Breast augmentation - AbsoluteAstronomy.com

Breast augmentation denotes the breast implant and fat-graft

Fat transfer

Fat transfer is a medical procedure that uses the patient`s own fat tissue to increase the volume of fat in the subcutaneous area of the body. Autologous adipose tissue transplantation has been used for breast augmentation for cosmetic reasons and after breast cancer surgery...

mammoplasty

Mammoplasty

Mammoplasty or mammaplasty can refer to the surgical procedure to insert cheek implants or augmentation mammoplasty, an enlarging of the breasts via implants...

procedures for correcting the defects, and for enhancing the size, form, and feel of a woman’s breast

Breast

The breast is the upper ventral region of the torso of a primate, in left and right sides, which in a female contains the mammary gland that secretes milk used to feed infants.Both men and women develop breasts from the same embryological tissues...

s. The surgical implantation approach effects global breast augmentation using either a saline-filled or a silicone-filled prosthetic breast; and it might also consist of corrections effected with transplanted skin flaps. The fat-transfer approach effects the augmentation, and corrects the contour defects of the breast hemisphere with grafts of autologous adipocyte fat tissue

Adipose tissue

In histology, adipose tissue or body fat or fat depot or just fat is loose connective tissue composed of adipocytes. It is technically composed of roughly only 80% fat; fat in its solitary state exists in the liver and muscles. Adipose tissue is derived from lipoblasts...

. Each augmentation approach corrects post–mastectomy

Mastectomy

Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women and some men believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer...

defects in a breast reconstruction

Breast reconstruction

Breast reconstruction is the rebuilding of a breast, usually in women. It involves using autologous tissue or prosthetic material to construct a natural-looking breast. Often this includes the reformation of a natural-looking areola and nipple...

procedure; congenital defects and congenital abnormalities

Congenital abnormality

A congenital anomaly is a condition which is present at the time of birth which varies from the standard presentation....

of the chest wall; and aesthetically enhances the natural size, look, and feel of the bust.

In breast reconstruction practice, the tissue expander

Tissue expansion

Tissue expansion is a technique used by plastic and restorative surgeons to cause the body to grow additional skin, bone or other tissues.-Skin expansion:...

is a temporary breast-implant device used to prepare the implant-pocket (recipient site), as part of a staged reconstruction mammoplasty procedure. In non-implant breast augmentation practice, some fat-graft injection approaches feature tissue engineering, which is the pre-operative external tissue expansion of the recipient site. In non-surgical practice, the corrective approaches might consist either of an externally-applied vacuum device, which will expand the tissues of the recipient site, or of oral medications; yet, in most instances, the medium-volume, fat-graft augmentation of the breast is limited to one brassière cup-size, or less.

Breast implants

For breast reconstruction

Breast reconstruction

and for the augmentation and aesthetic enhancement of the size, form, and feel of a woman’s breast

Breast

s, there are three (3) types of breast implant devices:

saline implants filled with sterile saline solution
Saline (medicine)
In medicine, saline is a general term referring to a sterile solution of sodium chloride in water but is only sterile when it is to be placed intravenously, otherwise, a saline solution is a salt water solution...
silicone implants filled with viscous silicone
Silicone
Silicones are inert, synthetic compounds with a variety of forms and uses. Typically heat-resistant and rubber-like, they are used in sealants, adhesives, lubricants, medical applications , cookware, and insulation....

gel
alternative-composition implants, filled with miscellaneous fillers — soy oil, polypropylene string
String breast implant
Polypropylene breast implants, also known as string breast implants, are a form of breast implant using polypropylene developed by Dr. Gerald W. Johnson...

, et cetera — that are no longer manufactured.

I. — Saline breast implant
The saline breast implant, filled with saline solution

Saline (medicine)

In medicine, saline is a general term referring to a sterile solution of sodium chloride in water but is only sterile when it is to be placed intravenously, otherwise, a saline solution is a salt water solution...

(biological-concentration salt water 0.90% w/v

Percentage solution

"Percentage solution" is an ambiguous term which is used to describe a solution with the unit "%". It may refer to:* Mass fraction if mass/mass is meant...

of NaCl

Sodium chloride

Sodium chloride, also known as salt, common salt, table salt or halite, is an inorganic compound with the formula NaCl. Sodium chloride is the salt most responsible for the salinity of the ocean and of the extracellular fluid of many multicellular organisms...

, ca. 300 mOsm/L.), was first manufactured by the Laboratoires Arion company, in France, and was introduced for use as a medical device

Medical device

A medical device is a product which is used for medical purposes in patients, in diagnosis, therapy or surgery . Whereas medicinal products achieve their principal action by pharmacological, metabolic or immunological means. Medical devices act by other means like physical, mechanical, thermal,...

in 1964. The contemporary models of saline breast implant are manufactured with thicker, room-temperature vulcanized

Vulcanization

Vulcanization or vulcanisation is a chemical process for converting rubber or related polymers into more durable materials via the addition of sulfur or other equivalent "curatives." These additives modify the polymer by forming crosslinks between individual polymer chains. Vulcanized material is...

(RTV) shells made of a silicone

Silicone

Silicones are inert, synthetic compounds with a variety of forms and uses. Typically heat-resistant and rubber-like, they are used in sealants, adhesives, lubricants, medical applications , cookware, and insulation....

elastomer

Elastomer

An elastomer is a polymer with the property of viscoelasticity , generally having notably low Young's modulus and high yield strain compared with other materials. The term, which is derived from elastic polymer, is often used interchangeably with the term rubber, although the latter is preferred...

. The study In vitro Deflation of Pre-filled Saline Breast Implants (2006) reported that the rates of deflation (filler leakage) of the pre-filled saline breast implant made it a second choice for corrective breast surgery. Nonetheless, in the 1990s, the saline breast implant was the prosthesis

Medical device

usual for breast augmentation, because of the U.S. FDA importation restriction against silicone breast implants.

The technical goal of saline-implant technology was allowing a surgical technique for emplacing an empty breast-implant device through a smaller surgical incision. In surgical praxis, after having emplaced the empty breast implants into the implant pockets, the plastic surgeon then fills each device with saline solution

Saline (medicine)

, and, because the required insertion incisions are small, the resultant incision-scars will be smaller than the surgical scar usual to the long incision required for inserting pre-filled, silicone-gel implants.

Although the saline breast implant can yield good-to-excellent results of breast size, contour, and feel, when compared to silicone-implant results, the saline implant is likelier to cause cosmetic problems such as rippling, wrinkling, and being noticeable to the eye and to the touch. This is especially true for women with very little breast

Breast

tissue, and for post-mastectomy

Mastectomy

reconstruction patients; thus, silicone-gel implants are the superior prosthetic

Prosthesis

In medicine, a prosthesis, prosthetic, or prosthetic limb is an artificial device extension that replaces a missing body part. It is part of the field of biomechatronics, the science of using mechanical devices with human muscle, skeleton, and nervous systems to assist or enhance motor control...

device for breast augmentation and for breast reconstruction

Breast reconstruction

. In the case of the woman with much breast tissue, for whom submuscular emplacement is the recommended surgical technique, saline breast implants can afford an aesthetic “look” of breast size, contour, and feel, much like that afforded by the silicone implant.

II. — Silicone-gel breast implant
The modern prosthetic breast was invented in 1961, by the American plastic surgeons

Plastic surgery

Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand...

Thomas Cronin and Frank Gerow, and the Dow Corning Corporation; in due course, the first augmentation mammoplasty was performed in 1962. There are five (5) generations of the medical device

Medical device

technology

Technology

Technology is the making, usage, and knowledge of tools, machines, techniques, crafts, systems or methods of organization in order to solve a problem or perform a specific function. It can also refer to the collection of such tools, machinery, and procedures. The word technology comes ;...

of the silicone breast implant, each is defined by common model-manufacturing techniques.

First generation
The Cronin–Gerow Implant, prosthesis model 1963, was a silicone rubber envelope-sac, shaped like a tear-drop, filled with viscous silicone-gel. To reduce the rotation of the emplaced breast-implant upon the chest wall, it was affixed to the implant pocket with a fastener-patch of Dacron material (Polyethylene terephthalate

Polyethylene terephthalate

Polyethylene terephthalate , commonly abbreviated PET, PETE, or the obsolete PETP or PET-P, is a thermoplastic polymer resin of the polyester family and is used in synthetic fibers; beverage, food and other liquid containers; thermoforming applications; and engineering resins often in combination...

) attached to the rear of the breast implant shell.

Second generation
In the 1970s, the first technological development, a thinner device-shell and a thinner, low-cohesion silicone-gel filler, impoved the functionality and verisimilitude (size, look, and feel) of the silicone breast implant. Yet, in clinical practice, the second-generation proved fragile, and suffered greater incidences of shell rupture, and of “silicone gel bleed” (filler leakage through an intact shell). The consequent, increased incidence-rates of medical complications (e.g. capsular contracture

Capsular contracture

Capsular contracture is an abnormal response of the immune system to foreign materials in the human body. Medically, it occurs mostly in context of the complications from breast implants and artificial joint prosthetics....

) precipitated U.S. government faulty-product class action-lawsuits

Class action

In law, a class action, a class suit, or a representative action is a form of lawsuit in which a large group of people collectively bring a claim to court and/or in which a class of defendants is being sued...

against the Dow Corning Corporation, and other manufacturers of prosthetic breast prostheses.

The second technological development was a polyurethane
Polyurethane
A polyurethane is any polymer composed of a chain of organic units joined by carbamate links. Polyurethane polymers are formed through step-growth polymerization, by reacting a monomer with another monomer in the presence of a catalyst.Polyurethanes are...

foam coating for the implant shell; it reduced the incidence of capsular contracture
Capsular contracture
Capsular contracture is an abnormal response of the immune system to foreign materials in the human body. Medically, it occurs mostly in context of the complications from breast implants and artificial joint prosthetics....

by causing an inflammatory reaction
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...

that impeded the formation of a capsule of fibrous collagen
Collagen
Collagen is a group of naturally occurring proteins found in animals, especially in the flesh and connective tissues of mammals. It is the main component of connective tissue, and is the most abundant protein in mammals, making up about 25% to 35% of the whole-body protein content...

tissue around the breast implant. Nevertheless, the medical use of polyurethane-coated breast implants was briefly discontinued because of the potential health-risk posed by 2,4-toluenediamine
TDA
TDA is a three-letter abbreviation that may refer to:* Taking and Driving Away, a former criminal offense under UK law, introduced in S.28 Road Traffic Act 1930, repeated in s.217 of the Road Traffic Act 1960, and with amendments became s.175 Road Traffic Act 1972 and s.178 Road Traffic Act 1988...

