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In 1895, the first breast augmentation was performed by Czerny who transplanted a benign fat mass, known as a lipoma, into a position underneath the breast gland in a woman desiring augmentation. Other such transplants, or fat grafts, were subsequently performed. However, the results were unpredictable and the appearance was poor. Complications such as the fat dying, chronic, draining wounds as well as the fat masses being absorbed by the body plagued these initial attempts and they fell by the wayside.
The first attempt at breast augmentation with foreign materials was made shortly after Czerny tried his fat transplant. In 1899, paraffin wax was injected into the breast with disastrous results. Persistent swelling and inflammation, death of tissue (necrosis), chronic draining wounds and, most notably, blindness resulted. The insertion of glass balls followed in the 1930s and polyvinyl alcohol sponges in the 1950s. Glass balls broke and the sponges degraded, causing breasts to become hard, distorted and painful. In the early 1960s, liquid silicone was first injected into the breast, with the same disastrous results of paraffin wax injections. Note that this is still done in some parts of the world. Please DO NOT consider this a viable means of breast augmentation!
The Invention of the Breast Implant
The first silicone breast implant was introduced in 1962 and was offered by Dow Corning in the open market in 1963. It consisted of a thick silicone rubber shell with a thick, viscous gel filler. It was extremely well made and almost indestructible – breakage was almost unheard of. However, because the shells were so thick, these implants were very prone to high rates of thick, tough scar formation around the implant known as capsular contracture. The capsule around these implant would often shrink, deforming the implant, causing a considerable amount of pain. These types of implants, known as the First Generation Implants, were in use from 1963 to 1972.
The Second Generation Breast Implant was introduced in 1972 in an effort to reduce the rate of capsular contracture and continued in production up until 1987. Shells were thinner and the gels less viscous or thick to give the implant a much more natural feel. Texturing of the breast implant surface was also introduced in the mid 1980s to help reduce contracture. The rates of capsular contracture decreased dramatically, but the shells were too thin and the rupture rate increased significantly. Studies showed that 90% of the implants ruptured at 10 years after implantation.
A happy medium was struck and the Third Generation of breast implant was developed in 1988 and is still in use today. The silicone shell is thicker and much stronger. It is often made of three or four layers of silicone elastomer to reduce rupture rates and prevent silicone from leaking out. Breast implant failure rates have significantly decreased and the problems of the earlier generations appear to have been solved. A very recent study has shown that rupture rates are as low as 1.1% in patients after 6 years of implantation. As well, shell technology has improved so that the amount of inflammation around the implants is less and the capsules appear to be thinner, thus reducing the potential for capsular contracture.
The Modern Breast Implant
Over the last ten years, the gel filling in silicone breast implants has improved to a new cohesive gel filling. This type of filling remains intact and is much less likely to leak out even if the implant breaks. Unlike older gel implants, which contain a thick, syrup-like gel, a cohesive gel implant contains a filler similar to that of Jell-O or a gummy bear. Thus, the filler in a cohesive gel implant is much less likely to ooze out in a sticky mess and retain its shape, even if ruptured. This offers obvious advantages, the most prominent being that if these implants are ruptured, they may go years before actually needing to be replaced. These are the types of breast implants most commonly used in breast augmentation today.