The History and Development of the Breast Implant

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The History and Development of the Breast Implant
By: D. Robert Wiemer, M.D.

The breast implant as we know it today is the culmination of many years of experimental trial and error using many products, often of dubious merit. In the early part of the century cosmetic surgery was in its infancy and was certainly not done openly. These operations were considered dangerous and sacrilegious and no self-respecting surgeon would consider attempting such a procedure nor would a journal publish them. As they were often done by less than qualified and respected individuals, reports are scanty on these early procedures and the materials used; such was the social climate at that time. Even after the development of the American Association of Plastic Surgery (1921) and later the American Society of Plastic and Reconstructive Surgery (1931) there was reluctance to publish articles on cosmetic subjects which persisted even after plastic surgeons developed their own journal, Plastic and Reconstructive Surgery, in 1946. This was the primary reason that the American Society of Aesthetic Plastic Surgery was formed in 1967.

The first report of augmentation of the breast was by paraffin injection in 1889. Other attempts were made to augment the breast with a variety of materials from ivory to waxes and other injectables during the early part of the century. Tissue augmentation of the breasts came later in the 1950’s and then was only occasionally done with de-epitheliazed abdominal flaps turned under the breast. Others attempted augmentation via the implantation of large amounts of totally free fat and dermis which were inevitably only partially successful with large amounts of fat necrosis. If these did not result in extrusion or chronic drainage, they certainly resulted in hard, calcified masses in the breast. The first implant approaching something that we use today was probably developed by Pangman in California in the late1930’s. He recognized that a sponge had the potential to represent the softness of the breast and implanted a series of Ivalon (polyether) sponges which was only reported obscurely as a case report from a conference in 1951. It is known that these also became hard in time from excessive tissue in-growth. He also recognized this and attempted to prevent this in-growth by implanting a number with their original cellophane or polyethylene packaging wrapper in place! Though these all became hard eventually, at least some remained in place for years and I am aware of a pair being removed for late infection after 1990! A variety of sponge types and coated sponges were implanted during this period. In the late 1950’s and into the 1960’s, the injection of liquid silicones was carried out by some medical as well as lay operators using a variety of medical grade to industrial silicones with unknown contaminants.

The first implant as we know it today was the “Eureka” event of Dr. Frank Gerow of Houston. As a resident in the early 1960’s, while handling a plastic bag of IV fluid, it dawned on him that a fluid filled bag might well be the solution to the tissue in-growth problem and subsequently in conjunction with Dr. Thomas Cronin and Dow Corning developed the silicone gel-filled silastic bag which was first used in 1963 and reported in 1964. Though there have been modifications, the implants that we use today are essentially the same.

This initial implant was rather thick walled and filled with a very cohesive gel. Believing that this implant might shift around on the chest wall and develop an abnormal position, fixation of the implant to the chest wall was considered important and the initial implants had a large woven Dacron patch over most of the back which resembled loops on Velcro. These implants were a great leap forward compared to the materials used previously but th