(TDA), a carcinogen
Carcinogen
A carcinogen is any substance, radionuclide, or radiation that is an agent directly involved in causing cancer. This may be due to the ability to damage the genome or to the disruption of cellular metabolic processes...

ic by-product of the chemical breakdown of the implant’s polyurethane foam coating. After reviewing the medical data, the U.S. Food and Drug Administration
Food and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...

concluded that TDA-induced breast cancer
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...

was an infinitesimal health-risk to women with breast implants, and did not justify legally requiring physicians to explain the matter to their patients. In the event, polyurethane-coated breast implants remain in plastic surgery practice in Europe and in South America; in the U.S., no breast implant manufacturer has sought the FDA’s approval for American medical sale.

The third technological development was the double lumen breast-implant, a double-cavity device composed of a silicone-implant within a saline-implant. The two-fold, technical goal was: (i) the cosmetic benefits of silicone-gel (the inner lumen) enclosed in saline solution (the outer lumen); (ii) a breast-implant device the volume of which is post-operatively adjustable. Nevertheless, the more complex design of the double-lumen breast-implant suffered a device-failure rate greater than that of single-lumen breast implants. The contemporary versions of Second generation devices, presented in 1984, are the “Becker Expandable” models of breast implant device, used primarily for breast reconstruction
Reconstructive surgery
Reconstructive surgery is, in its broadest sense, the use of surgery to restore the form and function of the body, although Maxillo-Facial Surgeons, Plastic Surgeons and Otolaryngologists do reconstructive surgery on faces after trauma and to reconstruct the head and neck after cancer.Other...

.

Third and Fourth generations
In the 1980s, the models of the Third and of the Fourth generations of breast-implant devices were sequential advances in manufacturing technology, e.g. elastomer

Elastomer

-coated shells that decreased gel-bleed (filler leakage), and a thicker filler (increased-cohesion) gel. Sociologically

Sociology of health and illness

The Sociology of Health and Illness examines the interaction between society and health. The objective of this topic is to see how social life has an impact on morbidity and mortality rate, and vice versa...

, the manufacturers then designed and fabricated varieties of anatomic models (natural breast) and shaped models (round, tapered) that realistically corresponded with the breast and body types presented by women patients. The tapered models of breast implant have a uniformly textured surface, to reduce rotation; the round models of breast implant are available in smooth-surface and textured-surface types.

Fifth generation
Since the mid-1990s, the Fifth generation of silicone breast implant is made of a semi-solid gel that mostly eliminates filler leakage (silicone gel bleed) and silicone migration from the breast to elsewhere in the body. The studies Experience with Anatomical Soft Cohesive Silicone gel Prosthesis in Cosmetic and Reconstructive Breast Implant Surgery (2004) and Cohesive Silicone gel Breast Implants in Aesthetic and Reconstructive Breast Surgery (2005) reported low incidence rates of capsular contracture

Capsular contracture

and of device-shell rupture, improved medical safety and technical efficacy greater than earlier generations of breast implant device.

The patient

Her psychology
The breast augmentation patient usually is a young woman whose personality profile indicates psychological distress about her personal appearance and her body (self image

Self image

A person's self-image is the mental picture, generally of a kind that is quite resistant to change, that depicts not only details that are potentially available to objective investigation by others A person's self-image is the mental picture, generally of a kind that is quite resistant to change,...

), and a history of having endured criticism (teasing) about the aesthetics of her person. The studies Body Image Concerns of Breast Augmentation Patients (2003) and Body Dysmorphic Disorder and Cosmetic Surgery (2006) reported that the woman who underwent breast augmentation surgery also had undergone psychotherapy

Psychotherapy

Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...

, suffered low self-esteem

Self-esteem

Self-esteem is a term in psychology to reflect a person's overall evaluation or appraisal of his or her own worth. Self-esteem encompasses beliefs and emotions such as triumph, despair, pride and shame: some would distinguish how 'the self-concept is what we think about the self; self-esteem, the...

, presented frequent occurrences of psychological depression

Depression (mood)

Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless...

, had attempted suicide

Suicide

Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...

, and suffered body dysmorphia, a type of mental illness. Post-operative patient surveys about mental health and quality-of-life, reported improved physical health, physical appearance, social life, self-confidence, self-esteem, and satisfactory sexual functioning

Sexual attraction

Sexual attractiveness or sex appeal refers to an individual's ability to attract the sexual or erotic interest of another person, and is a factor in sexual selection or mate choice. The attraction can be to the physical or other qualities or traits of a person, or to such qualities in the context...

. Furthermore, most of the women reported long-term satisfaction with their breast implants; some despite having suffered medical complications that required surgical revision, either corrective or aesthetic. Likewise, in Denmark, 8.0 per cent of breast augmentation patients had a pre-operative history of psychiatric hospitalization.

Her mental health
In 2008, the longitudinal study

Longitudinal study

A longitudinal study is a correlational research study that involves repeated observations of the same variables over long periods of time — often many decades. It is a type of observational study. Longitudinal studies are often used in psychology to study developmental trends across the...

Excess Mortality from Suicide and other External Causes of Death Among Women with Cosmetic Breast Implants (2007), reported that women who sought breast implants are almost 3.0 times as likely to commit suicide

Suicide

as are women who have not sought breast implants. Compared to the standard suicide-rate for women of the general populace, the suicide-rate for women with augmented breasts remained alike until 10-years post-implantation, yet it increased to 4.5 times greater at the 11-year mark, and so remained until the 19-year mark, when it increased to 6.0 times greater at 20-years post-implantation. Moreover, additional to the suicide-risk, women with breast implants also faced a trebled death risk from alcoholism

Alcoholism

Alcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing...

and drugs abuse. Although seven (7) studies have statistically connected a woman’s undergoing a breast augmentation procedure to a greater suicide-rate, the research indicates that augmenation surgery does not increase the suicide death-rate; and that, in the first instance, it is the psychopathologically

Psychopathology

Psychopathology is the study of mental illness, mental distress, and abnormal/maladaptive behavior. The term is most commonly used within psychiatry where pathology refers to disease processes...

-inclined woman who is likelier to undergo breast augmentation.

Moreover, the study Effect of Breast Augmentation Mammoplasty on Self-Esteem and Sexuality: A Quantitative Analysis (2007), reported that the women attributed their improved self-esteem, self-image, and increased, satisfactory sexual functioning to having undergone breast augmentation; the cohort, aged 21–57 years, averaged post-operative self-esteem increases ranging from 20.7 to 24.9 points on the 30-point Rosenberg Self-esteem Scale

Rosenberg self esteem scale

The Rosenberg self-esteem scale , developed by Dr. Morris Rosenberg, is a self-esteem measure widely used in social-science research.The RSES is designed similar to social-survey questionnaires. It is a ten-item Likert-type scale with items answered on a four-point scale — from strongly agree...

, which data supported the 78.6 per cent increase in the woman’s libido

Libido

Libido refers to a person's sex drive or desire for sexual activity. The desire for sex is an aspect of a person's sexuality, but varies enormously from one person to another, and it also varies depending on circumstances at a particular time. A person who has extremely frequent or a suddenly...

, relative to her pre-operative level of libido. Therefore, before agreeing to any surgical procedure, the plastic surgeon evaluates and considers the woman’s mental health

Mental health

Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...

to determine if breast implants can positively affect her self-esteem

Self-esteem

and sexual functioning

Sexual attraction

Indications

An augmenation mammoplasty for emplacing breast implants has three (3) therapeutic purposes —

primary reconstruction — to replace breast tissues damaged by trauma
Trauma (medicine)
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

(blunt
Blunt trauma
In medical terminology, blunt trauma, blunt injury, non-penetrating trauma or blunt force trauma refers to a type of physical trauma caused to a body part, either by impact, injury or physical attack; the latter usually being referred to as blunt force trauma...

, penetrating
Penetrating trauma
Penetrating trauma is an injury that occurs when an object pierces the skin and enters a tissue of the body, creating an open wound. In blunt, or non-penetrating trauma, there may be an impact, but the skin is not necessarily broken. The penetrating object may remain in the tissues, come back out...

, blast
Blast injury
A blast injury is a complex type of physical trauma resulting from direct or indirect exposure to an explosion. Blast injuries occur with the detonation of high-order explosives as well as the deflagration of low order explosives...

), disease (breast cancer
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...

), and failed anatomic development (tuberous breast deformity).
revision and reconstruction — to revise (correct) the outcome of a previous breast reconstruction surgery.
primary augmentation — to aesthetically augment the size, form, and feel of the breast
Breast
The breast is the upper ventral region of the torso of a primate, in left and right sides, which in a female contains the mammary gland that secretes milk used to feed infants.Both men and women develop breasts from the same embryological tissues...

s.

The operating room (OR) time of post–mastectomy

Mastectomy

breast reconstruction

Breast reconstruction

, and of breast augmentation surgery is determined by the emplacement procedure employed, the type of incisional technique, the breast implant (type and materials), and the pectoral locale of the implant pocket.

Incision types

The emplacement of a breast implant device is performed with five (5) types of surgical

Surgery

Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

incisions:

Inframammary — an incision made below the breast, in the infra-mammary fold (IMF), which affords maximal access for precise dissection and emplacement of the breast implant devices. It is the preferred surgical technique for emplacing silicone-gel implants, because of the longer incisions required; yet, IMF implantation can produce thicker, slightly more visible surgical scars.
Periareolar — an incision made along the areola
Areola
This article is about the breast tissue. For the entomology term, see the glossary of Lepidopteran terms. For an artistic cloud motif, see aureola. For the cactus feature, see Areole....

r periphery (border), which provides an optimal approach when adjustments to the IMF position are required, or when a mastopexy (breast lift) is included to the primary mammoplasty procedure. In the periareolar emplacement method, the incision is around the medial-half (inferior half) of the areola’s circumference. Silicone-gel implants can be difficult to emplace with this incision, because of the short, five-centimetre length (~ 5.0 cm.) of the required access-incision. Aesthetically, because the scars are at the areola’s border, they usually are less visible than the IMF-incision scars of women with light-pigment areolae. Furthermore, periareolar implantation produces a greater incidence of capsular contracture
Capsular contracture
Capsular contracture is an abnormal response of the immune system to foreign materials in the human body. Medically, it occurs mostly in context of the complications from breast implants and artificial joint prosthetics....

