History of breast augmentation

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  • Augmentation mammaplasty for cosmetic enlargement was first attempted in the 19th century.
    • In 1895, Czerny transplanted a patient’s lipoma to her breast to fill out a defect caused by removal of an adenoma.

  • In 1904, paraffin injections, often a combination of petroleum jelly and olive oil, were used.
    • This resulted in the formation of hard masses or paraffinomas from foreign body reactions, as well as inflammatory reactions, tissue necrosis, and draining sinus tracts.
    • More serious complications included pulmonary embolism and blindness due to cerebral embolism.

  • Because the early use of paraffin injections for augmentation mammaplasty often had disastrous effects, a search for an alternative substance resulted in the use of liquid silicone injections.
    • These were not well tolerated either and produced silicone granulomas resulting in painful nodularity and inflammation of the breast tissue.
    • Other complications from silicone injections included skin slough, migration of silicone along fascial planes, granulomatous hepatitis, embolism, or death.
    • Silicone injections were never approved by the Food and Drug Administration (FDA) for use in the breast.
    • Mammography continues to be a challenge in these patients, as the numerous opaque masses from the silicone granulomas are difficult to differentiate from other masses.

  • In 1958, polyvinyl alcohol sponge prostheses were cut into the desired shape and surgically placed.
    • The sponge prostheses were subject to organization by host fibrous tissue, causing shrinkage and undesirable change in the texture of the prostheses.

  • Another prosthetic material used during this time was polyethylene tapes, which were cut by a machine, wound into a ball, and then placed into the breast.

  • In 1962, Cronin and Gerow developed the silicone gel prosthesis. The gel is contained in a shell.

  • Various coatings of the surrounding shell, saline-filled implants, and combinations of saline and silicone-filled implants

were developed over the years.

  • Since April 1992, only the saline-filled implant are available for aesthetic breast augmentation.

  • Limited access to silicone implants is currently permitted by the FDA for women with temporary expanders who are waiting for permanent reconstructive surgery, patients undergoing reconstructive surgery at the time of mastectomy, and women with ruptuned silicone gel implants that need to be replaced.

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