==== ====For more information on breast augmentation procedures click here:www.breastbigger.co.uk==== ====According to the American Society of Aesthetic Plastic Surgery (ASAPS), nearly 400,000 breastimplant operations were performed in the USA during 2007, a rise of 4% on the previous year.In the UK, data from BAAPS, the British Association of Aesthetic Plastic Surgeons shows that theappetite for a full bosom is just as strong here as in America, with just under 6,500 breastaugmentation operations performed by its members in 2007, up 6% on the 2006 audit; making itthe most popular cosmetic surgery procedure in the UK, and accounting for 20% of all cosmeticsurgery operations carried out by BAAPS members.Add to that data from The Harley Medical Group, one of the UKs largest cosmetic surgery chains,who have seen the demand for breast enlargement rise by 39% in the last 25 years, and who notethat it accounted for 30% of all procedures performed in its clinics in the last 12 months, and itshows the obvious popularity of this procedure.Industry analysts Mintel also put the UK spend on breast augmentation in 2005 at£100million with expectations that this will rise dramatically year on year.With such a strong demand, its no surprise to discover that both new developments in implanttechnology and alternative techniques and procedures for breast augmentation have dominatedresearch by many aesthetic companies in recent years.In this months feature article we look at some of the new ways companies are offering to give youthe bust you always dreamed of.A Brief History of Breast AugmentationThere are many reasons why women choose to seek a breast augmentation or enhancementprocedure. Whether for reasons of self confidence and dissatisfaction with the size and shape oftheir breasts, or because of congenital abnormalities from birth, asymmetry, trauma, such as postcancer mastectomies, or simply to regain the breasts that they feel they had before childbirth andbreast feeding. Breasts denote a feeling of womanliness and therefore hold great psychologicalpower over the female mind. Hence, methods of breast enlargement have been dabbled with,sometimes with the most dubious of substances, from the early 1930s onwards.The first breast implants were developed by two plastic surgeons from Texas, Frank Gerow andThomas Cronin, in the early 1960s. These were filled with silicone and signalled the beginning ofthe breast implant revolution as we know it. Saline implants filled with a salt water solution wereintroduced in 1965.
In the early 1990s, breast implants became the subject of heated controversy as reports of womenclaiming their silicone implants had seriously damaged their health became widely publicised inthe American media. This, and a handful of court cases, caused the U.S. Food and DrugAdministration (FDA) to issue an outright ban on the use of silicone-gel filled implants for cosmeticaugmentation in January 1992. At the time many claimed that this was politically and sociallymotivated rather than based on any scientific proof; and following the submission of large scaleclinical data from the various manufacturers involved, the ban was subsequently lifted in 2006.Due to the 14 year gap, saline implants dominated the market in the U.S., whilst with no such banexisting or ever having existed in the U.K. silicone implants have always been the favoured option.Although with the more natural shape and feel achievable with silicone filled devices and theadvancements in their make-up during the interim period, many U.S. surgeons are now starting toturn away from saline since the lifting of the FDA ban, with ASAPS statistics showing a move to a60 - 40 split of saline versus silicone procedures last year, up from an 80 - 20 split in 2006.Traditional taboos regarding breast augmentation have also fallen by the wayside in recent years,with more and more woman in their thirties, wanting a natural outcome with a modest increase inbreast size, following pregnancy and childbirth turning up in the surgeons waiting room. Breastimplants are no longer simply the choice of the glamour model, lap dancer or celebrity copyingteenager. Implant manufacturers themselves have also noticed a growing trend in the demand forsmaller implant sizes and more natural, anatomical shapes which are preferred by thisdemographic.So Whats Involved in Breast Augmentation Surgery?Aside from the type of implant to be used, the primary consideration involved in a breastaugmentation operation is deciding if the implant should sit above or below the pectoral or chestmuscle within the breast area.If the implantation is carried out above the muscle, but below the glandular breast tissue, this isreferred to as sub glandular. Conversely, an implant placed below or underneath the muscle isreferred to as sub muscular. In both cases, an incision is generally made either below the base ofthe breast, in the natural crease created there by gravity, or within the armpit area adjacent to thebreast. A pocket is then created by separating out the various tissues, into which the implant canbe safely and correctly fitted without causing any squashing of the implant due to an inadequatesized pocket.The decision regarding the most appropriate method and implant type to use on an individualpatient is often reliant on the structure of the chest area prior to surgery, with considerations suchas how much natural breast tissue is already available and the integrity of it, as well as the BMI ofthe patient all factoring into the decision making process for the surgeon.Mr Rajiv Grover, Consultant Plastic Surgeon, Secretary of the BAAPS and medical advisor to TheConsulting Room(TM) comments on a recently pioneered technique which he believes hasrevolutionised his practice."The American surgeon John Tebbetts introduced the concept of the Dual Plane which differs inplacing the implant below the muscle but also separating the gland from the muscle so the two canslide on each other. This allows a woman who is thin and has a minor degree of droop to have