, severs the milk ducts and the nerve
Nerve
A peripheral nerve, or simply nerve, is an enclosed, cable-like bundle of peripheral axons . A nerve provides a common pathway for the electrochemical nerve impulses that are transmitted along each of the axons. Nerves are found only in the peripheral nervous system...

s to the nipple, thus causes the most post-operative functional problems, e.g. impeded breast feeding.
Transaxillary — an incision made to the axilla (armpit), from which the dissection tunnels medially, thus allows emplacing the implants without producing visible scars upon the breast proper; yet is likelier to produce inferior asymmetry of the implant-device position. Therefore, surgical revision of transaxillary emplaced breast implants usually requires either an IMF incision or a periareolar incision. Transaxillary emplacement can be performed bluntly or with an endoscope (illuminated video microcamera).
Transumbilical — a trans-umbilical breast augmentation
Trans-umbilical breast augmentation
The Trans-Umbilical Breast Augmentation is a type of breast augmentation in which breast implants are placed through an incision at the navel rather than the chest.-History:...

(TUBA) is a less common implant-device insertion technique wherein the incision is at the navel
Navel
The navel is a scar on the abdomen caused when the umbilical cord is removed from a newborn baby...

, and the dissection tunnels superiorly. This surgical approach enables emplacing the breast implants without producing visible scars upon the breast; but it makes appropriate dissection and device-emplacement more technically difficult. A TUBA procedure is performed bluntly — without the endoscope’s visual assistance — and is not appropriate for emplacing (pre-filled) silicone-gel implants, because of the great potential for damaging the elastomer silicone shell of the breast-implant device during its manual insertion through the short — two-centimetre (~2.0 cm.) — incision at the navel, and because pre-filled silicone-gel implants are incompressible, and cannot be inserted through so small an incision.
Transabdominal — as in the TUBA procedure, in the transabdominoplasty breast augmentation (TABA), the breast implants are tunneled superiorly from the abdominal incision into bluntly dissected implant pockets, whilst the patient simultaneously undergoes an abdominoplasty
Abdominoplasty
Abdominoplasty or "tummy tuck" is a cosmetic surgery procedure used to make the abdomen more firm. The surgery involves the removal of excess skin and fat from the middle and lower abdomen in order to tighten the muscle and fascia of the abdominal wall...

.

Implant pocket placement

The four (4) surgical

Plastic surgery

approaches to emplacing breast implants to the implant pocket are described in anatomic

Human anatomy

Human anatomy is primarily the scientific study of the morphology of the human body. Anatomy is subdivided into gross anatomy and microscopic anatomy. Gross anatomy is the study of anatomical structures that can be seen by the naked eye...

relation to the pectoralis major muscle

Pectoralis major muscle

The pectoralis major is a thick, fan-shaped muscle, situated at the chest of the body. It makes up the bulk of the chest muscles in the male and lies under the breast in the female...

Subglandular — the breast implant is emplaced to the retromammary space
Retromammary space
Retromammary space is a loose areolar tissue that separates the breast from the pectoralis major muscle.- References :The retromammary space is often the site of breast implantation due to its location away fro key nerves and structures that supoort the breast...

, between the breast tissue and the pectoralis major muscle
Pectoralis major muscle
The pectoralis major is a thick, fan-shaped muscle, situated at the chest of the body. It makes up the bulk of the chest muscles in the male and lies under the breast in the female...

. This position closely approximates the plane of normal breast tissue, and affords the most aesthetic results; but, in patients with thin pectoral soft-tissue, the subglandular position is likelier to show the ripples and wrinkles of the underlying implant. Moreover, the capsular-contracture rate is slightly greater with the subglandular implantation approach.
Subfascial — the breast implant is emplaced beneath the fascia
Fascia
A fascia is a layer of fibrous tissue that permeates the human body. A fascia is a connective tissue that surrounds muscles, groups of muscles, blood vessels, and nerves, binding those structures together in much the same manner as plastic wrap can be used to hold the contents of sandwiches...

of the pectoralis major muscle
Pectoralis major muscle
The pectoralis major is a thick, fan-shaped muscle, situated at the chest of the body. It makes up the bulk of the chest muscles in the male and lies under the breast in the female...

; this is a variant of the subglandular position. The technical benefits of the subfascial breast-implant pocket technique are debated; proponent surgeons report that the layer of fascial tissue
Fascia
A fascia is a layer of fibrous tissue that permeates the human body. A fascia is a connective tissue that surrounds muscles, groups of muscles, blood vessels, and nerves, binding those structures together in much the same manner as plastic wrap can be used to hold the contents of sandwiches...

provides greater implant coverage and better sustains its position.
Subpectoral (dual plane) — the breast implant is emplaced beneath the pectoralis major muscle
Pectoralis major muscle
The pectoralis major is a thick, fan-shaped muscle, situated at the chest of the body. It makes up the bulk of the chest muscles in the male and lies under the breast in the female...

, after releasing the inferior muscular attachments, with or without partial dissection of the subglandular plane. Resultantly, the implant is partially beneath the pectoralis major muscle in the upper pole, while the implant’s lower pole is in the subglandular plane. This implantation technique achieves maximal coverage of the upper pole of the implant, whilst allowing the expansion of the implant’s lower pole; however, animation (movement) of the breast implants in the subpectoral plane can be excessive for some patients, a condition known as “animation deformity”.
Submuscular — the breast implant is emplaced beneath the pectoralis major muscle
Pectoralis major muscle
The pectoralis major is a thick, fan-shaped muscle, situated at the chest of the body. It makes up the bulk of the chest muscles in the male and lies under the breast in the female...

, without releasing the inferior origin of the muscle proper. Total muscular coverage of the implant can be achieved by releasing the lateral muscles of the chest wall — either the serratus muscle or the pectoralis minor muscle
Pectoralis minor muscle
The pectoralis minor is a thin, triangular muscle, situated at the upper part of the chest, beneath the pectoralis major.-Origin and insertion:...

, or both — and suturing it, or them, to the pectoralis major muscle. In breast reconstruction
Breast reconstruction
Breast reconstruction is the rebuilding of a breast, usually in women. It involves using autologous tissue or prosthetic material to construct a natural-looking breast. Often this includes the reformation of a natural-looking areola and nipple...

surgery, the submuscular implantation approach effects maximal coverage of the breast implants.

Post-surgical recovery

The surgical

Surgery

scar

Scar

Scars are areas of fibrous tissue that replace normal skin after injury. A scar results from the biological process of wound repair in the skin and other tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound results in...

s of a breast augmentation mammoplasty

Mammoplasty

Mammoplasty or mammaplasty can refer to the surgical procedure to insert cheek implants or augmentation mammoplasty, an enlarging of the breasts via implants...

heal at 6-weeks post-operative, and fade within several months, according to the skin type of the woman. Depending upon the daily physical activity the woman might require, the augmentation mammoplasty patient usually resumes her normal life activities at about 1-week post-operative. The woman who underwent submuscular implantation (beneath the pectoralis major muscles) usually has a longer post–operative convalescence, and experiences more pain, because of the healing of the deep-tissue cuts into the chest muscles for the breast augmenation. The patient usually does not exercise or engage in strenuous physical activities for about 6 weeks. Moreover, during the initial convalescence, the patient is encouraged to regularly exercise (flex and move) her arms to alleviate pain and discomfort; and, as required, analgesic

Analgesic

An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....

medication catheters for alleviating pain.

Complications

The plastic surgical

Plastic surgery

emplacement of breast-implant devices, either for breast reconstruction

Breast reconstruction

or for aesthetic purpose

Plastic surgery

, presents the same health risks common to surgery

Surgery

, such as adverse reaction to anesthesia

Anesthesia

Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...

, hematoma

Hematoma

A hematoma, or haematoma, is a localized collection of blood outside the blood vessels, usually in liquid form within the tissue. This distinguishes it from an ecchymosis, which is the spread of blood under the skin in a thin layer, commonly called a bruise...

(post-operative bleeding), seroma

Seroma

A seroma is a pocket of clear serous fluid that sometimes develops in the body after surgery. When small blood vessels are ruptured, blood plasma can seep out; inflammation caused by dying injured cells also contributes to the fluid....

(fluid accumulation), incision-site breakdown (wound infection). Complications specific to breast augmentation include breast pain, altered sensation, impeded breast-feeding function, visible wrinkling, asymmetry, thinning of the breast tissue, and symmastia

Symmastia

Symmastia is a rare congenital anomaly in which soft tissue connects, or webs, both breasts across the midline anterior to the sternum. It can be surgically corrected by a plastic surgeon....

, the “bread loafing” of the bust that interrupts the natural plane between the breasts. Specific treatments for the complications of indwelling breast implants — capsular contracture

Capsular contracture

and capsular rupture — are periodic MRI monitoring and physical examinations. Furthermore, complications and re-operations related to the implantation surgery, and to tissue expanders

Tissue expansion

Tissue expansion is a technique used by plastic and restorative surgeons to cause the body to grow additional skin, bone or other tissues.-Skin expansion:...

(implant place-holders during surgery) can cause unfavorable scar

Scar

ring in approximately 6–7 per cent of the patients.
Statistically

Statistics

Statistics is the study of the collection, organization, analysis, and interpretation of data. It deals with all aspects of this, including the planning of data collection in terms of the design of surveys and experiments....

, 20 per cent of women who underwent cosmetic implantation, and 50 per cent of women who underwent breast reconstruction implantation, required their explantation at the 10-year mark.

Implant rupture

Because a breast implant is a Class III medical device
Medical device
A medical device is a product which is used for medical purposes in patients, in diagnosis, therapy or surgery . Whereas medicinal products achieve their principal action by pharmacological, metabolic or immunological means. Medical devices act by other means like physical, mechanical, thermal,...

of limited product-life, the principal rupture-rate factors are its age and design; nonetheless, a breast implant device can retain its mechanical integrity for decades in a woman’s body. When a saline breast implant ruptures, leaks, and empties, it quickly deflates, and thus can be readily explanted (surgically removed). The follow-up report, Natrelle Saline-filled Breast Implants: a Prospective 10-year Study (2009) indicated rupture-deflation rates of 3–5 per cent at 3-years post-implantation, and 7–10 per cent rupture-deflation rates at 10-years post-implantation. When a silicone breast implant ruptures it usually does not deflate, yet the filler gel does leak from it, which can migrate to the implant pocket; therefore, an intracapsular rupture (in-capsule leak) can become an extracapsular rupture (out-of-capsule leak), and each occurrence is resolved by explantation. Although the leaked silicone filler-gel can migrate from the chest tissues to elsewhere in the woman’s body, most clinical complications are limited to the breast

Breast

and armpit areas, usually manifested as granulomas (inflammatory nodules) and axillary lymphadenopathy

Lymphadenopathy

Lymphadenopathy is a term meaning "disease of the lymph nodes." It is, however, almost synonymously used with "swollen/enlarged lymph nodes". It could be due to infection, auto-immune disease, or malignancy....

