History of breast augmentation
Breast augmentation (also known as augmentation mammaplasty) for cosmetic enlargement has been performed for well over a century. Below is a brief summary of its history.
Breast augmentation was first attempted in the 19th century, when in 1895, Czerny transplanted a patient’s lipoma to her breast to fill out a defect caused by the removal of an adenoma.
In 1904, paraffin injections, often a combination of petroleum jelly and olive oil, were used. This, unfortunately, resulted in the formation of hard masses or paraffinomas from foreign body reactions, as well as inflammatory reactions, tissue necrosis, and draining sinus tracts. More serious complications included pulmonary embolism and blindness due to cerebral embolism.
As a result of the complications related to paraffin, a search for an alternative substance resulted in the use of liquid silicone injections. Overall these were not well tolerated and produced silicone granulomas resulting in painful nodularity and inflammation of the surrounding breast tissue. Other complications from silicone injections included skin slough, migration of silicone along fascial planes, granulomatous hepatitis, embolism, and even death. Silicone injections were never approved by the Food and Drug Administration (FDA) for use in the breast.
As many women have had this procedure, and such injections are still practiced in parts of Asia, these images occasionally are seen. Mammography and ultrasound in these patients is a challenge, as the numerous opaque masses from the silicone granulomas are difficult to differentiate from other masses.
In 1958, polyvinyl alcohol sponge prostheses were cut into the desired shape and surgically placed. The sponge prostheses were subject to organisation by host fibrous tissue, causing shrinkage and undesirable change in the texture of the prostheses.
Another prosthetic material used during this time was polythene tapes, which were cut by a machine, wound into a ball, and then placed into the breast.
In 1962, Cronin and Gerow developed the silicone gel prosthesis where the silicon gel is contained in a synthetic shell. Various coatings of the surrounding shell, saline-filled implants, and combinations of saline and silicone-filled implants have been developed over the years.
As a result of legal action trying to link silicon implants to various systemic disease (a claim that is highly contentious) as of April 1992, only the saline-filled implant are available for aesthetic breast augmentation
Limited access to silicone implants is currently permitted by the FDA for women:
- requiring temporary expanders who are waiting for permanent reconstructive surgery
- patients undergoing reconstructive surgery at the time of mastectomy
- ruptured silicone gel implants that need to be replaced