Photo: Sheyla Hershey, 30 years old, Brazilian model living in Houston, Texas, is known for her huge breast implants. After 8 surgeries, she had a recorded breast size of 34FFF in May 2008, and by the end of January 2009, after another operation, she was reported to be a size 38KKK.
According to the American Society of Plastic Surgeons, breast augmentation is the most commonly performed cosmetic surgical procedure in USA. It is also known by names such as breast implants, breast enlargement, mammoplasty, or the common slang term, boob job, and it is a prosthesis used to alter the size and shape of a woman's breasts, mostly, for cosmetic reasons.
Breast implants have been used since the late nineteenth century, the earliest known implant being attempted by an Austrian-German surgeon Vincenz Czerny (1842-1916), using a woman's own adipose tissue. Since then a variety of materials have been tried by surgeons as breast implants, such as paraffin injections, ivory, glass balls, ground rubber, ox cartilage, Terylene wool, gutta-percha, Dicora, polyethylene chips, Ivalon, polyether sponge (Etheron), polyethylene tape (Polystan), polyurethane sponge, Silastic rubber, teflon-silicone prostheses, and silicone injections. In recent times, various creams and medications have also been used in attempts to increase bust size of women.
Saline-filled and silicone-gel-filled implants are the two primary types of breast implants. Saline implants have a silicone elastomer shell filled with sterile saline liquid. Silicone gel implants have a silicone shell filled with a viscous silicone gel.
Saline-filled breast implants were first manufactured in France in 1964. Currently available saline implants are manufactured with thicker vulcanized shells made of silicone elastomer and the implants are filled with saline (salt water). Since the implants are empty when they are surgically inserted, the scar is smaller than is necessary for silicone gel breast implants.
Saline implants were the most common implants used in USA during the 1990s. Though results were good, compared to silicone gel implants, saline implants are more likely to cause cosmetic problems such as rippling, wrinkling, and can be visible or felt by touch. For women with very little breast tissues and for post-mastectomy breast reconstruction, silicone gel implants are considered as superior.
Two plastic surgeons, Thomas Cronin and Frank Gerow of Houston (Texas) developed the first silicone breast prosthesis in 1961 and the first woman was implanted in 1962. Since then silicone implants have undergone many improvements to reach the present levels of perfection, and the developmental stages are generally described in terms of five generations based on manufacturing techniques.
The fifth generation breast implants mark the evolution of ‘gummy bear’ or solid, high-cohesive and form-stable implants, widely used in the United States since the mid 1990s, and in other countries. The semi-solid gel in these types of implants eliminates the possibility of silicone migration. These implants have shown significant improvements in safety over the older implants.
The surgical procedure for breast augmentation takes about one to two hours. Variations in procedures are due to the incision types, implant materials, and implant pocket placements. After a breast augmentation procedure, generally women can resume normal activity in about a week. Women who have their implants placed underneath the muscle (submuscular placement) will generally have a longer recovery time. Exercise and strenuous physical activity may need to be avoided for up to six weeks. Scars from a breast augmentation surgery will last for six weeks or longer and begin to fade away a few months after surgery.
Breast implants, whether for cosmetic or reconstructive purposes, carry risks common to other types of surgery, including reactions to anesthesia, infections, change in sensation, bleeding, scars, interference with breast feeding, wrinkling, asymmetry of breasts and thinning of the breast tissues. Breast implants can remain intact for decades in the body without rupture.
Women with implants can breastfeed babies. Implants may cause difficulties in nursing, and some procedures such as periareolar incisions and sub-glandular placements can cause greater difficulties. For this reason, a woman in her childbearing years is advised to discuss breastfeeding and other health implications with a well-qualified plastic surgeon before surgery. Other plastic surgeries such as breast lifts or nipple surgery may also cause difficulties, while breast reduction surgery is more likely to cause nursing difficulties, due to removal of breast tissues.
Surveys on the mental health and quality of life of women who underwent breast implants showed improvements on physical health, social life, self confidence, self esteem, physical appearance and better sex life, though these improvements may be transitory. Most women surveyed were satisfied in the long run with their implants.
Since the early 1990s, dozens of systemic reviews have been commissioned by various agencies to examine the alleged links between silicone gel breast implants and systemic diseases. A clear consensus has emerged from these independent scientific reviews in countries such as UK, USA, France, Australia, Germany and Spain that there is no clear evidence of a link between silicone implants and connective tissue diseases.
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