30 years ago when I first started performing breast augmentation the options for implants and incisions were quite limited. Don't get me wrong, were getting great results with smooth round saline and silicone implants placed through the areola or underneath the breast. Around that time an implant (the Meme) of thicker silicone and wrapped in a polyurethane was found to decrease capsular contracture right significantly even if placed above the muscle. (We did finally confirm in the 80's that the placement of the implants behind the muscle was causing less capsular contracture (hardening of the breasts) than above the muscle placement or as it is known more properly subglandular placement.) Unfortunately, this device was taken off the market in 1991 with concerns that the polyurethane manufacturing left residue on the implant which could be toxic. However the texture which was used was thought to contribute to the lower capsular contracture right. Thanks to this early implant the textured implants that are now available in known as the gummy bear or form stable implants were developed. These implants I believe have a greater place when we're reconstructing breast after cancer ordering complex cases. There is a place for a textured anatomical implant as a first choice in breast augmentation in some cases. I believe that I can deliver a great result in breast augmentation in approximately 90% of the cases with a round smooth implants placed behind the muscle. In some cases of switching the implant from below the muscle to above the muscle I used a space called the sub-fascial where we tried to get the best of both worlds. In those cases the gummy bear or form stable textured anatomical implants are the best option. I often use this operation when the patients have an overdeveloped pectoral muscle from their time spent at the gym. Placement of the implant below the muscle in these cases could result in a hyperactive-appearing breast with every pectoral contraction. If there is significant breast tissue to start with this is not really a problem.
in the early 90s the trans-axillary or armpit incision was popularized can I became enamored with this approach for approximately 2 years. At that time the use of the endoscope for proper dissection and hemostasis was not used in plastic surgery sewed the placement of the implants through the armpit was rather imprecise. A novel but rather crude approach known as the trans-umbilical or bellybutton approach was then popularized in the media. The incision was made in the bellybutton and the placement was above the muscle and somewhat blind. Although initially these usually overinflated saline implants look great, in a couple years they usually drop like falling throat as a lot of the ligaments that naturally held the breast in place were disrupted. The use of the endoscope and plastic surgery briefly brought back the transaxillary or armpit approach. A steady performed approximately 5 years ago related each incision for contributing to capsular contracture right. The hiatus was the armpit or transaxillary approach followed by the periareolar or nipple approach and release the inframammary approach. The current thought was that either the sweat glands of the armpit or the milk producing glands exiting through the nipple contain bacteria live in them and will jump on the implants as they're passing the area and while not causing an infection would contaminate the surface enough to irritate the body. This would lead to the bodies reaction causing a capsular contracture or hardening. This has caused me to change the majority of my augmentation from the peri areolar to the inframammary incision. The trans-umbilical augmentation mammoplasty or TUBA has never really taken off in the plastic surgery field.
With the information that bacteria on the skin could contribute to implant infections and hardening, the use of a malleable plastic funnel was developed.The Keller insertion funnel is used to deliver the implant into the space created without it touching the skin was developed. The stress on the implant is also reduced minimizing the possibility and probability of an early leak of the device.
The next great piece of information was that the confirmation of the benefits of using an antibiotic solution to wash the pocket before placement of the implant. The studies concluded S chance of an infection and the lower capsular contracture rate..
The last great advance in breast augmentation actually is the improved precision in which the correct implant can be chosen for the individual patient. This is been possible thanks to a remarkable 3-dimensional camera and software system known as the Vectra 3-D system. With this technology the individual can see how they would look with any of these devices and any size before stepping into the operating room. While all this information can be overwhelming, it is also very important for those individuals desiring as close to a perfect outcome as possible!