BREAST AUGMENTATION- PAST PRESENT AND FUTURE By Dr. Ajaya Kashyap, MD, FACS
Diplomate American Board – General Surgery
Diplomate American Board – Plastic Surgery
To
have shapely breasts have been the desire of all women since before the
start of history. The desirable size of the breasts in today’s culture
is a C-cup size such that the waist to breast ratio is 0.67. The height
and built of the individual are of course important criteria.
Breast augmentation has been attempted with non-surgical means using
medications and massages little success. Subsequently other means of
breast augmentation were tried including injections of various
medications. This also had variable but overall disappointing results. A
variety of substances were injected in the breast from foam to paraffin
and wool, all with disastrous results. This went on from late
nineteenth to early twentieth century . A nother approach that was
attempted in the late nineteenth century was use of patient’s own fat
and tissue from the chest with somewhat better results although the
techniques were rather crude by todays standards. During the mid
twentieth century silicone injections were used on over fifty thousand
women with disastrous results .
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Then in 1961 the first silicone
filled breast implants were devised and were used clinically in 1962. In
1964 saline filled breast implants were developed in France which
lagged behind in popularity till the controversy in the 1990s Since the
development of implants breast augmentation has become the most common
cosmetic surgical procedure in the U.S. and many other countries.
In
1990s following a TVshow in the US the controversy started about the
linkage of silicone filled breast implants with a variety of medical
problems. The silicone filled implants were promptly pulled off the US
market. The linkage was never established and in fact the safety of
silicone
breast implants was subsequently established through extensive
studies. This was the time when rapid developments in technology took
place. The size, shape and projection of implants evolved , polyurethane
coated implants came and went as did soya-been filled implants. Now
that the safety of silicone implants is established they are back in
almost all the countries. The ne avatar of these implants is the
cohesive gel or “gummy bear” implants which do no not flow out even when
ruptured. There are many more and safer implant choices that are
available today .
There are multiple approaches for
breast augmentation . These include putting implants through the armpit, from
below the breast fold, through the nipple areola or even through the
navel. The first two are the most common approaches for silicone
implants. The layer which the implants are put under is also variable ,
above or below the muscle. There are advantages and disadvantages of
both.
In spite of the established safety record of breast
implants several concerns remain. If non medical grade silicone is used
as in the PRP implants major problems can happen. It is important to use
US FDA approved implants which do not have these issues. There is also
the possibility of leakage which can occur years after the implant.
There is formation of a film of scar tissue around the implant which is
called a capsule. The newer techniques and implants have minimized this
problem. Further progress is being made in the manufacture of implants
as well as techniques used to insert them Cancer screening which was
difficult before is becoming easier with MRI technology.
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