Cosmetic & Plastic Surgery Reference Articles – Breast Augmentation
Historical Perspective and Current Status
By: Randall Weil, M.D.
The evolution of breast augmentation has been a fascinating one, to be sure.
In the ’50s and ’60s the saline (salt water) filled implant was basically all that was available.
The implant shell was silicone elastomer, the same as it is today.
Over the years, soft silicone gel fill was introduced as an option to saline fill. For many years, the single lumen implant (with just silicone gel) or the double lumen implant (inner silicone, outer saline) were tremendously popular.
The early ’90s saw the removal of silicone as the filler due mainly to concerns over leakage (“bleed”) and autoimmune disease. Over the past 10 years, hundreds if not thousands of scientific articles have repeatedly demonstrated the safety of the silicone implant. Today this material is offered to women who need reconstruction after mastectomy and for women who desire breast lifting (mastopexy).
In all likelihood, within the next 18-24 months all women will once again be given the option of silicone gel filled breast implants.
Why silicone and all?
There are many superb plastic surgeons that only use saline as the filler and consistently get beautiful, soft, movable breasts. Yet many plastic surgeons still are convinced that women’s breasts are softer and feel more “natural” with silicone gel filled breast implants. Another issue is that of rippling (being able to actually see the ripples of the bag against the skin). This problem may happen with very thin individuals who have very little breast tissue to cushion the bag against the skin. Most surgeons agree there is less rippling with silicone filled implants.
Breast firmness or “contracture” is another important concern. This is a result of encircling scar tissue about the implants which contracts over a period of months or years resulting in a firm and sometimes misshapen appearance. Even though we are still not totally certain what causes the problem, we do know that it can happen either with silicone or saline implants.
What would I use given the option?
As of today, there still is not an option for primary breast augmentation since saline fill is mandated.
If and when silicone filled implants become available again, all women considering breast augmentation will be informed of the pros and cons of each type of implant. Each woman can then choose based on their specific needs and desires.