The prosthesis to enlarge the size of the women’s breast for cosmetic

or reconstruction reasons is called a breast implant. It is also known as breast augmentation.

This is the third most commonly performed cosmetic surgical procedure in the United States.

In 2005, 291,000 breast augmentation procedures were performed.

There are two types of breast implants.

1. Saline filled implants: they have a silicone

elastomer shell filled with sterile saline liquid.

2. Silicone gel filled implants: these have a

silicone shell filled with a viscous silicone gel.

History:

Since 1895 implantation has been going on to augment the size and the

shape of the women’s breast. The first attempt was done by Czerny. Then

Berson and Maliniac performed a flap based augmentation by rotating the

patient’s chest wall tissue into the breast to add volume.

Indications used in breast implantations:

Patient characteristics:

1. younger

2. women who have breast fed their children

3. higher socio economic status

4. greater distress about their appearance

5. Endured more teasing about their appearance.

6. low self-esteem

Types of Breast Implant:

1. Saline Implants:

They were introduced by Arion in France in the year 1964.

2. Silicone Gel Implants:

Thomas Cronin and Frank Gerow, plastic surgeons developed

the first silicon breastprosthesis with the Dow Corning Corporation in 1961.

First woman was implanted in 1962.

Silicone implant generations:

Silicone breast implants are best described in five generations. We

discuss the common characteristics of manufacturing techniques.

1. first generation:

the Cronin-Gerow implants were made of a silicone rubber envelop and

filled with a thick viscous silicone gel with a Dacron patch on the

posterior shell. They had a “teardrop” anatomic shape and were firm.

2. second generation:

the breast implants were redesigned with thinner gel and thinner shells

in 1970’s. There was also the development of polyurethane foam

coating which was effective in diminishing capsular contracture by

causing an inflammatory reaction that discouraged formation of fibrous

tissue around the capsule. The second generation implants also included

various “double lumen” designs.

3. third and fourth generation

The principle of the third

generation was to elastomer-coated to decrease gel

bleed, and filled with

thicker, more cohesive gel. The gel filler reduces leakage of the

gel compared to earlier devices. Anatomic

shaped implants are uniformly textured to reduce rotation, while round

devices are available in smooth or textured surfaces.

4. fifth generation:

In the United States of America in the preliminary stages the

form-stable of implants were “gummy-bear” or high-cohesive. When there

is a high degree of gel cohesion it will significantly reduce the

possibility of silicone migration.

Breast Implant placement techniques:

There are many kinds of implant placement techniques such as

• Inframammary.

• Periareolar.

• Transaxillary.

• Transumbilical.

• Transabdominoplasty.

Breast Implant pocket placement:

The placement of implants is described in relation to the pectoralis

major muscle.

• Subglandular

• Subfascial

• Subpectoral

• Submuscular

Complications:

There are always negative points whenever you get a

surgery done. Some of the risks of breast implant surgery are:

• Post-operative bleeding

• Fluid collections

• Surgical site infection

• Breast pain

• Alterations in nipple sensation

• Interference with breast feeding

• Visible wrinkling

• Asymmetric appearance

• Wound dehiscence

• Thinning of the breast tissue

• Synmastia

There are also some very common reasons which ask for a re-operation

after the breast implantation is done

1. rupture

• saline implant rupture

• silicone implant rupture

• capsular contracture

• systematic reviews on claims of systemic illness

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