Women have used breast prostheses of one form or another for a very long time. In the past this has largely been in an effort to improve their apparent proportions by adding something into their clothing on the anterior chest. The current version of this is well known as a breast prosthesis called a ‘chicken fillet’ which is placed into the bra. The other common alternative currently used is the padded bra. Both these implements tend to augment the apparent breast size.
For many years now there has also been an attempt to augment the breast using breast implants. This implies putting the prosthesis inside the patient’s tissues and hence converting the external breast prosthesis to a breast implant.
This history goes back many years and has included the use of a patient’s own fat as far back as the late nineteenth century. Other materials have been used. They have included injections of paraffin and the use of some unusual materials such as ivory, rubber and glass balls (the latter can only be considered to be either very heavy or very fragile). The evolution into modern style breast implants began in the 1960’s. This included the development of both saline filled and silicon filled breast implants.
The modern history of silicon filled implants began with the development by Plastic Surgeon’s Cronin and Gerow in conjunction with the Dow Corning Company in 1961. This led to the first breast implant being carried out the following year.
Tear drop shaped implants were amongst the first breast implants actually designed and made. The shape of these implants was maintained by the shape of the silicon shell.
The next development was to make a more naturally feeling implant using a thinner shell with a round shape filled by a thinner silicone gel. The drawback of this breast implant was that whilst it was very cosmetically acceptable it did have a higher tendency to leak or rupture.
It was also a smooth surfaced breast implant and there were problems relating to the scar capsule in that scar capsular contractual was relatively common with these breast implants.
This led to the development of various surfaces on the outside of breast implants. The idea of a textured surfaced breast implant whether it is made with polyurethane or an intrinsic texturing of the silicon shell of the implant is to allow the scar capsule to form a neat bond (like Velcro) to the shell of the breast implant.
This does two things. It allows the prosthesis to be better stabilised in its position and it reduces the percentage chance of capsular contractual.
As stated previously, amongst the earlier silicon filled breast implants, were tear drop shaped implants. More recently (1996) tear drop implants re-emerged. Plastic Surgeons like Ivo Pitanguy, Patrick Maxwell and John Tibbets were involved in developing the new tear drops. This time however the shape of the implant was not held by the shell of the breast implant, but by the shape of the gel within the breast implant. These implants have been referred to as ‘Gummy Bear Implants’. More accurately however they should be described as anatomically shaped, form stable implants, containing cohesive silicone gel. The great advantage of this type of gel is that even if the implant ruptures, the potential for the gel to spread is greatly minimised.
The other evolution that has occurred with breast implants is a change in the permeability of the shell of a breast implant. The original runny gel smooth surfaced breast implants did have a relatively high degree of permeability allowing what is referred to as ‘gel bleed’ to occur. This is where the gel inside the implant seeps through the shell of the implant and into the space between the breast implant and the scar capsule. The newer breast implants have a thicker shell and gel bleed is reduced to an absolute minimum.
In recent years, there has been concern regarding the development of a rare type of blood cell cancer, called lymphoma, in the tissue surrounding breast implants. The incidence of this is extremely low, ranging between one in eight thousand to one in two and a half thousand women with breast implants, (for perspective, the incidence of breast cancer in Australian women is around one in ten.) It does not appear to have a relationship to silicon but may have an association with the textured surface on some implants. Australia is a world leader in the research into this problem and it is probably multi-factorial involving bacteria and genetics.
New implants are becoming available which combine the advantages of the improvements mentioned earlier and improvements to minimise the risk of lymphoma. Some even have a microchip in them, not so that “Big Brother” can trace your movements, but to allow a scanner to accurately identify the details of your implant.
There has been a considerable evolution of breast implants over time. They have gone from the fairly rudimentary devices of the past through to the moderately complex, much safer and more natural devices of today.
Consequently, there is a wide variety of implants now. If you are considering Breast Implantation, discuss your choices with your Plastic Surgeon and select the ones that suit you physically and with which you can be both comfortable and confident. If you have breast implants and are concerned about them in any way, consult your GP, have an ultrasound of your breasts, and ask for a referral to a Plastic Surgeon to discuss your concerns.
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