Breast augmentation (also breast enlargement) is a plastic surgery procedure by which either a breast implant or a fat-graft implant is emplaced to the thorax to increase the size of the breasts in order to correct congenital defects of the breast and of the chest wall. Consequently, after the breast-enlargement surgery, the symmetrical breast hemisphere is of proportionate size, has a smooth contour, and is anatomically consistent with the woman's body.
Three therapeutic purposes require the emplacement of a prosthetic breast: (i) primary reconstruction surgery of the chest and breast tissues damaged by breast cancer, blunt trauma, penetrating trauma, and blast injury; and of developmental defects of the thoracic anatomy, e.g. the tuberous breast deformity; (ii) the surgical revision and reconstruction of chest-and-breast-tissue complications arisen from a previous mammoplasty; and (iii) primary augmentation to surgically enhance the aesthetics of the bust and the breasts.
To augment the volume of the breast hemisphere, a prosthetic breast (saline or silicone) establishes the initial spherical augmentation of the breast for contouring by the plastic surgeon. To augment the volume of the breast hemisphere with autologous adipocyte tissue, the surgeon injects the woman's refined body-fat into the skin envelope to correct contour defects of the breast hemisphere. A fat-graft breast augmentation yields a breast-size increase is of modest volume, usually one brassière cup-size, consequent to the body's usual resorbtion of most of the autologous fat-graft.Cell-assisted Lipotransfer for Cosmetic Breast Augmentation: Supportive Use of Adipose-Derived Stem/Stromal Cells (2007)
Breast-augmentation prostheses
Background history The four types of breast-implant prostheses available for surgical breast reconstruction, breast augmentation, and the aesthetic enhancement (size, shape, texture) of the breasts of a woman are:
Saline breast prosthesis filled with sterile saline solution. Silicone breast prosthesis filled with viscous silicone gel. Alternative-composition breast prosthesis filled with various fillers (soy oil, polypropylene string); now discontinued. Structured breast prosthesis constructed of nested shells, made of elastomer silicone, with saline solution filling the space between the silicone shells; now discontinued.
Saline breast prosthesis The first commercial model of a breast prosthesis filled with saline solution was made by Laboratoires Arion of France, which they publicly presented as a prosthetic medical device in 1964. The modern models of prosthetic breasts filled saline-solution are made with vulcanized shells composed of a silicone elastomer of great elasticity, like that of the skin and tissues of a woman's breast. In an augmentation mammoplasty to emplace a saline breast-prosthesis, the plastic surgeon employs a short incision to the chest wall, through that incision the surgeon then inserts the collapsed, empty prosthetic breast into the breast-implant socket, then fills the implanted breast prosthesis with saline solution. The surgeon then contours the implanted prosthetic breast for anatomical symmetry, and afterwards sutures shut the insertion incision.
Functionally, the implantation of a saline breast-prosthesis yields good-to-excellent results of increased breast-size, a smoother contour for the breast hemisphere, and anatomic symmetry; however, such a breast augmentation might ripple and wrinkle the skin envelope of the breast, cosmetic defects that make noticeable the presence of the prosthetic breast to the eye and to the touch. Such cosmetic defects of the breast surgery usually occur among women with a small volume of adipose tissue in their breast hemispheres. In a woman with much breast tissue, for whom submuscular emplacement is the recommended surgical therapy, the aesthetic results of a saline breast-prosthesis are a proportionate breast-size, a smooth contour to the breast hemisphere, and anatomic symmetry, like the therapeutic results achieved with a prosthetic breast filled with silicone-gel.
Silicone-gel breast prosthesis The first commercial model of a prosthetic breast filled with a type of silicone gel was invented in 1961, by the American plastic surgeons Frank Gerow and Thomas Cronin, manufactured by the Dow Corning Corporation, and in 1962 was the first silicone-gel prosthetic breast used for augmentation mammoplasty. The medical-device technology of the silicone-gel prosthetic breast is in five model generations.
First generation The Cronin–Gerow prosthetic breast, Model 1963, was in the shape of a teardrop, made as a silicone rubber envelope-sack filled with a viscous silicone-gel. In surgical practise, to reduce the possible rotation of the prosthetic breast already emplaced in the implant socket in the chest, the Model 1963 breast prosthesis was held in place in the implant-socket with a fastener-patch of Dacron material (polyethylene terephthalate) that was attached to the back of the breast-prosthesis shell.
Second generation In the 1970s, the first technology was a model of prosthetic-breast with a shell of thin-gauge material and a filler-gel of low-cohesion silicone, which materials improved anatomic function and symmetry (size, appearance, texture) after contouring by the surgeon. In practise, second-generation breast prostheses proved fragile, with greater rates of shell-rupture and filler-leakage. The increased rates-of-incidence of capsular contracture consequently resulted in faulty-product class action-lawsuits by the U.S. government against the manufacturers of thin-gauge-shell breast prostheses.