(enlarged lymph glands in the armpit area).

The suspected mechanisms of breast-implant rupture are:

damage during implantation
damage during (other) surgical procedures
chemical degradation of the breast implant shell
trauma (blunt trauma
Blunt trauma
In medical terminology, blunt trauma, blunt injury, non-penetrating trauma or blunt force trauma refers to a type of physical trauma caused to a body part, either by impact, injury or physical attack; the latter usually being referred to as blunt force trauma...

, penetrating trauma
Penetrating trauma
Penetrating trauma is an injury that occurs when an object pierces the skin and enters a tissue of the body, creating an open wound. In blunt, or non-penetrating trauma, there may be an impact, but the skin is not necessarily broken. The penetrating object may remain in the tissues, come back out...

, blast trauma
Blast injury
A blast injury is a complex type of physical trauma resulting from direct or indirect exposure to an explosion. Blast injuries occur with the detonation of high-order explosives as well as the deflagration of low order explosives...

)
mechanical pressure of traditional mammographic
Mammography
Mammography is the process of using low-energy-X-rays to examine the human breast and is used as a diagnostic and a screening tool....

breast examination

From the long-term MRI data for single-lumen breast implants, the European literature about Second generation silicone-gel breast implants (1970s design), reported silent device-rupture rates of 8–15 per cent at 10-years post-implantation (15–30% of the patients). In 2009, a branch study of the U.S. FDA’s core clinical trial

Clinical trial

Clinical trials are a set of procedures in medical research and drug development that are conducted to allow safety and efficacy data to be collected for health interventions...

s for primary breast augmentation

Breast augmentation

Breast augmentation denotes the breast implant and fat-graft mammoplasty procedures for correcting the defects, and for enhancing the size, form, and feel of a woman’s breasts...

surgery patients, reported low device-rupture rates of 1.1 per cent at 6-years post-implantation. The first series of MRI evaluations of the silicone breast implants with thick filler-gel reported a device-rupture rate of 1.0 per cent, or less, at the median 6-year device-age. Statistically, the manual examination (palpation) of the woman is inadequate for accurately evaluating if a breast implant has ruptured. The study, The Diagnosis of Silicone Breast-implant Rupture: Clinical Findings Compared with Findings at Magnetic Resonance Imaging (2005), reported that, in asymptomatic patients, only 30 per cent of the of ruptured breast implants is accurately palpated and detected by an experienced plastic surgeon, whereas MRI examinations accurately detected 86 per cent of breast-implant ruptures. Thus, the U.S. FDA recommended scheduled MRI examinations, as silent-rupture screenings, beginning at the 3-year-mark post-implantation, and then every two years, thereafter. Nonetheless, beyond the U.S., the medical establishments of other nations have not endorsed routine magnetic resonance image (MRI) screening, proposing that such a radiologic

Radiology

Radiology is a medical specialty that employs the use of imaging to both diagnose and treat disease visualized within the human body. Radiologists use an array of imaging technologies to diagnose or treat diseases...

examination be reserved for two purposes: (i) for the woman with a suspected breast-implant rupture; and (ii) for the confirmation of mammographic

Mammography

Mammography is the process of using low-energy-X-rays to examine the human breast and is used as a diagnostic and a screening tool....

and ultrasonic

Ultrasound

Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...

studies that indicate the presence of a ruptured breast implant. Furthermore, The Effect of Study design Biases on the Diagnostic Accuracy of Magnetic Resonance Imaging for Detecting Silicone Breast Implant Ruptures: a Meta-analysis (2011) reported that the breast-screening MRIs of asymptomatic women might be overestimating the incidence of breast-implant rupture.

Capsular contracture

The human body’s immune response to a surgically installed foreign object — breast implant, cardiac pacemaker

Pacemaker

An artificial pacemaker is a medical device that uses electrical impulses to regulate the beating of the heart.Pacemaker may also refer to:-Medicine:...

, orthopedic prosthesis

Prosthesis

— is to cover (encapsulate) it with scar tissue

Scar

capsules of tightly woven collagen

Collagen

Collagen is a group of naturally occurring proteins found in animals, especially in the flesh and connective tissues of mammals. It is the main component of connective tissue, and is the most abundant protein in mammals, making up about 25% to 35% of the whole-body protein content...

fibers, to maintain bodily integrity by isolating the foreign object, and so tolerate its presence. Capsular contracture

Capsular contracture

— which should be distinguished from normal capsular tissue — occurs when the collagen-fiber capsule thickens and compresses the breast implant; it is a painful complication that might distort either the breast implant, or the breast, or both. The cause of capsular contracture is unknown, but the common incidence factors include bacterial contamination, device-shell rupture, filler leakage, and hematoma

Hematoma

The device implantation surgical procedures that have reduced the incidence of capsular contracture include submuscular implant placement, using textured-surface implant devices (polyurethane-coated); limited handling of the implants, limited contact with the recipient-site skin before emplacement, and irrigation with triple-antibiotic solutions.

The correction of capsular contracture might require an open capsulotomy (surgical release) of the collagen-fiber capsule, or the removal, and possible replacement, of the breast implant. Furthermore, in treating capsular contracture, the closed capsulotomy (disruption via external manipulation) once was a common maneuver for treating hard capsules, but now is a discouraged technique, because it can rupture the breast implant. Non-surgical treatments for collagen-fiber capsules include massage, external ultrasonic therapy, leukotriene pathway inhibitors

Leukotriene antagonist

A leukotriene antagonist is a drug that inhibits leukotrienes, which are fatty compounds produced by the immune system that cause inflammation in asthma and bronchitis, and constrict airways....

such as zafirlukast

Zafirlukast

Zafirlukast is an oral leukotriene receptor antagonist for the maintenance treatment of asthma, often used in conjunction with an inhaled steroid and/or long-acting bronchodilator. It is available as a tablet and is usually dosed twice daily. Another leukotriene receptor antagonist is montelukast...

(Accolate) or montelukast

Montelukast

Montelukast is a leukotriene receptor antagonist used for the maintenance treatment of asthma and to relieve symptoms of seasonal allergies. It is usually administered orally...

(Singulair), and pulsed electromagnetic field therapy

Pulsed Electromagnetic Field Therapy

Pulsed Electromagnetic Field Therapy , also called Pulsed Magnetic Therapy, Pulse Magnetotherapy, or PEMF, is a reparative technique most commonly used in the field of orthopedics for the treatment of non-union fractures, failed fusions, congenital pseudarthrosis and depression...

(PEMFT).

Repair and revision surgeries

When the woman is unsatisfied with the outcome of the augmentation mammoplasty; or when technical or medical complications occur; or because of the breast implants’ limited product life (Class III medical device

Medical device

, in the U.S.), it is likely she might require replacing the breast implants. The common revision surgery indications include major and minor medical complications, capsular contracture

Capsular contracture

, shell rupture, and device deflation. Revision incidence rates were greater for breast reconstruction patients, because of the post-mastectomy changes to the soft-tissues and to the skin envelope of the breast, and to the anatomical

Human anatomy

borders of the breast, especially in women who received adjuvant external radiation therapy

Radiation therapy

Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...

. Moreover, besides breast reconstruction, breast cancer

Breast cancer

Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...

patients usually undergo revision surgery of the nipple-areola complex (NAC), and symmetry procedures upon the opposite breast, to create a bust of natural appearance, size, form, and feel. Carefully matching the type and size of the breast implants to the patient’s pectoral soft-tissue characteristics reduces the incidence of revision surgery. Appropriate tissue matching, implant selection, and proper implantation technique, the re-operation rate was 3.0 per cent at the 7-year-mark, compared with the re-operation rate of 20 per cent at the 3-year-mark, as reported by the U.S. Food and Drug Administration.

Systemic disease and sickness

Since the 1990s, independent, comprehensive reviews of the studies seeking causal links between silicone-gel breast implants and systemic disease

Systemic disease

Life-threatening disease redirects here.A systemic disease is one that affects a number of organs and tissues, or affects the body as a whole. Although most medical conditions will eventually involve multiple organs in advanced stage Life-threatening disease redirects here.A systemic disease is one...

reported no causal link between the implants and subsequent systemic and autoimmune diseases. Nonetheless, during the 1990s, thousands of women claimed sickness caused by their breast implants; the medical complaints included neurological

Neurology

Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...

and rheumatological

Rheumatology

Rheumatology is a sub-specialty in internal medicine and pediatrics, devoted to diagnosis and therapy of rheumatic diseases. Clinicians who specialize in rheumatology are called rheumatologists...

health problems. In the Journal of Rheumatology, the article Where There’s Smoke There’s Fire: the Silicone Breast Implant Controversy Continues to Flicker: a New Disease that needs to be Defined (2003), reported that some of the studies indicated that the psychosomatic (subjective) symptoms and the clinical (objective) symptoms reported by the women might improve after explantation of the breast implants.

Longer post-operative tracking of breast augmentation patients yielded much information about the symptomatic incidence of systemic diseases and autoimmune diseases. In the study Long-term Health Status of Danish Women with Silicone Breast Implants (2004), the national healthcare system of Denmark reported that women with implants did not risk a greater incidence and diagnosis of autoimmune disease

Autoimmune disease

Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. In other words, the body actually attacks its own cells. The immune system mistakes some part of the body as a pathogen and attacks it. This may be restricted to...

, when compared to same-age women in the general population; that the incidence of musculoskeletal disease was lower among women with breast implants than among women who had undergone other cosmetic surgery; and that they had a lower incidence rate than like women in the general population. Follow-up longitudinal studies

Longitudinal study

of these breast implant patients confirmed the previous findings on the matter.

European and North American studies reported that women who underwent augmentation mammoplasty, and any plastic surgery procedure, tended to be healthier and wealthier than the general population, before and after surgery; that plastic surgery patients had a lower standardized mortality ratio

Standardized mortality ratio

The standardized mortality ratio or SMR in epidemiology is the ratio of observed deaths to expected deaths, where expected deaths are calculated for a typical area with the same age and gender mix by looking at the death rates for different ages and genders in the larger population.The SMR may be...

than did patients for other surgeries; yet faced an increased risk of death by lung cancer

Lung cancer

Lung cancer is a disease characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung in a process called metastasis into nearby tissue and, eventually, into other parts of the body. Most cancers that start in lung, known as primary...

than other plastic surgery patients. Moreover, because only one study, the Swedish Long-term Cancer Risk Among Swedish Women with Cosmetic Breast Implants: an Update of a Nationwide Study (2006), controlled for tobacco smoking

Tobacco smoking

Tobacco smoking is the practice where tobacco is burned and the resulting smoke is inhaled. The practice may have begun as early as 5000–3000 BCE. Tobacco was introduced to Eurasia in the late 16th century where it followed common trade routes...

