Breast Implants

Excerpt

Breast augmentation and reconstruction with implants remain among the top 5 surgical procedures performed by plastic and cosmetic surgeons worldwide. The evolution of breast enhancement has been marked by continuous innovation and refinement since 1895, when Vincenz Czerny first attempted fat transfer for breast reconstruction. Early efforts using paraffin injections, glass balls, ivory, and synthetic sponges often led to complications such as contracture, infection, and skin erosion. The discovery of silicone in the mid-twentieth century brought new promise, though direct silicone injections were also fraught with adverse outcomes. Modern breast implant surgery was revolutionized in 1962 when Dr Thomas Cronin and Dow Corning introduced the first silicone gel-filled implant, marking the beginning of contemporary prosthetic breast surgery. Over subsequent decades, improvements in implant design—including eliminating fixation points, developing cohesive gel, and reducing “gel bleed”—have enhanced durability and safety.

Saline implants, introduced in 1968, gained popularity during the 1990s when silicone implants faced a United States Food and Drug Administration (FDA) moratorium following public concern over potential autoimmune risks—claims later refuted by the Institute of Medicine’s 2000 review, which found no causal link between implants and systemic disease. Continued innovation led to more cohesive silicone gels and the introduction of various surface textures and shapes. Textured implants, once believed to reduce capsular contracture, were later implicated in breast implant–associated anaplastic large cell lymphoma (BIA-ALCL), leading to the withdrawal of Biocell textured devices from the market. Smooth, round implants have since become the standard due to their safety profile and equivalent aesthetic outcomes. More recently, the emergence of breast implant illness has sparked renewed scientific inquiry, though current evidence does not demonstrate a statistically significant association between implants and systemic symptoms.

Today, breast implant technology is highly advanced, with FDA-approved manufacturers such as Mentor, Natrelle (Allergan), Sientra, and Motiva offering implants with improved safety, longevity, and warranties. Nevertheless, implants are not lifelong devices; patients should anticipate future revision or replacement. For clinicians, understanding the historical context, material science, surgical techniques, and evolving safety considerations surrounding breast implants is essential for providing evidence-based, patient-centered care. This review aims to provide a comprehensive, professional-level examination of breast implant evaluation, complications, diagnostic strategies, and multidisciplinary management—equipping healthcare professionals with the knowledge necessary to enhance clinical decision-making, optimize outcomes, and ensure patient safety in implant-based breast surgery.