A History of Breast Augmentation

Some of the earliest attempts to surgically modify the breasts can be traced back to the 1880s, when any number of materials, such as glass, rubber, and ivory were inserted into the breasts. Fat grafting was another early method of breast augmentation that was relatively less harmful, wherein fat was harvested from other areas of the body and injected into the breasts.Unfortunately, problems with reabsorption made the technique largely ineffective. By the 1940s, paraffin, petroleum jellies, and later silicone fluid, both industrial and medical-grade, were injected directly into the breasts, mostly by unlicensed practitioners. Unsurprisingly, these methods of breast modification led to numerous complications, pulmonary embolism, disfigurement,  and even death.

Fortunately, breast augmentation procedures have been greatly improved over the course of the 20th and 21st centuries.

A History of Breast Augmentation

Modern Breast Augmentation Techniques

First-Generation Implants

Thick shells, low rupture rate, but lead to capsular contracture

The history of modern breast augmentation begins in the early 1960s, with the introduction by the Dow Corning Corporation of the first silicone-gel implant, which was used for the first modern breast augmentation (performed in 1962). The first silicone implants had thick shells and were tear-drop shaped, with seams and a smooth surface, and their rupture rates were very low. Unfortunately, the thick shells contributed to complications such as capsular contracture, and seepage of the firm silicone gel contained in the implants was likely a significant issue. The earliest silicone implants also included a fastener patch designed to attach to the rear of the breast cavity in order to reduce implant rotation. Meanwhile, across the Atlantic, a French company called Laboratoires Arion developed the first saline implants in 1964, for use as a medical prosthetic device.

Second-Generation Implants

Seamless implants, low-cohesion silicone, reduced capsular contracture

By the late 1960s and early 1970s, a new “generation” of implants had been introduced. These implants were generally seamless and much thinner than the previous generation, and contained a low-cohesion silicone gel. Unfortunately, while these second-generation implants were touted as an aesthetic and functional improvement, they turned out to be much more fragile than their predecessors, and rupture rates were high, as well as fluid “bleeding” through the intact membrane. Another technological advancement of the second generation of breast implants was a polyurethane coating that greatly reduced the incidence of capsular contracture. However, fears arose around its potentially carcinogenic properties as the polyurethane disintegrated in the body, and it has since been pulled from North American markets. Some second generation implant models were also “double lumen,” and were essentially composed of a silicone implant contained within a saline implant, in an attempt to get the aesthetic benefits of silicone with an adjustable coating of “safe” saline solution. Unfortunately, in practice, the double lumen implants suffered high device failure rates.

Third-Generation Implants

Lower Contracture, Deflation, Bleed, and Rupture Rates.

The popularity of breast implants for cosmetic purposes really took off in the 1980s, when a number of technological advances improved the safety, functionality, and aesthetic appeal of implants. This next generation of implants included elastomer-coated shells that significantly reduced problems with gel bleeding, and higher-cohesion silicone gels were developed. “Anatomic” models that more closely resembled a “natural” breast shape were also introduced at this time. In addition, implants became available with textured surfaces, which helped to hold the implant tightly in the breast cavity and reduce rotation. The textured surface was also speculated to reduce rates of capsular contracture because it stimulated an inflammatory response, although there is little evidence to support that this is a long-term benefit. Nonetheless, the third generation of implants generally found lower contracture, deflation, bleed, and rupture rates.

FDA Regulation of Silicone Breast Implants

In 1992, the United States Food and Drug Administration (FDA) introduced a moratorium on the sale of silicone implants, because of fears that they led to a number of immune diseases such as lupus and rheumatoid arthritis. At this time, saline implants became the only option for women seeking breast augmentations in the United States, virtually replacing silicone gel implants. The FDA lifted its restrictions on silicone implants in 2006, after it was sufficiently demonstrated that the rates of immune diseases were not higher in women with implants than without.

Today, women are offered a choice between saline and silicone implants. The newest generation of silicone implants features a highly cohesive gel, which is semi-solid, retaining its shape in case of shell rupture and making for fewer complications related to silicone leakage. The newest generation of implants have come a long way from their predecessors in terms of medical safety and efficacy, and breast augmentation today is a relatively safe, effective, and an incredibly popular cosmetic procedure.