How the surgical technique has evolved to the present

Since the 1960s, plastic surgeons have been carrying out breast enlargement by placing an artificial device (prosthesis or implant) in the breast. Despite a storm of controversy that has surrounded the operation since its inception, it continues to satisfy the vast majority of patients.

Complications are fortunately few. However, as with any procedure that is done very often (probably over 2 million women have breast implants), occasionally major problems do occur.

Even though the procedure does not always provide excellent results, only a very small proportion of women ever consider having the implants removed, and satisfaction rates on the part of both surgeons and patients are high. Despite this, the continuing controversy regarding the operation has necessitated a re-evaluation and careful assessment of the success of surgery. This has resulted in even more careful study of the long-term results of breast augmentation than was previously available. Fortunately, these current studies have largely reinforced the general impression that we have always had, which is that it is a rewarding procedure.

The typical patient

The woman who chooses to have breast augmentation is usually either in her early 20s or 30s. The women in their 20s tend to have very little breast development, and often have siblings, aunts or a mother with a significantly larger breast size. Women in their 30s tend to have a loss of breast volume after having gone through one or several pregnancies and breast-feeding periods.

Historical development of the operation

In the 1950s, women who wanted larger breasts, usually those involved in burlesque shows or the US entertainment industry, were treated outside North America with materials injected directly into the breasts, such as liquid silicone or paraffin. The results were often disastrous. They experienced painful cyst formation, drainage of infected material, and distortion of the breast shape. This caused surgeons in North America to begin searching for reliable and reasonably safe ways of increasing breast size.

The result was an implant made of a silicone rubber shell, or balloon, that could be filled with either a silicone gel material (manufactured to have the same feel as normal breast tissue) or during the surgery itself, filled with sterile salt water (saline) or another liquid material no longer used (dextran solution). Instead of placing the implant in the breast gland itself, the implant was placed under the breast, leaving the breast, nipple, and areola, essentially intact.

The operation was gradually refined and some modifications were introduced, but the method has stayed essentially the same. Although gel-filled implants are no longer available, the silicone rubber shell remains, as does the method of placing the implant under the breast.

Saline filler for breast implants

Saline (salt and water) is now used to fill breast implants. There is probably no safer filler than saline, especially since extensive, long-term testing is needed to develop a reliable and safe substitute. Because the human body is 71% salt water, if a saline filled implant leaks, the saline simply goes into the general circulation and results in no ill effects other than loss of breast fullness.

How the augmented breast is shaped

To understand the changes that are made in the shape and size of the breast, the operation essentially takes a roughly cone-shaped part of the body (the breast) and increases both the base and its forward projection by adding a round disc (the implant) to the base of the cone.

Benjamin Gelfant, MD, 
in association with the MediResource Clinical Team