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The Good, the Bad and the Beautiful - Part I

Breast Implants and Breast Surgery: The Good, the Bad and the Beautiful – Part I

EVOLV / April 9, 2024


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 has 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 improvement 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 where 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 in order 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.  Prior to 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: salt water 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 have 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 that provides clear and transparent communication and lifelong service.


Finally, it is imperative that each patient with breast implants know 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 either breast cancer, autoimmune disorders or a documented medical illness, they can, like any implanted medical device, be associated with complications.  Some of the more textured devices, which have been taken off the market, have been linked to a rare form of lymphoma and there are occasional patients that have reported symptoms that they believe are associated with their implants although no documentation has been proven.  For all these reasons the importance of each patient finding an experienced and qualified plastic surgeon who provides clear, comprehensive and complete communication is paramount.


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