Ever since the first breast implant was placed for breast augmentation in Houston, Texas, over 70 years ago, this aesthetic operation has become and remained the most popular cosmetic surgical procedure throughout the world. So why have this device and breast implant augmentation attracted so much interest as well as controversy?
We will be discussing these issues and the use of breast implants, their benefits as well as risks in breast augmentation in this month’s article, and then next month in Part II, reviewing their application in secondary or what is called breast revisional surgery.
It is important to understand that breast implant development has changed dramatically over the years with significant and impactful improvements in technology, manufacturing standards, versatility, and safety. In addition, a better understanding and appreciation of the specific elements of surgical planning and technique have resulted in improved results and more natural and predictable outcomes.
Breast augmentation has undergone a significant change in terms of that ‘look’. Where previously breast enlargement was focused on size or ‘volume-driven’ augmentation, today the procedure has developed into a comprehensive planning process driven by shape and tissue distribution rather than only increasing size. In the past, when a simple addition of volume to the breast with the implant was the primary focus, modern aesthetic breast implant augmentation now prioritizes volume distribution as well as three-dimensional tissue planning to obtain the ultimate aesthetic goal of a naturally attractive and balanced breast contour that optimizes each patient’s result and provides long-term safety and satisfaction.
The first breast implants developed in 1962 consisted of a liquid silicone gel encased in a thin silicone shell that resulted in frequent gel leakage, shell fracture, and subsequently numerous complications. Before the development of gel implants, women throughout the world had tried a variety of methods to increase breast contour, including injections of glycerin, body fat, cartilage, oil, and even snake venom, all of which carried high risk and dangerous side effects.
After many years of well-documented scientific and clinical studies and testing, the Federal Drug Administration (FDA) has approved silicone gel and saline implants for increasing breast size (augmentation) as well as in breast reconstruction after cancer surgery or trauma, and to correct developmental defects or asymmetries. The FDA has also approved breast implants to correct or improve the result of a previous surgery (breast revision surgery, which will be discussed in this column next month.
There are two types of FDA-approved breast implants: saltwater or saline-filled and silicone gel-filled. Both have a silicone outer shell and vary in size, shell thickness, shell surface texture, shape, and contour. Implant design, manufacturing, and performance have continued to improve and evolve with successful developments often being referred to as the implant ‘generations’. The most current breast implants are considered ‘fifth generation’ devices and have more durable shells and are filled with a more cohesive soft gel that has the consistency of soft Jell-O and has been termed ‘gummy-bear’ implants.
It is important to understand that breast implants are not and were never intended to be lifetime devices. Although recent advances in their design and composition, such as the fifth-generation implants, have improved performance and longevity, the life span of breast implants varies by person and cannot be exactly predicted. That means that everyone with breast implants may need additional surgery, such as implant exchange and/or shaping procedures, to revise the aging breast. That is why the most important consideration in aesthetic breast surgery, as well as any cosmetic procedure, is to find an experienced and well-trained board-certified plastic surgeon who provides clear and transparent communication and lifelong service.
Finally, it is imperative that each patient with breast implants knows the long-term risks of these devices and communicates with their surgeon and providers. Although there has never been a single published study that specifically links breast implants to breast cancer, autoimmune disorders, or a documented systemic illness, implants, like any medical device, can be associated with complications over time. Certain textured implants, which have since been removed from the market, were linked to a rare form of lymphoma, and some patients have reported symptoms they believe may be implant-related, although no definitive causal evidence has been established. For these reasons, patients researching options such as breast implant removal near me should prioritize consultation with an experienced, board-certified plastic surgeon who provides clear, comprehensive, and transparent guidance throughout every stage of care.
We encourage anyone interested or seeking more information on the safety and considerations of breast implants to call or stop by EVOLV Plastic Surgery and Medical Aesthetics to learn more.
Frank Barone, MD FACS
