Breast Augmentation – An Expert’s Perspective

The complexities of breast augmentation including choice of implant, access incisions, anesthesia, subglandular, submuscular or dual plane implant placement need not be further belabored. Our expert surgeons’ personal preferences and biases are based on their training, experience, and in general – what has been working well in their hands. Once again, as with many other aesthetic surgical operations, there is more than one way to achieve a great result.

An aesthetically pleasing breast size and shape, including nipple characteristics and position, has been historically idealized across all cultures.

Interventions aimed at enlarging breast size range from injections of paraffin, other oils, silicone and many other substances unfortunately have been and still are being practiced today with catastrophic outcomes, at times present only years later.

A Brief Breast Augmentation History

The first recorded surgical augmentation was that of Czerny of Heidelberg, Germany in 1895, who transferred a large lipoma from the buttock of an actress to her breast to treat breast asymmetry. The first report on silicone implants was from Cronin and Gerow in the early 1960’s, marking the beginning of a procedure which has remained one of the foremost commonly carried out operations, statistically now for more than 15 years according to the American Society for Aesthetic Plastic Surgery’s annual procedural statistics. A temporary dip in the popularity of implant breast enlargement, fueled in no small measure by the press and subsequently by the “ambulance chasing” tactics of trial attorneys, occurred after a television news report by Ms. Connie Chung in December, 1990. Not based on any solid scientific proof, ultimately in 1992, the FDA removed from the market, the use of silicone filled breast implants for the purpose of aesthetic breast augmentation. In spite of much confirmatory evidence of the safety of these devices, to date silicone breast implants remain a politically, financially and emotionally charged issue, which is not expected to be resolved in the near future. While hundreds of thousands of women have overwhelmingly positive experiences with improvement of their body image, self confidence and sexuality resulting from breast augmentation, some have unfortunately become victimized by fear and concern. Breast augmentation, as any aesthetic operation, is associated with potential risks and side effects not to be ignored. The fact remains that a foreign body is inserted and as the experts repeatedly recommended in this chapter, long term follow up is wise.

Breast Augmentation Safety

Initially, it may seem attractive to undergo the procedure in a “plastic surgery mill” for cost saving reasons. In the long term, the extra expense afforded by quality preoperative evaluation, implant selection, surgical intervention and postoperative care all in a patient individualized and customized manner is expense very wisely spent.

On the positive side of the coin, the breast implant safety debate and the compulsory use of saline devices has fueled much laboratory and clinical research in breast augmentation. As a result, we now know a lot more about breast implants and how to best use them, as well as about postoperative mammographic imaging. Good scientific research for better yet implant designs and filler materials continues relentlessly with a few on the horizon, the use of which hopefully will not be unduly delayed by government or regulatory issues.

Patient’s own fat injection for breast augmentation condemned for almost two decades primarily for reasons of false positive mammography is also now being revisited. Advances in mammographic techniques and in our ability to transfer fat with a better chance for long term survival has led some of us to take a fresh look at this method. To proceed with this deliberately and incrementally is of the essence, otherwise this approach with otherwise many potential advantages could readily fall into the wrong hands with disastrous consequences.

At any rate, breast augmentation is a worthwhile aesthetic surgical option for patients to diligently evaluate. A good understanding of the intricacies involved is a major step forward toward a happy outcome from this very popular operation.

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