, the data were insufficient to establish verifiable statistical differences between smokers and non-smokers that might contribute to the higher lung cancer

Lung cancer

mortality rate of women with breast implants. The long-term study of 25,000 women, Mortality among Canadian Women with Cosmetic Breast Implants (2006), reported that the “findings suggest that breast implants do not directly increase mortality in women.”

Furthermore, the study, Silicone gel Breast Implant Rupture, Extracapsular Silicone, and Health Status in a Population of Women (2001), reported an increased incidence of fibromyalgia

Fibromyalgia

Fibromyalgia is a medical disorder characterized by chronic widespread pain and allodynia, a heightened and painful response to pressure. It is an example of a diagnosis of exclusion...

among women who suffered extracapsular silicone-gel leakage

Capsular contracture

than among women whose breast implant devices neither ruptured nor leaked. The study later was criticized as methodologically flawed, and later studies failed to establish such a causal device–disease association. After investigating, the U.S. FDA reported that “the weight of the epidemiological

Epidemiology

Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...

evidence published in the literature does not support an association between fibromyalgia and breast implants.” Nonetheless, excluding the possibility that a small group of breast implant patients might sicken through (as yet) unknown disease mechanisms, the international medical consensus is that silicone-gel breast implant devices neither cause nor aggravate systemic and auto-immune diseases.

Platinum toxicity

In the manufacture of silicone breast implants, the metallic element

Metal

A metal , is an element, compound, or alloy that is a good conductor of both electricity and heat. Metals are usually malleable and shiny, that is they reflect most of incident light...

platinum

Platinum

Platinum is a chemical element with the chemical symbol Pt and an atomic number of 78. Its name is derived from the Spanish term platina del Pinto, which is literally translated into "little silver of the Pinto River." It is a dense, malleable, ductile, precious, gray-white transition metal...

is a catalyst (a chemical that accelerates a reaction between two other chemicals, without becoming part of the new compound chemical) used to transform silicone oil

Silicone oil

A silicone oil is any polymerized siloxanes with organic side chains. They are formed of alternating silicon-oxygen atoms or siloxane, rather than carbon atoms . Other species attach to the tetravalent silicon atoms, not to the divalent oxygen atoms which are fully committed to forming the...

into silicone gel for the elastomer

Elastomer

silicone shells, and other medical-silicone devices. The literature indicates that trace quantities of platinum leak from such types of silicone breast implant; therefore, platinum is present in the surrounding pectoral tissue(s). The rare pathogenic consequence is an accumulation of platinum in the bone marrow

Bone marrow

Bone marrow is the flexible tissue found in the interior of bones. In humans, bone marrow in large bones produces new blood cells. On average, bone marrow constitutes 4% of the total body mass of humans; in adults weighing 65 kg , bone marrow accounts for approximately 2.6 kg...

, from where blood cells might deliver it to nerve endings

Nerve

A peripheral nerve, or simply nerve, is an enclosed, cable-like bundle of peripheral axons . A nerve provides a common pathway for the electrochemical nerve impulses that are transmitted along each of the axons. Nerves are found only in the peripheral nervous system...

, thus causing nervous system

Nervous system

The nervous system is an organ system containing a network of specialized cells called neurons that coordinate the actions of an animal and transmit signals between different parts of its body. In most animals the nervous system consists of two parts, central and peripheral. The central nervous...

disorders such as blindness, deafness, and nervous tics

Tic

A tic is a sudden, repetitive, nonrhythmic, stereotyped motor movement or vocalization involving discrete muscle groups. Tics can be invisible to the observer, such as abdominal tensing or toe crunching. Common motor and phonic tics are, respectively, eye blinking and throat clearing...

(involuntary muscle contractions). In 2002, the U.S. Food and Drug Administration reviewed the pertinent studies on the human biological effects of breast-implant platinum, and reported little causal evidence of platinum toxicity to the women with breast implants.

In the scientific journal Analytical Chemistry

Analytical chemistry

Analytical chemistry is the study of the separation, identification, and quantification of the chemical components of natural and artificial materials. Qualitative analysis gives an indication of the identity of the chemical species in the sample and quantitative analysis determines the amount of...

, the study Total Platinum Concentration and Platinum Oxidation States in Body Fluids, Tissue, and Explants from Women Exposed to Silicone and Saline Breast Implants by IC-ICPMS (2006), proved controversial for claiming to have identified previously undocumented toxic platinum oxidative states in vivo. Later, in a letter to the readers, the editors of Analytical Chemistry published their concerns about the faulty experimental design

Experiment

An experiment is a methodical procedure carried out with the goal of verifying, falsifying, or establishing the validity of a hypothesis. Experiments vary greatly in their goal and scale, but always rely on repeatable procedure and logical analysis of the results...

of the study, and warned readers to “use caution in evaluating the conclusions drawn in the paper.” Furthermore, after reviewing the research data of the study, and other pertinent literature, the U.S. FDA reported that the data do not support the findings presented; that the platinum used, in new-model breast-implant devices, likely is not ionized

Ionization

Ionization is the process of converting an atom or molecule into an ion by adding or removing charged particles such as electrons or other ions. This is often confused with dissociation. A substance may dissociate without necessarily producing ions. As an example, the molecules of table sugar...

, and therefore is not a significant risk to the health of the women.

Non-implant breast augmentation

Technical background
Liposuction
The technique of liposuction

Liposuction

Liposuction, also known as lipoplasty , liposculpture suction lipectomy or simply lipo is a cosmetic surgery operation that removes fat from many different sites on the human body...

(lipoplasty) was conceived by the Italian plastic surgeons Arpat Fischer and Giorgio Fischer in 1974, and was put into medical practice in 1975. Autologous adipocyte fat was harvested by means of 5-mm incisions, and an electrically and pneumatically powered instrument that rotated and alternated in its aspiration of the fat through a cannula

Cannula

A cannula or canula is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of data...

. Meanwhile, through a separate incision to the fat-tissue harvest site, saline solution was injected to dilute the fat and facilitate its aspiration.
In 1977, Fisher and Fischer reviewed 245 cases with the “planotome” instrument for treating cellulite in the lateral trochanteric (hip-thigh) areas. There was a 4.9 per cent incidence of seroma

Seroma

s, despite incision-wound suction catheter

Catheter

In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...

s and compression dressings; 2.0 per cent of the cases presented pseudo-cyst formation that required removal of the capsule (cyst

Cyst

A cyst is a closed sac, having a distinct membrane and division on the nearby tissue. It may contain air, fluids, or semi-solid material. A collection of pus is called an abscess, not a cyst. Once formed, a cyst could go away on its own or may have to be removed through surgery.- Locations :* Acne...

) through a wider incision (+ 5 mm) and the use of the panotome.

The advent of liposuction technology facilitated medical applications of the liposuction-harvested fat tissue as autologous filler for injection to correct bodily defects, and for breast augmentation. Dr. Melvin Bircoll introduced the practice of contouring the breast and for correcting bodily defects with autologous fat grafts harvested by liposuction; and he presented the fat-injection method used for emplacing the fat grafts. The surgeon E. Krulig emplaced fat grafts with a syringe and needle (lipo-injection), and later used a disposable fat trap to facilitate the collection and to ensure the sterility of the harvested adipocyte tissue.

Lipo-injector gun
To emplace the autologous fat tissue grafts, Drs. J. Newman and J. Levin designed a lipo-injector gun with a gear-driven plunger that allowed the even injection of autologous fat tissue to the desired recipient sites. The control afforded by the injector gun assisted the plastic surgeon in controlling excessive pressure to the fat in the barrel of the syringe, thus avoiding over-filling the recipient site. The later-design lipo-injector gun featured a ratchet-gear operation that that afforded the surgeon great control in accurately emplacing autologous fat to the recipient site; a trigger action injected 0.1 cc of filler. Since 1989, most non-surgical, fat-graft augmentation of the breast features the emplacement of adipocyte fat outside the breast parenchyma

Parenchyma

Parenchyma is a term used to describe a bulk of a substance. It is used in different ways in animals and in plants.The term is New Latin, f. Greek παρέγχυμα - parenkhuma, "visceral flesh", f. παρεγχεῖν - parenkhein, "to pour in" f. para-, "beside" + en-, "in" + khein, "to pour"...

— up to 300 ml of fat, in three equal measures (aliquots), is emplaced to the subpectoral space and to the intrapectoral muscle space of the pectoralis major muscle, and the submammary space, to achieve a breast outcome of natural appearance and contour.

Autologous fat grafting

Autologous fat grafting to the breast

Breast

is applied to the correction of breast asymmetry, the correction of breast deformities, breast reconstruction

Breast reconstruction

(as adjunct and primary technique), for the improvement of soft-tissue coverage of breast implants, and for the aesthetic enhancement of the bust. The careful harvesting and centrifugal

Centrifuge

A centrifuge is a piece of equipment, generally driven by an electric motor , that puts an object in rotation around a fixed axis, applying a force perpendicular to the axis...

refinement of the mature adipocyte tissue — to be injected in small aliquots — allows the transplanted fat tissue to remain viable in the breast and provide it the structure and contour that cannot be achieved solely with breast implants or with corrective surgery. As in all breast procedures, the grafted fat tissue

Tissue (biology)

Tissue is a cellular organizational level intermediate between cells and a complete organism. A tissue is an ensemble of cells, not necessarily identical, but from the same origin, that together carry out a specific function. These are called tissues because of their identical functioning...

can suffer necrosis

Necrosis

Necrosis is the premature death of cells in living tissue. Necrosis is caused by factors external to the cell or tissue, such as infection, toxins, or trauma. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death...

, and concomitant calcification

Metastatic calcification

Metastatic calcification is deposition of calcium salts in otherwise normal tissue, because of elevated serum levels of calcium in blood, which can occur because of deranged metabolism as well as increased absorption or decreased excretion of calcium and related minerals.It occurs as opposed to...

s and cysts, and palpable lumps; the cause of calcification is unknown, but the post-procedure tissue changes resemble those resulting from other breast procedures such as breast reduction

Breast reduction

Reduction mammoplasty is the plastic surgery procedure for correcting over-sized breasts...

. The research indicates the efficacy of fat grafting for breast reconstruction the treatment of radiation damage to the chest, the incidental reduction of capsular contracture

Capsular contracture

, and the improved soft-tissue coverage of breast implants.