breast enlargement, but also the implant can give the nipple a lift without needing a specific upliftwhich would leave scars on the breast.""Most surgeons who perform a lot of this operation would probably agree that you need to placethe implant where it would look most natural for each patient. I use 65-70% under muscle (usuallywith dual plane) and 30-35% above muscle (sub glandular)"; concludes Rajiv.Other, more controversial techniques have been tried in recent years, including the placement ofsaline implants in the breast area (prior to filling) following an incision in the umbilicus or bellybutton area, aimed at avoiding any scarring in the breast area. Dissecting the pocket for theimplant from this access point is considered to be very inaccurate and creating the finer nuancesof symmetry and breast cleavage is not as controllable so many surgeons regard this as more of amarketing gimmick rather than a tried and tested technique for breast augmentation.Breast augmentation is primarily performed under a general anesthesia in a hospital setting,although some offer a twilight sedation method involving the use of a local anesthesia and asedative, so you remain awake throughout the procedure, but in a drowsy state with no feelings ofpain or discomfort. If there is no facility for an overnight stay at the clinic where the surgery isbeing carried out, such ambulatory or out-patient practices may be more commonplace, especiallyin America. Most surgeons would argue that the use of a full general anesthesia gives themmaximum control and safety and would generally recommend this as the best option for theirpatients. Certainly this is the preferred option in the UK.Surgery to enlarge or enhance the breasts isnt something to be taken lightly, and carries as manyrisks as would be associated with other types of surgery, both from the anesthesia and thepossibilities of scarring or post-surgical infections.A condition known as capsular contracture is one of the most common risks or complicationsfollowing breast implant surgery. This happens because, if a foreign body, such as an implant, isintroduced into the chest, your body will automatically grow a wall of scar tissue around it as aprotective process against the alien invader. This scar tissue can then contract, pushing into theimplant and causing it to deform. Often, the implant becomes hard and, in some cases, painful.The implant may then have to be removed, along with the capsule of scar tissue and replaced, ifappropriate, with another implant.Recent changes in implant design with the introduction of textured implants (implants that have aroughened surface as opposed to a smooth one) and cohesive silicone gel which does not leak orbleed from the implant have reduced the likelihood of capsular contracture from an estimated 15%of all cases, 10 years post surgery, to a rate of more like 4 - 5 %.New Advances in Implant TechnologyAccording to Millennium Research Groups Global Markets for Breast Implants 2008 report, theU.S. breast implant market was worth over $378 million in 2007 and is expected to grow by atleast 10% a year to over $620 million in 2012, driven in large part by the FDA re-approval ofsilicone breast implants.The two market leading, global manufacturers of silicone and saline breast implants are Mentor
Corporation and Allergan Inc., (having previously bought out Inamed Inc. in 2006); althoughseveral other smaller manufacturers exist, such as Nagor, Poly Implant Prosthesis, Eurosiliconeand Polytech Silimed.All of Allergans and Mentors silicone gel implants are now made from an outer silicone shell andan inner cohesive silicone gel filling, which means that the gel filler acts as a solid, rather than aliquid, and cannot leak, whilst still retaining a natural feel that is said to better resemble actualbreast tissue. This advancement in silicone technology has yet further increased the safety ratingof silicone implants, compared to earlier more liquid developments.In America, such cohesive silicone gel implants have been nicknamed gummy bear implants dueto the comparison of the consistency of the implant, if you were to cut one in half, with that of thechildrens jelly sweets.Rajiv Grover believes the most revolutionary advancement in implant technology to arrive in recentyears is the introduction of the tear drop shaped implant, which allows a more natural look forwomen who have a thin chest, particularly after breast feeding.The move away from the typical spherical or round shaped implant to more anatomicallycontoured developments, which are thinner at the top than at the bottom, thus mimicking the effectgravity has on normal breast tissue, has meant that surgeons are now able to offer their patients aresult which is more aesthetically pleasing; looking less like a person has actually had breastimplant surgery.Such contoured or tear drop implants are available in a variety of shapes according to twodiffering parameters, known as implant height and implant profile or projection. The height refersto the size and shape of the implant footprint, i.e. the section that sits against the chest itself onceimplanted. This choice will vary according to how wide or narrow the patients chest is. The profileor projection refers to how far outwards the drop on the tear comes away from the chest, as anatural breast would. The actual cup size or volume can then be decided on once the anatomicalshape has been established.Another recent advancement in implant technology is the adjustable implant designed to correctthe problem of asymmetry or lop-sided breasts, where one breast is either significantly smallerthan the other, sometimes by as much as one cup size, or where one sits higher than the other onthe chest. Asymmetry can arise due to congenital defects that a person was born with, or acquiredthrough trauma or childbirth and breastfeeding. Such problems can cause self consciousness andlow self image, which can dramatically impact on lifestyle and relationships.Consultant Plastic & Reconstructive Surgeon, Mr. David Ross, who heads Plastic SurgeryW1 in Central London, says: There is no doubt that breast asymmetry can have a profound effecton many womens quality of life. For these women it is important to correct this, which is why theyopt for surgery."According to a recent UK survey of 2,500 women carried out by Mentor Medical Systems, a thirdof those polled were not happy with the shape of their breasts, with 15% only being happy oncethey had added some form of padding to the area. 1 in 10 respondents also claimed a whole cupsize difference between their breasts, while a third said one sits lower than the other.