The second technology was a prosthetic breast with a polyurethane foam coating that reduced the rate of incidence of capsular contracture by causing an inflammatory reaction within the implant-socket in order to impede the formation of a capsule of fibrous collagen tissue around the prosthetic breast. In the event, the use of prosthetic breasts coated with polyurethane was discontinued in the U.S. because of the health risk posed by the carcinogenic chemical 2,4-toluene diamine (TDA), a by-product of the chemical breakdown of the polyurethane coating the prosthetic breast. Ultimately, prosthetic breasts coated with polyurethane remain in use in Europe and in South America.
The third technology for breast surgery was the double-lumen prosthetic breast, which featured a lumen (a breast prosthesis filled with silicone-gel) contained within a larger lumen (a breast prosthesis filled with saline-solution). The two-fold purpose of the double-lumen technology was: (i) the aesthetic benefits of silicone gel (contained in the inner lumen) that is enclosed within the outer lumen, which is filled with saline solution; and (ii) a breast prosthesis whose volume is post-operatively adjustable. In surgical practise, the double-lumen prosthetic breast is used primarily in reconstructive surgery of the breasts.
Third and fourth generations In the 1980s, the third and fourth generations of breast prostheses featured shells coated with an elastomer that decreased gel bleed (filler leakage) into the thorax of the woman, which was achieved with thick filler-gels of various viscosities for the different models of prosthetic breast. The designs of the models of breast prostheses are anatomically symmetrical, in accordance with the body type of the woman. The shaped models realistically reproduce the types of breast hemispheres for the corresponding body-types of women. The tapered models of breast prosthesis feature a uniformly textured surface that produces friction to limit the rotation of the breast prosthesis within the implant-socket. Moreover, the round models of breast prosthesis are available in textured-surface models and in smooth-surface models, for when the prosthetic breast is not expected to rotate within the implant-socket.
Fifth generation In the 1990s, the fifth generation of silicone-gel breast prosthesis contained a semi-solid silicone-gel with a viscosity that reduced the occurrence of filler leakage and the occurrence of the filler migration throughout the woman's body of any silicone-filler that leaked from the implant-pocket. The plastic surgery studies Experience with Anatomical, Soft Cohesive Silicone-gel Prosthesis in Cosmetic and Reconstructive Breast Implant Surgery (2004) and Cohesive Silicone-gel Breast Implants in Aesthetic and Reconstructive Breast Surgery (2005) reported lower incidence-rates of capsular contracture and lower incidence-rates of shell rupture, and rates of medical safety and technical efficacy greater than the rates of safety and efficacy of early-generation prosthetic breasts.
Alternative-composition breast prosthesis The third category of prosthetic breast includes alternative-composition breast prostheses that featured fillers such as soy oil, polypropylene string, ox cartilage, Terylene wool, ground rubber, silastic rubber, and Teflon-silicone, which are substances harmful to the woman's body.
Structured breast prosthesis The fourth category of prosthetic-breast technology is the structured breast-prosthesis, which was approved for breast surgery by the Food and Drug Administration in the U.S. and by Health Canada in Canada in 2014. As a medical device, the structured prosthetic-breast incorporates the technologies of saline-solution and of silicone-gel to achieve anatomical function and aesthetic symmetry. Technologically, the internal structure of the breast prosthesis is composed of three, nested shells (made of silicone rubber) that support the upper half of the breast hemisphere; the two spaces between the three nested shells is filled with saline solution. To implant a structured breast prosthesis, the plastic surgeon emplaces the folded, empty prosthetic breast into the implant-socket, then fills the prosthetic breast with saline solution, and afterwards sutures shut the insertion incision.
Breastfeeding and the prosthetic breast The breasts of a woman are apocrine glands that produce breastmilk with which to feed an infant child.Tortora, Gerard J. Introduction to the Human Body, Fifth Edition. John Wiley & Sons, Inc.: New York, 2001. p. 560. A woman with implanted prosthetic breasts can breastfeed an infant, yet the breast implants can interfere with the breastfeeding function, especially in the case of a woman whose breast augmentation surgery accidentally cut into the nipple-areola complex (NAC) and might either have damaged the lactiferous ducts or damaged the nerves that serve the nipple-areola complex.
The breast augmentation procedures realised by way of IMF augmentation (through the inframammary fold), of the TABA augmentation via the armpit (trans-axillary breast augmentation), and of the TUBA augmentation via the navel (trans-umbilical breast augmentation) avoid the nipple-areola complex in order to preserve the tactile sensitivity of the areola and the breastfeeding functions. Moreover, two conditions most affect and interfere with the functioning of the lactiferous ducts: (i) the subglandular implantation of the prosthetic breast, and (ii) the implantation of oversized prosthetic-breasts. Therefore, the implantation of small prosthetic breasts and a submuscular implant-pocket are the breast-augmentation surgeries that least thwart the breastfeeding function.Breastfeeding after Breast Surgery , La Leche League (2009-09-05).Breastfeeding and Breast Implants , Selected Bibliography April 2003, LLLI Center for Breastfeeding Information.Beam, Christopher (2009-12-11). Inorganic Milk: Can Kendra Wilkinson breast-feed her baby even though she has implants? , Slate.com.
Breast-filler toxicity