In Fat Grafting to the Breast Revisited: Safety and Efficacy (2007), Sydney Coleman and Alessia Saboeiro reported successful transferences of fat to the breast

Breast

, and proposed fat grafting as a non-implant alternative to the usual surgical procedures for breast augmentation, breast defect correction, and breast reconstruction. Moreover, although liposuction is currently used to harvest fat for grafting to the breast, in 1895, in the nineteenth century, Dr. Vincent Czerny effected the earliest breast enlargement with fat when he used the patient’s autologous adipose tissue, harvested from a benign lumbar lipoma

Lipoma

A lipoma is a benign tumor composed of adipose tissue. It is the most common form of soft tissue tumor. Lipomas are soft to the touch, usually movable, and are generally painless. Many lipomas are small but can enlarge to sizes greater than six centimeters. Lipomas are commonly found in adults...

, to repair the asymmetry of the breast from which he had removed a tumor.

In a 17-patient cohort, 2 patients had breast cancer

Breast cancer

, diagnosed by mammogram

Mammography

Mammography is the process of using low-energy-X-rays to examine the human breast and is used as a diagnostic and a screening tool....

, one at 12-months post-procedure, and the other at 92-months, after the fat transfer to the breast. In contemporary praxis, beyond the breast proper, fat grafts are injected to the pectoralis major muscle, and to the postpectoral space and to the prepectoral space, before and behind the muscle. In post-mastectomy breast reconstruction, the grafted fat is used to create a breast mound, by augmenting the extant breast tissues. Structural fat grafting was performed to either one or both breasts of the 17 women; the age range of the women was 25–55 years, the mean age was 38.2 years. The indications included micromastia

Micromastia

Micromastia, or breast hypoplasia, is a medical term describing the postpubertal underdevelopment of a woman's breast tissue. Just as it is impossible to define 'normal' breast size, there is no objective definition of micromastia. Breast development is commonly asymmetric and one or both breasts...

(10 patients); explantation deformity (one patient); post-augmentation deformity with breast implants (two patients); tuberous breast deformity

Tuberous breast deformity

Tuberous breasts are a result of a congenital breast deformity or abnormality which can occur in both men and women . During puberty breast development is stymied and the breasts fail to develop normally and fully. The exact cause of this is as yet unclear...

(one patient); Poland’s syndrome

Poland syndrome

Poland syndrome is a rare birth defect characterized by underdevelopment or absence of the chest muscle on one side of the body and webbing of the fingers of the hand on the same side mostly common on the right...

(one patient); and post-mastectomy reconstruction

Breast reconstruction

deformity (two patients). The pre-procedure mammograms were negative for malignant neoplasms. The types of anaesthesia applied were general (two patients) and epidural analgesia

Epidural

The term epidural is often short for epidural analgesia, a form of regional analgesia involving injection of drugs through a catheter placed into the epidural space...

plus sedation, with local infiltration and intercostal nerve blocks (15 patients). The autologous adipocyte tissue was grafted in one-to-three stages; the average tissue graft volume was 278.6 cc of fat per operation per breast. Post-procedure, the patient was instructed to regard any lump

Breast disease

Breast diseases can be classified either with disorders of the integuement, or disorders of the reproductive system. A majority of breast diseases are noncancerous.Breast awareness is a goal of the breast health movement...

in the breasts as unrelated to the fat grafts, until after a complete medical workup of the breast lump had been performed.

Techniques

Fat harvesting and contouring
The centrifugal refinement of the liposuction-harvested adipocyte tissues removes blood products and free lipids to produce autologous breast filler. The injectable filler-fat is obtained by centrifuging (spinning) the fat-filled syringes for sufficient time to allow the serum, blood, and oil (liquid fat) components to collect, by density, apart from the refined, injection-quality fat. To refine the fat for facial injection quality, the fat-filled syringes are centrifuged for 1.0 minute at 2,000 RPM, which separates the unnecessary solution, leaving refined filler fat. Moreover, centrifugation at 10,000 RPM for 10 minutes produces a “collagen graft”; the histologic

Histology

Histology is the study of the microscopic anatomy of cells and tissues of plants and animals. It is performed by examining cells and tissues commonly by sectioning and staining; followed by examination under a light microscope or electron microscope...

composition of which is cell

Cell (biology)

The cell is the basic structural and functional unit of all known living organisms. It is the smallest unit of life that is classified as a living thing, and is often called the building block of life. The Alberts text discusses how the "cellular building blocks" move to shape developing embryos....

residues, collagen

Collagen

fibres, and 5.0 per cent intact fat cells. Furthermore, because the patient’s body naturally absorbs some of the fat grafts, the breasts maintain their contours and volumes for 18–24 months.
In the Coleman–Saboeiro study, the autologous fat was harvested by liposuction, using a 10-ml syringe attached to a two-hole Coleman harvesting cannula

Cannula

A cannula or canula is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of data...

; after centrifugation, the refined breast-filler fat was transferred to 3-ml syringes. Blunt infiltration cannulas were used to emplace the fat through 2-mm incisions; the blunt cannula injection method allowed greater dispersion of small aliquots (equal measures) of fat, and reduced the possibility of intravascular fat injection; no sharp needles are used for fat-graft injection to the breasts. The 2-mm incisions were positioned to allow the infiltration (emplacement) of fat grafts from at least two directions; a 0.2 ml fat volume was emplaced with each withdrawal of the cannula.

The breasts were contoured by layering the fat grafts into different levels within the breast, until achieving the desired breast form. The fat-graft injection technique allows the plastic surgeon precise control in accurately contouring the breast — from the chest wall to the breast-skin envelope — with subcutaneous fat grafts to the superficial planes of the breast. This greater degree of breast sculpting is unlike the global augmentation realised with a breast implant emplaced below the breast or below the pectoralis major muscle, respectively expanding the retromammary space

Retromammary space

Retromammary space is a loose areolar tissue that separates the breast from the pectoralis major muscle.- References :The retromammary space is often the site of breast implantation due to its location away fro key nerves and structures that supoort the breast...

and the retropectoral space. The greatest proportion of the grafted fat usually is infiltrated to the pectoralis major muscle, then to the retropectoral space, and to the prepectoral space, (before and behind the pectoralis major muscle). Moreover, although fat grafting to the breast parenchyma

Parenchyma

usually is minimal, it is performed to increase the degree of projection of the bust

Cleavage

Cleavage may refer to:*Cleavage , partial exposure of the separation between a woman's breasts.**Cleavage enhancement, methods of making a person's breast cleavage look more substantial than it really is....

.

Fat-graft injection
The biologic survival of autologous fat tissue

Tissue (biology)

depends upon the correct handling of the fat graft, of its careful washing (refinement) to remove extraneous blood cells, and of the controlled, blunt-cannula injection (emplacement) of the refined fat tissue grafts to an adequately vascularized

Circulatory system

The circulatory system is an organ system that passes nutrients , gases, hormones, blood cells, etc...

recipient site. Because the body resorbs some of the injected fat grafts (volume loss), compensative over-filling aids in obtaining a satisfactory breast outcome for the patient; thus the transplantation of large-volume fat grafts greater than required, because only 25–50 per cent of the fat graft survives at 1-year post-transplantation. Correct technique maximizes fat graft survival by minimizing cellular

Cell (biology)

trauma during the liposuction harvesting and the centrifugal refinement, and by injecting the fat in small aliquots (equal measures), not clumps (too-large measures). Injecting minimal-volume aliquots with each pass of the cannula

Cannula

A cannula or canula is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of data...

maximizes the surface area contact between the grafted fat tissue and the recipient breast-tissue, because proximity to a vascular system (blood supply

Circulatory system

The circulatory system is an organ system that passes nutrients , gases, hormones, blood cells, etc...

) encourages histologic

Histology

survival and minimizes the potential for fat necrosis. Transplanted autologous fat tissue undergoes histologic changes like those undergone by a bone transplant; if the body accepts the fat-tissue graft, it is replaced with new fat tissue, if the graft dies it is replaced by fibrous tissue. New fat tissue is generated by the activity of a large, wandering histocyte

Histiocyte

A histiocyte is a cell that is part of the mononuclear phagocyte system . The mononuclear phagocytic system is part of the organism's immune system...

-type cell

Cell (biology)

, which ingests fat and then becomes a fat cell. When the breast filler fat is injected to the breasts in clumps (too-large measures), fat cells emplaced too distant from blood vessels might die, which can lead to fat tissue necrosis, causing lumps, calcifications, and the eventual formation of liponecrotic cysts.

The operating room (OR) time required to harvest, refine, and emplace fat to the breasts is greater than the usual 2-hour OR time; the usual infiltration time was approximately 2-hours for the first 100 cc volume, and approximately 45 minutes for injecting each additional 100 cc volume of breast-filler fat. The technique for injecting fat grafts for breast augmentation allows the plastic surgeon great control in sculpting the breasts to the required contour, especially in the correction of tuberous breast deformity

Tuberous breast deformity

. In which case no fat graft is emplaced beneath the nipple-areola complex (NAC), and the skin envelope of the breast is selectively expanded (contoured) with fat emplaced subcutaneously, immediately beneath the skin. Such controlled contouring selectively increased the proportional volume of the breast in relation to the size of the areola-nipple complex, and thus created a breast of natural form and appearance; greater verisimilitude than is achieved solely with breast implants. The fat-corrected breast implant deformities were inadequate soft-tissue coverage of the implant(s) and capsular contracture

Capsular contracture

, achieved with subcutaneous fat grafts that hid the implant-device edges and wrinkles, and decreased the palpability of the underlying breast implant. Furthermore, grafting autologous fat around the breast implant can result in softening the breast capsule.

External tissue expansion
The successful outcome of fat graft breast augmentation is enhanced by achieving a pre-expanded recipient site to create the breast-tissue matrix

Matrix (biology)

In biology, matrix is the material between animal or plant cells, in which more specialized structures are embedded, and a specific part of the mitochondrion that is the site of oxidation of organic molecules. The internal structure of connective tissues is an extracellular matrix...

that will receive grafts of autologous adipocyte fat. The recipient site is expanded with an external vacuum tissue-expander applied upon each breast. The biological effect of negative pressure (vacuum

Vacuum

In everyday usage, vacuum is a volume of space that is essentially empty of matter, such that its gaseous pressure is much less than atmospheric pressure. The word comes from the Latin term for "empty". A perfect vacuum would be one with no particles in it at all, which is impossible to achieve in...

) expansion upon soft tissues derives from the ability of soft tissues to grow when subjected to controlled, distractive, mechanical forces. (see distraction osteogenesis

Distraction osteogenesis

Distraction osteogenesis, also called callus distraction, callotasis and osteodistraction is a surgical process used to reconstruct skeletal deformities and lengthen the long bones of the body...

