Latest Advances in Breast Augmentation

Breast augmentation has been available for 50 years. During that time, we have seen a number of changes- some for the better and some decidedly for the worst.

Regarding breast augmentation using implants, undoubtedly the biggest advance was the discovery in 1979 that, instead of placing the implant behind the breast, you could place the implant deeper behind the pectoral muscle and still have a natural looking breast. The great advantage of placing an implant behind the muscle was that it essentially solved the problem of capsule contracture. This is a condition where the body forms scar tissue around the implant causing the breasts to feel hard. In the early days of breast augmentation, when implants were placed in front of the muscle, almost every implant developed capsule contracture which then had to be treated by methods such as closed capsulotomy (where the breast was forcibly squeezed resulting in the scar capsule rupturing and the breasts becoming soft), or open capsulotomy where the capsule was divided in a surgical operation.

Placing the implants behind the muscle made the complication of capsule contracture extremely rare and so resulted in softer more natural appearing breasts.

There has been a lot of competition amongst implant manufacturers to produce the “best implant”. This resulted in the development of implants with a textured rather than a smooth surface. The texturing was supposed to enable the implant to attach to the tissues and therefore prevent capsule contracture. It was therefore initially proposed only for implants that were being placed in front of the muscle as capsule contracture was not really a problem with implants placed behind the muscle. With time however surgeons began to use textured implants both in front of and behind the muscle. It is now known that these textured implants, due to their sandpaper-like surfaces, can actually irritate the tissues causing inflammation which can lead to the symptoms we now associated with Breast Implant Associated Illness. Rarely this can also progress to a condition known as Anaplastic Large Cell Lymphoma. This has resulted in textured implants, except those with the finest of textures, being removed from sale.

We are now left with implants with a smooth surface and implants with minimal texturing that are known not to cause any tissue irritation. These minimally textured implants do not attach to the tissues and therefore behave essentially in the same way as smooth-walled implants. Many surgeons feel that they offer no advantage despite their higher cost.
Smooth-walled implants have the advantage of being slightly mobile and this can often translate as a softer more natural breast.

Breast implants can be filled either with saline or silicone gel. It is usually impossible to tell the difference in softness or “feel” between saline and silicone implants, so long as they are placed behind the muscle. Saline implants have the additional safety benefit that, in the event of leakage, it is only saline that is released in the tissues and this is rapidly and safely absorbed. Silicone implants, on the other hand, when they leak, release silicone gel which can be problematic.

The latest advance in breast augmentation has been the introduction of Autologous Breast Augmentation. This refers to using your own tissue rather than implants. There are two methods available. The first is to do a breast lift, which rearranges your breast tissue to transform sag into projection. The second is to transfer fat from one area of the body to another for the purposes of tissue augmentation. Specific techniques are now available which enable transfer or relatively large volumes of fat from areas of the body such as the thighs or abdomen into the breast. Usually at least a 1 cup size increase can be obtained. If the fat is strategically placed in areas such as the cleavage, then a significant improvement in appearance is gained without the risks associated with breast implants.

Of course, not all surgeons are experienced in all methods of breast augmentation and all will have their favourite method. But with our current knowledge it makes sense to have an Autologous Breast Augmentation if possible and to supplement this with a small smooth-walled implant placed behind the muscle if additional volume is required.