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Breast Implants: Is it time for a Change? (Original Article)

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Breast augmentation continues to be the most common cosmetic procedure performed by plastic surgeons. Although breast implants have been popularized by celebrities such as Pamela Anderson and Britney Spears, the history of these controversial devices began five decades ago.

Initially women’s breasts were enlarged using surgically placed sponges. The procedure was crude and fraught with complications. Modern augmentation took hold in the 1970’s with the use of silicone gel implants. The benefits of breast implants were even touted in the song “Dance 10, Looks 3”from the hit Broadway musical “A Chorus Line”.

The Controversy Years


            The 1980’s brought the largest surge in breast augmentation procedures. A variety of implant types were available from multiple manufacturers. Most devices were filled with silicone gel or saline, salt water solutions. In the late 1980’s and early 90’s reports of arthritic-type diseases associated began to surface. Citing a lack of safety data for the implant devices, the Food and Drug Administration withdrew silicone gel implants from Most of the existing companies left the implant market, leaving only twoU.S.manufacturers. California-based Mentor Medical and McGhan Medical (later Inamed/Allergan) remained as the onlyU.S.producers of breast implants.

Limitations were placed in 1991 on the availability of silicone gel implants. Saline filled became the only devices available for primary cosmetic breast augmentation. With rare exception, in theU.S., gel devices were approved only for reconstruction following mastectomy. However, throughout the 1990’s, the implants continued to be the most popular devices for augmentation outside theU.S.andCanada. Ironically, the cosmetic gel implants produced by the U.S. manufacturers were available only for export to women outside the U.S.

Saline Implants Rule

The 1990’s and first half of this decade were defined by a growth in breast augmentation surgery using saline implants. They are silicone rubber bags filled with a salt water solution. Vocal celebrities, reality TV shows and a growing image-conscious society combined for a boom in plastic surgery procedures, led by saline implants.

The implant is placed empty into the pocket and folded like a taco, so the scar is only slightly larger than an inch. The smaller scars allow for greater flexibility, including the incision around the areola or even the belly button. It is filled to the actual size with the saline solution on the operating table. More water can be added to one side, if necessary, to correct a size disparity. The implants can be placed in front, or behind the pectoralis chest muscle.

The implants are not without occasional problems, though. A thick scar tissue shell, termed a capsular contracture, may occur causing hardness or distortion to the breast. Deflation of the implant with loss of the water solution is also possible. Both of these problems may require additional surgery. Patients sometimes can feel, or even see, the rippling edges of the implant. In some cases this is very bothersome. In addition, in patients with very large implant pockets the cleavage can be unpleasantly wide. Despite the occasional complications, however, the procedure carries a very high degree of satisfaction.

They’re Baaaack…

            Saline implants ruled in theU.S.until late in 2006, when the F.D.A. approved silicone gel implants for primary cosmetic augmentation. The twoU.S.manufacturers partnered with selected plastic surgeons with expertise in breast augmentation. The National Council of Leaders in Breast Aesthetics was formed to provide feedback on the new prostheses.

The new gel implants, sold internationally for years, are different from the prostheses of the 1980’s. The gel is not as liquid as before making leakage less problematic. The new implants are often called “gummy bears” because of their cohesive, firmer filling. The new gels are the most natural feeling implants to date. They are also lighter than the saline implants, a feature especially valuable for women with looser breast skin.

The gels have some disadvantages too, however. The implant is prefilled and sealed so the incision required is slightly larger and adjustment of minor asymmetries is not possible. In addition, the F.D.A. attached a few strings to their approval. Patients must be 22 years old and M.R.I. examination of the breasts is recommended to detect leaks. The new gel implants are also more expensive than saline.


What’s Next

            The past two years have seen a transition from saline implants to the new silicone gels. In our practice most new patients are choosing gel implants because of their softer, more natural feel and lighter weight. In addition, many patients with existing saline implants, especially those with hardness, rippling or deflation, are opting for a change to silicone. In cases of malposition or unpleasantly wide cleavage, reshaping the implant pocket is also possible.

The newest breast implant on the horizon is a combination of silicone gel with an inner saline chamber. This exciting new prosthesis allows for the soft feel of silicone with the adjustability of saline. The water can even be added weeks after the surgery allowing the patient to choose her final size. Although it is produced by a U.S. manufacturer, the implants are not yet available here.

Finally, women considering breast augmentation should have multiple consultations with board certified plastic surgeons experienced in the procedure.


About the Author:


Jorge A. Perez, M.D., F.A.C.S. is a member of the NOVO National Council of Leaders in Breast Aesthetics. He has served as a consultant for both Mentor (J&J) and Inamed (Allergan), leading breast implant manufacturers.

He has lectured internationally on the subject of breast surgery and has been selected among the Castle Connolly (U.S. News & World Report) America’s Top Doctors. More information is available at or or call (954) 351-2200.

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