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Implants have been used since 1895 to augment the size or shape of women's breasts. A number of substances have been used to implant into women, such as: ivory, glass balls, ground rubber, ox cartilage, wool, polyester (polyurethane foam sponge) Silastic rubber, and teflon-silicone prostheses. In the 1950s and 1960s silicone injections were used by an estimated 50,000 women. These injections caused silicone granulomas and hardening of the breasts that were in some cases so severe that women needed to have to mastectomies for treatment. (

Current breast augmentation patients have more choices than ever before -- including where they want the plastic surgeons to make the incisions. Breast implants are now being made in various sizes and shapes so women with varying body types can enjoy an augmentation that is balanced, natural and matches the patient's frame.

Surgeons start a breast augmentation in one of four ways: they make an opening in one of the creases in the patient's belly button (the transumbilical procedure); in the area where the breast meets the wall of her chest (infra-mammary); in the armpit (transaxillary) or in the areola, (peri-areolar,) the area of dark skin surrounding the nipple. Saline implants can be rolled up like a cigar and inserted through the incision, through a channel just under the skin and into a surgically made pocket over or under the chest muscles. Once in place, the implant is then inflated. The belly button procedure can only be done with saline implants. The gummy bear implant must be done through the nipple under the breast.

Currently there are two different types of breast implants being used by board certified plastic surgeons: saline and silicone. Saline implants are the most commonly used implant in the United States because of restrictions on silicone. Saline implants were first manufactured in France in 1964. The shells of the saline implant are made of silicone elastomer and the implants are filled with salt water after the implant is placed in the body. Since the implants are empty when they are surgically inserted, the scar is smaller than is necessary for silicone gel breast implants (which are filled with silicone before the surgery is performed). Saline implants can be inserted through any four of the insertion methods discussed above. (

In 1992, the US Food and Drug Administration (FDA) reclassified silicone breast implants as experimental and restricted them to clinical trials, primarily for women needing reconstruction after mastectomy or breast deformity, or for women with implants that need to be replaced. This ban was due to reports linking the implants with a variety of connective tissue diseases and neurological disorders. (

A new study is being performed with cohesive-gel silicone (or gummy bear) implants in a few areas of the US. Unlike liquid-filled implants (saline and liquid silicone), a high-strength gel implant maintains its shape and upright position, which decreases the incidence of the implant shell folding and the development of rippling. Also unlike liquid-filled implants, high-strength gel implants do not leak if the implant shell is broken. These implants are starting to become available in various sizes and dimensions. The incision to insert a semi-solid implant must be slightly larger because that type insert can't be rolled up like a saline implant. This eliminates the ability to insert the gummy bear implant through the belly-button or armpit.( High-Strength gel is a form of silicone that, due to tighter molecular bonds in the silicone, is semi-solid. When it is cut, it is similar to cutting into a gummy bear. If the silicone rubber shell of a high-strength gel implant is cut or punctured it maintains its shape and does not leak. (

Breast Augmentation - Saline Breast Implants
Breast Augmentation - Silicone Breast Implants
Breast Augmentation - Gummy Bear Silicone Implants

Evolution of Silicone Implants

Implant Generation Production Period Characteristics
1st Generation 1960s Thick Shell (0.25mm average)

Thick, Viscous Gel

Teardrop shape

Dacron Patch
2nd Generation 1970s Thin Shell (0.13mm average)

Less Viscous Gel

Dacron Patch discontinued

Double Lumen Implants Introduced

Polyurethane Implants Introduced

Round shape
3rd Generation 1980s - 1992 Thick, Barrier Coat Shells

Round shape
4th Generation 1992-present Stricter manufacturing standards; Refined 3rd Generation devices

More Cohesive Gel

Textured Surfaces

Round & Anatomic Shapes
5th Generation 1993-present Highly Cohesive Gel

Form-stable Anatomic Design

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