) The study Non-surgical Breast Enlargement using an External Soft Tissue Expansion System (2000) reported the technical effectiveness of recipient-site pre-expansion. In a single-group study, 17 healthy women (aged 18–40 y.o.) wore a brassiere-like vacuum system that applied a 20-mmHg vacuum (controlled, mechanical, distraction force) to each breast for 10–12 hours daily for 10-weeks. Pre- and post-procedure, the breast volume (size) was periodically measured; likewise, a magnetic resonance image (MRI) of the breast-tissue architecture and water density was taken during the same phase of the patient’s menstrual cycle

Menstrual cycle

The menstrual cycle is the scientific term for the physiological changes that can occur in fertile women for the purpose of sexual reproduction. This article focuses on the human menstrual cycle....

; of the 17-woman study group, 12 completed the study, and 5 withdrew, because of non-compliance with the clinical trial protocol

Clinical trial protocol

A clinical trial protocol is a document that describes the objective, design, methodology, statistical considerations, and organization of a clinical trial...

.

The breast volume (size) of all 17 women increased throughout the 10-week treatment period, the greatest increment was at week 10 (final treatment) — the average volume increase was 98+/–67 per cent over the initial breast-size measures. Incidences of partial recoil occurred at 1-week post-procedure, with no further, significant, breast volume decrease afterwards, nor at the follow-up treatment at 30-weeks post-procedure. The stable, long-term increase in breast size was 55 per cent (range 15–115%). The MRI visualizations of the breasts showed no edema

Edema

Edema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...

, and confirmed the proportionate enlargement of the adipose and glandular components of the breast-tissue matrices

Matrix (biology)

. Furthermore, a statistically significant decrease in body weight occurred during the study, and self-esteem

Self-esteem

questionnaire scores improved from the initial-measure scores.

Because external vacuum expansion of the recipient-site tissues permits injecting large-volume fat grafts (+300cc) to correct defects and enhance the bust, the histologic

Histology

viability of the breast filler (adipocyte fat) and its volume must be monitored and maintained. The long-term, volume maintenance data reported in Breast Augmentation using Pre-expansion and Autologous Fat Transplantation: a Clinical Radiological Study (2010) indicate the technical effectiveness of external tissue expansion of the recipient site for a 25-patient study group, who had 46 breasts augmented with fat grafts. The indications included micromastia

Micromastia

(under-development), explantation deformity (empty implant pocket), and congenital defects (tuberous breast deformity

Tuberous breast deformity

, Poland’s syndrome

Poland syndrome

). Pre-procedure, every patient used external vacuum expansion of the recipient-site tissues to create a breast-tissue matrix to be injected with autologous fat grafts of adipocyte tissue, refined via low G-force centrifugation. Pre- and post-procedure, the breast volumes were measured; the patients underwent pre-procedure and 6-month post-procedure MRI and 3-D volumetric imaging examinations. At 6-months post-procedure, each woman had a significant increase in breast volume, ranging 60–200 per cent, per the MRI (n=12) examinations. The size, form, and feel of the breasts was natural; post-procedure MRI examinations revealed no oil cysts or abnormality (neoplasm) in the fat-augmented breasts. Moreover, given the sensitive, biologic nature of breast tissue, periodic MRI and 3-D volumetric imaging examinations are required to monitor the breast-tissue viability and the maintenance of the large volume (+ 300cc) fat grafts.

Indications

Non-implant breast augmentation with injections of autologous fat grafts (adipocyte tissue) is indicated for woemen requiring breast reconstruction

Breast reconstruction

, defect correction, and the æsthetic enhancement of the bust.

breast reconstruction — post-mastectomy re-creation of the breast(s); trauma-damaged tissues (blunt, penetrating), disease (breast cancer
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...

), and explantation deformity (empty breast-implant socket).

congenital defect correction — micromastia
Micromastia
Micromastia, or breast hypoplasia, is a medical term describing the postpubertal underdevelopment of a woman's breast tissue. Just as it is impossible to define 'normal' breast size, there is no objective definition of micromastia. Breast development is commonly asymmetric and one or both breasts...

, tuberous breast deformity
Tuberous breast deformity
Tuberous breasts are a result of a congenital breast deformity or abnormality which can occur in both men and women . During puberty breast development is stymied and the breasts fail to develop normally and fully. The exact cause of this is as yet unclear...

, Poland’s syndrome
Poland syndrome
Poland syndrome is a rare birth defect characterized by underdevelopment or absence of the chest muscle on one side of the body and webbing of the fingers of the hand on the same side mostly common on the right...

, et cetera.

primary augmentation — the æsthetic enhancement (contouring) of the size, form, and feel of the breasts.

The operating room (OR) time of breast reconstruction, congenital defect correction, and primary breast augmentation procedures is determined by the indications to be treated.

Procedures

Post-mastectomy surgical reconstruction
Surgical post-mastectomy breast reconstruction

Breast reconstruction

requires general anaesthesia, cuts the chest muscles, produces new scars, and requires a long post-surgical recovery for the patient. The surgical emplacement of breast implant devices (saline or silicone) introduces a foreign object to the patient’s body (see capsular contracture

Capsular contracture

). The TRAM flap (Transverse Rectus Abdominis Myocutaneous flap) procedure reconstructs the breast using an autologous flap of abdominal, cutaneous, and muscle tissues. The latissimus myocutaneous flap employs skin fat and muscle harvested from the back, and a breast implant. The DIEP flap

DIEP flap

A DIEP flap is a type of breast reconstruction in which blood vessels called deep inferior epigastric perforators , and the skin and fat connected to them are removed from the lower abdomen and transferred to the chest to reconstruct a breast after mastectomy without the sacrifice of any of the...

(Deep Inferior Epigastric Perforators) procedure uses an autologous flap of abdominal skin and fat tissue.

Post-mastectomy fat graft reconstruction
The reconstruction of the breast(s) with grafts of autologous fat is a non-implant alternative to further surgery after a breast cancer surgery, be it a lumpectomy

Lumpectomy

Lumpectomy is a common surgical procedure designed to remove a discrete lump, usually a benign tumor or breast cancer, from an affected man or woman's breast...

or a breast removal — simple (total) mastectomy, radical mastectomy, modified radical mastectomy, skin-sparing mastectomy, and subcutaneous (nipple-sparing) mastectomy. The breast is reconstructed by first applying external tissue expansion to the recipient-site tissues (adipose, gland

Gland

A gland is an organ in an animal's body that synthesizes a substance for release of substances such as hormones or breast milk, often into the bloodstream or into cavities inside the body or its outer surface .- Types :...

ular) to create a breast-tissue matrix that can be injected with autologous fat grafts (adipocyte tissue); the reconstructed breast has a natural form, look, and feel, and is generally sensate throughout and in the nipple-areola complex (NAC). The reconstruction of breasts with fat grafts requires a 3-month treatment period — begun after 3–5 weeks of external vacuum expansion of the recipient-site tissues. The autologous breast-filler fat is harvested by liposuction from the patient’s body (buttocks, thighs, abdomen), is refined and then is injected (grafted) to the breast-tissue matrices (recipient sites), where the fat will thrive.

One method of non-implant breast reconstruction is initiated at the concluding steps of the breast cancer surgery, wherein the oncological

Oncology

Oncology is a branch of medicine that deals with cancer...

surgeon is joined by the reconstructive plastic surgeon, who immediately begins harvesting, refining, and seeding (injecting) fat grafts to the post-mastectomy recipient site. After that initial post-mastectomy fat-graft seeding in the operating room, the patient leaves hospital with a slight breast mound that has been seeded to become the foundation tissue matrix for the breast reconstruction. Then, after 3–5 weeks of continual external vacuum expansion of the breast mound (seeded recipient-site) — to promote the histologic

Histology

regeneration of the extant tissues (fat, gland

Gland

ular) via increased blood circulation to the mastectomy scar (suture site) — the patient formally undergoes the first fat-grafting session for the reconstruction of her breasts. The external vacuum expansion of the breast mound created an adequate, vascularised

Circulatory system

The circulatory system is an organ system that passes nutrients , gases, hormones, blood cells, etc...

, breast-tissue matrix to which the autologous fat is injected; and, per the patient, such reconstruction affords almost-normal sensation throughout the breast and the nipple-areola complex. Patient recovery from non-surgical fat graft breast reconstruction permits her to resume normal life activities at 3-days post-procedure.

Tissue engineering
I. — the breast mound
The breast-tissue matrix consists of engineered tissues of complex, implanted, biocompatible scaffolds seeded with the appropriate cells. The in-situ creation of a tissue matrix in the breast mound is begun with the external vacuum expansion of the mastectomy defect tissues (recipient site), for subsequent seeding (injecting) with autologous fat grafts of adipocyte tissue. The study Tissue Engineering a Breast Mound by External Expansion & Autologous Fat Grafting (2010), reported that serial fat-grafting to a pre-expanded recipient site achieved (with a few 2-mm incisions and minimally invasive blunt-cannula injection procedures), a non-implant outcome equivalent to a surgical breast reconstrcution by autologous-flap

DIEP flap

procedure. Technically, the external vacuum expansion of the recipient-site tissues created a skin envelope as it stretched the mastectomy scar, and so generated a fertile breast-tissue matrix to which were injected large-volume fat grafts (150–600 ml) to create a breast of natural form, look, and feel.

The fat graft breast reconstructions for 33 women (47 breasts, 14 irradiated), whose clinical statuses ranged from 0-days to 30-years post-mastectomy, began with the pre-expansion of the breast mound (recipient site) with an external vacuum tissue-expander for 10 hours daily, for 10–30 days before the first grafting of autologous fat. The breast mound expansion was adequate when the mastectomy scar tissues stretched to create a 200–300 ml recipient matrix (skin envelope), that received a fat-suspension volume of 150–600 ml in each grafting session.

At 1-week post-procedure, the patients resumed using the external vacuum tissue-expander for 10 hours daily, until the next fat grafting session; 2–5 outpatient procedures, 6–16 weeks apart, were required until the plastic surgeon and the patient were satisfied with the volume, form, and feel of the reconstructed breasts. The follow-up mammogram and MRI examinations found neither defects (necrosis) nor abnormalities (neoplasms). At 6-months post-procedure, the reconstructed breasts had a natural form, look, and feel, and the stable breast-volumes ranged 300–600 ml per breast. The post-procedure mammographies indicated normal, fatty breasts with well-vascularized fat, and few, scattered, benign oil cysts. The occurred complications included pneumothorax

Pneumothorax

Pneumothorax is a collection of air or gas in the pleural cavity of the chest between the lung and the chest wall. It may occur spontaneously in people without chronic lung conditions as well as in those with lung disease , and many pneumothoraces occur after physical trauma to the chest, blast...

and transient cysts.

