Breast Implants/Breast Reconstruction

Over the past 30 years, breast reconstruction and cosmetic breast augmentation surgery has undergone immense evolution, striving to improve the physical appearance and the quality of life of an individual. Breast reconstruction is typically performed in the surgical management of individuals with breast cancer and can entail the use of breast implants, whereas cosmetic breast augmentation is primarily done for purely cosmetic purposes.

In the surgical treatment of breast cancer, a mastectomy is typically performed, which entails the removal of breast tissue, relevant skin, and the nipple-areolar complex. Therefore, the primary aim of breast reconstruction following a mastectomy is to reconstruct the breast mound and the skin. A secondary objective is the reconstruction of the nipple-areola complex and possibly the neighboring breast to obtain a certain aesthetic symmetric outcome. The timing of breast reconstruction varies, being either immediate or delayed. Furthermore, various breast reconstruction techniques are performed and include nonautologous methods (fixed volume breast implants, breast expanders), combination of nonautologous and autologous methods (latissimus dorsi flap with breast implants), autogenous methods (deep inferior epigastric artery perforator, extended latissimus dorsi flap, superior gluteal artery perforator flap, and transverse rectus abdominus myocutaneous flap), and oncoplastic methods (breast lift or breast reduction techniques).

In cosmetic breast augmentation surgery, a popular form of aesthetic enhancement and reconstruction entails the use of an artificial implant. Breast implants provide greater symmetry than alternative methods, are versatile in size and morphology, and provide natural aesthetics as compared to alternative methods. In 1962, plastic surgeons Cronin and Gerow invented silicone gel breast implants. Since then, over two million women in the United States and Canada have received these implants. Of those utilized, 20 to 30 percent were implemented for reconstruction and 70 to 80 percent were used for cosmetic augmentation. Because of reports of silicone leakage, other complications, and the need for further investigation, saline implants were developed and are also currently being utilized. These implants are composed of a saline-filled inner core with a cross-linked layer of silicone elastomer envelope that is in direct contact with the periprosthetic capsular tissue following implantation. These implants allow ease of surgical implementation and quick postoperative recovery.

Plastic surgery has enjoyed much attention and wide success, especially in the past two decades when the surge of breast implantations gained particular attention. Many factors are at play in regards to patient outcome in reconstructive and cosmetic breast implant surgery. Time of surgery, patient acceptance, complication rates, and cost effectiveness are issues [Page 309]that are thoroughly examined before surgical intervention is sought. Costs of such treatment vary between physicians.