BREAST AUGMENTATION
For Size Enhancement and Minimal Lift

 Background
 Patient Groups
 Patient Concerns and Planning
 Preparing for Surgery
 The Operation
 Recovery
 At Home
 Office Visits and Follow-up
 Outcome and Complications
 Case Histories (Before and After)

BACKGROUND (See Wilipedia)
The earliest report of breast augmentation was in 1895 when Czerny attempted to transfer a fatty tumor called a lipoma (collection of adipose tissue) from the back to the breasts. Untoward complications occurred when Gersuny injection paraffin (wax) in 1889. In the first half of the twentieth century numerous substances were experimented with, including ox cartilage, ground rubber, polyethylene tape, gutta percha, and polyvinyl alcohol-formaldehyde polymer sponge called Ivalon (Ivalon sponge implants introduced in 1950). Marilyn Monroe was purported to have breast augmentation with Ivalon sponges encased in polyethylene sacs, and had complications with persistent nipple drainage. Polyethylene taped wrapped into a ball (Polystan), polyurethane foam, silicone rubber, and combinations of Teflon and Silicone were tried. A piece of tissue called a dermal fat graft taken was used by the renowned Plastic Surgeon Maliniac in 1950. Assorted creams and medications were applied in order to increase bust size.

Various injections including paraffin and oils, plus liquid silicone were used in the 1950s and 1960s and still practiced in outlying clinics throughout the world today. Serious problems arose from this industrial grade and chemical grade silicone liquid leading to dense hardening and deformity of breasts many years after injection. This has lead to the need for mastectomy in some patients. The advent of the true silicone gel implant with a more resilient shell began in 1963 with the Cronin-Gerow prosthesis. Further developments lead to better processing of the silicone gel and implant shell casing, as well as the advent of saline-containing, lipid suspension-containing, and sugar polymers, for internal molding of implants. The latter two ingredients were found not be valid due to late problems.

The problems of implant hardening and shell failure with suspicion that leaking silicone might lead to chronic illness, lead to further research which culiminated into more stable silicone gel composites, increased cohesive gel material, improved shell integrity, with attempts to use a polyurethane shell to reduce scarring around implants. Saline implants, developed by France in 1964 have been more popular following this silicone gel controversy and FDA ban with restriction on implantation of silicone-gel implants from 1992 to the present day. Research studies guided by clinical trials among many Plastic Surgical practices have yielded promise for reintroduction of silicone gel implants to the general public.

A new high-cohesive gel implant "the gummy bear" (Fourth Generation) that does not ooze out and migrate is being tested and may pass FDA clearance by 2007. Newer methods of insertion and implant care, with attention to technique and antibiotic coverage have provided better safety with regard to breast augmentation. Studies currently have determined low implant rupture rates for silicone and saline implants. Long term studies on saline implants are being reviewed. There is currently no association of breast implants with cancer, chronic disease, effects on childbearing, or other conditions according the culmination of findings by the FDA in their report dated September of 1999. While implants are mechanical devices and foreign bodies, they can cause problems as with any implanted material. There will be a time following breast augmentation that some revision may be anticipated which includes replacement for rupture, hardening issues, and for general cosmetic reasons to seek adjustment or implant replacement.

The patient satisfaction rate with breast implants well exceeds 90%. Over 290,000 breast augmentations with implants were performed in 2005 which places this procedure third in overall popularity with patients undergoing cosmetic surgical procedures.