had patches in the back that could be sewn in.The first generation implants suffered from a high capsular contracture rate. Capsular contracture is when the tissue the body uses to wall off the implant becomes a tight scar. This can be as mild as a firmer implant to a deformed, painful capsule (grading system below). The second generation sought to reduce capsular contracture by making a round implant with a thinner shell and less viscous gel. This also had the added benefit of creating an implant that was more deformable and thus could be inserted through a smaller incision. However, the thin shell led to a higher implant failure rate. The less viscous inner gel easily dispersed and made removal very difficult (example to the right).
Around this time, lawsuits began developing alleging the silicone implants were inducing autoimmune diseases. Many large settlements were won, and by the early 1990's Dow Corning filed for bankruptcy protection due to the mounting lawsuit losses. The FDA enacted a moratorium on aesthetic use of silicone implants while studies could be performed. The silicone implants were still available for use in breast reconstruction. To date, multiple large studies have found no link between silicone implants and autoimmune disease. The moratorium was lifted in 2004.Following the second generation, silicone implants developed progressively thicker and multi-layered shells as well as a thicker and more cohesive gel. The implants currently referred to as the "gummy bear" implant are the most cohesive. If you were to cut one of these implants, the gel would hold its form, similar to a gummy bear. The video below shows an example of a more cohesive gel a step below the gummy bear implants. The implant has a break in the shell. In earlier generations the gel would have flowed out, but with this gel it flows out under pressure but reverts when the pressure is removed.
Other varieties of silicone implants include anatomically shaped. These have more volume in the lower half and less in the upper half. This is to recreate the natural slope of the upper half of the breast rather than create the convex surface seen with traditional implants. The shaped implants are all textured. The texturing allows the body to grasp the implant preventing rotation of the anatomically shaped implants.
Several years after the first silicone implant, the French developed the saline implant. Dr. Arion created the inflatable device in 1965. By inserting it deflated, a smaller incision could be used to place the implant in the breast. These first devices suffered from a high rupture rate of almost 80% in 3 years. Similar to silicone implants, progressive generations of saline implants developed thicker and multi-layered shells. Due to the moratorium on silicone implants in the 1990's, saline implants
gained popularity. The trans-umbilical approach was created specifically for saline implants.
Today saline implants have become the minority again, being used almost exclusively in the United States. Nationwide and worldwide, silicone implants are the dominant implant. The choice of saline implants is usually financially related, costing around 50-70% of the silicone equivalent. Regardless of the implant chosen modifications and improvements are always being made. The current trend is using fat liposuctioned from other areas of the body to augment the breasts. Almost as if we've come full circle to Dr. Czerny's initial procedure.