II. — Explantation deformity
The autologous fat graft replacement of breast implants (saline and silicone) resolves medical complications such as: capsular contracture

Capsular contracture

, implant shell rupture, filler leakage (silent rupture), device deflation, and silicone-induced granulomas, which are medical conditions usually requiring re-operation and explantation (breast implant removal). The patient then has the option of surgical or non-implant breast corrections, either replacement of the explanted breast implants or fat-graft breast augmentation. Moreover, because fat grafts are biologically sensitive, they cannot survive in the empty implantation pocket, instead, they are injected to and diffused within the breast-tissue matrix (recipient site), replacing approximately 50 per cent of the volume of the removed implant — as permanent breast augmentation. The outcome of the explantation correction is a bust of natural appearance; breasts of volume, form, and feel, that — although approximately 50 per cent smaller than the explanted breast size — are larger than the original breast size, pre-procedure.

III. — Breast augmentation
The outcome of a breast augmentation with fat-graft injections depends upon proper patient selection, preparation, and correct technique for recipient site expansion, and the harvesting, refining, and injecting of the autologous breast-filler fat. Technical success follows the adequate external vacuum expansion of the recipient-site tissues (matrix) before the injection of large-volume grafts (220–650 cc) of autologous fat to the breasts. After harvesting by liposuction, the breast-filler fat was obtained by low G-force syringe centrifugation of the harvested fat to separate it, by density, from the crystalloid component. The refined breast filler then was injected to the pre-expanded recipient site; post-procedure, the patient resumed continual vacuum expansion therapy upon the injected breast, until the next fat grafting session. The mean operating room (OR) time was 2-hours, and there occurred no incidences of infection

Infection

An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...

, cysts, seroma

Seroma

, hematoma

Hematoma

, or tissue necrosis.

The breast-volume data reported in Breast Augmentation with Autologous Fat Grafting: A Clinical Radiological Study (2010) indicated a mean increase of 1.2-times the initial breast volume, at 6-months post-procedure. In a 2-year period, 25 patients underwent breast augmentation by fat graft injection; at 3-weeks pre-procedure, before the fat grafting to the breast-tissue matrix (recipient site), the patients were photographed, and examined via intravenous contrast MRI or 3-D volumetric imaging, or both. The breast-filler fat was harvested by liposuction (abdomen, buttocks, thighs), and yielded fat-graft volumes of 220–650 cc per breast. At 6-months post-procedure, the follow-up treatment included photographs, intravenous contrast MRI or 3-D volumetric imaging, or both. Each woman had an increased breast volume of 250 cc per breast, a mean volume increase confirmed by quantitative MRI analysis. The mean increase in breast volume was 1.2-times the initial breast volume measurements; the statistical difference between the pre-procedure and the 6-month post-procedure breast volumes was (P< 00.0000007); the percentage increase basis of the breast volume was 60–80 per cent of the initial, pre-procedure breast volume.

Complications and limitations

In every surgical and non-surgical procedure, the risk of complications exists before, during, and after a procedure, and, given the sensitive biological nature of breast tissues (adipocyte, glandular), this is especially true in the case of fat graft breast augmentation. Despite its relative technical simplicity, the injection (grafting) technique for breast augmentation is accompanied by post-procedure complications — fat necrosis, calcification, and sclerotic nodules

Sclerotic fibroma

Sclerotic fibromas are a cutaneous condition characterized by well-circumscribed, dome-shaped, dermal hypocellular nodules composed predominantly of sclerotic thick collagen bundles....

— which directly influence the technical efficacy of the procedure, and of achieving a successful outcome. The Chinese study Breast Augmentation by Autologous Fat-injection Grafting: Management and Clinical analysis of Complications (2009), reported that the incidence of medical complications is reduced with strict control of the injection-rate (cc/min.) of the breast-filler volume being administered, and by diffusing the fat-grafts in layers to allow their even distribution within the breast tissue matrix. The complications occurred to the 17-patient group were identified and located with 3-D volumetric and MRI

Magnetic resonance imaging

Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...

visualizations of the breast tissues and of any sclerotic lesions and abnormal tissue

Breast disease

masses (malignant neoplasm). According to the characteristics of the defect or abnormality, the sclerotic lesion was excised and liquefied fat was aspirated; the excised samples indicated biological changes in the intramammary fat grafts — fat necrosis, calcification, hyalinization

Hyaline

The term hyaline denotes a substance with a glass-like appearance.-Histopathology:In histopathological medical usage, a hyaline substance appears glassy and pink after being stained with haematoxylin and eosin — usually it is an acellular, proteinaceous material...

, and fibroplasia.

The complications associated with injecting fat grafts to augment the breasts are like, but less severe, than the medical complications associated with other types of breast procedure. Technically, the use of minuscule (2-mm) incisions and blunt-cannula

Cannula

A cannula or canula is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of data...

injection much reduce the incidence of damaging the underlying breast structures (milk ducts, blood vessels, nerves). Injected fat-tissue grafts that are not perfused among the tissues can die, and result in necrotic cysts and eventual calcifications — medical complications common to breast procedures. Nevertheless, a contoured abdomen for the patient is an additional benefit derived from the liposuction harvesting of the adipocyte tissue injected to the breasts. (see abdominoplasty

Abdominoplasty

Abdominoplasty or "tummy tuck" is a cosmetic surgery procedure used to make the abdomen more firm. The surgery involves the removal of excess skin and fat from the middle and lower abdomen in order to tighten the muscle and fascia of the abdominal wall...

)

When the patient’s body has insufficient adipocyte tissue to harvest as injectable breast filler, a combination of fat grafting and breast implants might provide the desired outcome. Although non-surgical breast augmentation with fat graft injections is not associated with implant-related medical complications (filler leakage, deflation, visibility, palpability, capsular contracture

Capsular contracture

), the achievable breast volumes are physically limited; the large-volume, global bust augmentations realised with breast implants are not possible with the method of structural fat grafting. Global breast augmentation contrasts with the controlled breast augmentation of fat-graft injection, in the degree of control that the plastic surgeon has in achieving the desired breast contour and volume. The controlled augmentation is realised by infiltrating and diffusing the fat grafts throughout the breast; and it is feather-layered into the adjacent pectoral areas until achieving the desired outcome of breast volume and contour. Nonetheless, the physical fullness-of-breast achieved with injected fat-grafts does not visually translate into the type of buxom fullness achieved with breast implants; hence, patients who had plentiful fat-tissue to harvest attained a maximum breast augmentation of one brassiėre cup-size

Brassiere

A brassiere is an undergarment that covers, supports, and elevates the breasts. Since the late 19th century, it has replaced the corset as the most widely accepted method for supporting breasts....

in one session of fat grafting to the breast.

Breast cancer
Detection
A contemporary woman’s life-time probability of developing breast cancer is approximately one in seven; yet there is no causal evidence that fat grafting to the breast might be more conducive to breast cancer than are other breast procedures; because incidences of fat tissue

Tissue (biology)

necrosis and calcification occur in every such procedure: breast biopsy

Biopsy

A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...

, implantation, radiation therapy

Radiation therapy

, breast reduction

Breast reduction

Reduction mammoplasty is the plastic surgery procedure for correcting over-sized breasts...

, breast reconstruction

Breast reconstruction

, and liposuction of the breast. Nonetheless, detecting breast cancer is primary, and calcification incidence is secondary; thus, the patient is counselled to learn self-palpation of the breast and to undergo periodic mammographic examinations. Although the mammogram is the superior diagnostic technique for distinguishing among cancerous and benign lesions to the breast, any questionable lesion

Lesion

A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...

can be visualized ultrasonically and magnetically

Magnetic resonance imaging

Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...

(MRI); biopsy

Biopsy

follows any clinically suspicious lesion or indeterminate abnormality appeared in a radiograph.

Therapy
Breast augmentation via autologous fat grafts allows the oncological

Oncology

Oncology is a branch of medicine that deals with cancer...

breast surgeon to consider conservative breast surgery procedures that usually are precluded by the presence of alloplastic breast implants, e.g. lumpectomy

Lumpectomy

Lumpectomy is a common surgical procedure designed to remove a discrete lump, usually a benign tumor or breast cancer, from an affected man or woman's breast...

, if cancer is detected in an implant-augmented breast. In previously augmented patients, aesthetic outcomes cannot be ensured without removing the implant and performing mastectomy. Moreover, radiotherapy treatment is critical to reducing cancerous recurrence and to the maximal conservation of breast tissue; yet, ironically, radiotherapy of an implant-augmented breast much increases the incidence of medical complications — capsular contracture

Capsular contracture

, infection, extrusion, and poor cosmetic outcome.

Post-cancer breast reconstruction
After mastectomy, surgical breast reconstruction with autogenous skin flaps and with breast implants can produce subtle deformities and deficiencies resultant from such global breast augmentation, thus the breast reconstruction

Breast reconstruction

is incomplete. In which case, fat graft injection can provide the missing coverage and fullness, and might relax the breast capsule

Capsular contracture

. The fat can be injected as either large grafts or as small grafts, as required to correct difficult axillary deficiencies, improper breast contour, visible implant edges, capsular contracture, and tissue damage consequent to radiation therapy

Radiation therapy

Thailand Breast Slap

The Thailand Breast Slap is a non-surgical method of breast augmentation endorsed by the Thai

Thailand

Thailand , officially the Kingdom of Thailand , formerly known as Siam , is a country located at the centre of the Indochina peninsula and Southeast Asia. It is bordered to the north by Burma and Laos, to the east by Laos and Cambodia, to the south by the Gulf of Thailand and Malaysia, and to the...

government as an alternative to surgical breast augmentation with breast implants. The Thailand Breast Slap was proposed by beautician Khemmikka Na Sonkhla, who reported that her grandmother used the technique to augment her own bust; proponents also claim it reduces the risk of breast cancer

Breast cancer

. The Thai government have enrolled more than 20 women in publicly-funded courses for the teaching of the Thailand Breast Slap technique for breast augmentation; nonetheless, beyond Thailand, the technique is not endorsed by the mainstream medical community. Yet, despite the promising results of a six-month study of the therapeutic effectiveness of the Thai Breast Slap, the research physician recommended to the participant women that they also contribute to augmenting their busts by gaining weight.

Breast implants

The patient

Indications

Incision types

Implant pocket placement

Post-surgical recovery

Complications

Implant rupture

Capsular contracture

Repair and revision surgeries

Systemic disease and sickness

Platinum toxicity

Non-implant breast augmentation

Autologous fat grafting

Techniques

Indications

Procedures

Complications and limitations

Thailand Breast Slap

See also