Mentor has now developed their unique Spectra® range to address the problem of moderateasymmetry. Their round implant is designed on the principle of a bag-within-a-bag, whereby anouter textured silicone casing holds an adjustable inner chamber which is filled with a salinesolution via a self-sealing valve system and tubing. This enables the surgeon to alter the volume ofeach implant individually during the operation until the desired level of symmetry is obtained, atwhich point the tubing is removed.This system differs from a traditional single shell saline implant as the outer silicone casing comesin a variety of densities with a differing size inner vessel for saline inclusion. This gives theimplants more of the natural breast mimicking qualities of cohesive silicone gel implants but withthe added adjustability created by the addition of saline within to correct any asymmetries.Alternative Solutions for Breast AugmentationFat TransferThe potential use of fatty tissue for breast augmentation has been talked about for years, bothwithin the medical field and amongst the layperson. Most women out there will admit to havingthought at one time or another, "wouldnt it be great if only I could move the fat in my bottom up tomy breasts instead".Previously, although some surgeons have tried to graft liposuctioned fat from the thighs, buttocksor abdomen into the breast region, transplantation has been far from successful with resultsremaining only temporarily as the fat is ultimately absorbed by the body. Additional more seriouscomplications, such as fat calcification or hardening of the injected fat cells, which cause benignlumps within the breasts, have also been reported. Such lumps create both worry and confusionduring routine mammogram checks for breast cancer tumours.Further studies evaluating the safety, efficacy, technique and appropriate patient selection for thistype of procedure are ongoing in American funded by the Aesthetic Surgery Education andResearch Foundation.Meanwhile, Cytori Therapeutics Inc. has developed the Cellution(TM) System designed toautomate the extraction and isolation of stem and regenerative cells from liposuctioned fat, readyfor reinjection into a patient.Adipose or fat is one of the bodys richest and most accessible sources of regenerative cells.Adipose-derived regenerative cells include adult stem cells in addition to other important cell typesthat have been shown to improve tissue retention compared to non- cell enhanced tissuetransfers. For this reason, Cytori believe that these cells potentially may improve fat transferprocedures, as well as enable more predictable outcomes and retention when applied to cosmeticand reconstructive surgery.The system is currently undergoing substantial clinical trials both in Japan and in Europe toexamine the effect of adult stem and regenerative cells derived from adipose tissue in breastaugmentation. In the studies, a patients breast is augmented with her own liposuctioned fat, whichhas been combined and enhanced with her own fat-derived stem and regenerative cells. The
results and volume retention will then be evaluated at regular intervals by independent evaluators.Current studies are focusing on breast reconstruction applications, such as following partialmastectomy, however if proven successful the technology will no doubt be commercialised as analternative to traditional breast implant operations.Hyaluronic AcidIn March this year, we reported on the introduction of Q-Meds Non-Animal Stabilised HyaluronicAcid (NASHA) technology in its new Macrolane(TM) VRF product being used for volumeenhancements including breast augmentation.Macrolane(TM) VRF is currently indicated and CE approved for volume restoration and shaping ofbody surfaces, for example, shaping of the breasts, calves and buttocks and also for evening outdiscrepancies in skin surface such as those sometimes caused by liposuction.Although the use of Macrolane(TM) in the breast is currently available under the body shapingindication, and can achieve approximately a one to one and a half cup size increase in mostwomen, ongoing research is being conducted to further evaluate the efficacy of its use in this areaand to establish the best techniques and protocols for the procedure.Treatment involves a small 2-3mm incision in the crease under each breast, and the injection ofthe substance (100ml per breast) using a thin cannula or large gauge spinal needle deep into thesubcutaneous skin layer above the muscle, under local anaesthetic. The product is placedunderneath the breast tissue, much like an implant, so does not threaten the functioning of thebreast in the event of future breast feeding.Initial patient feedback is very positive, with many noting that they are unable to feel anythingsignificantly different in their treated breasts from how their own natural breasts felt; this isparticularly noted in those patients where only one breast is treated for asymmetry, giving animmediate split-body comparison. Additionally the free movement of the breast to create a naturalcleavage and to fit correctly in underwear is said to be unaffected, areas which are oftendramatically altered with the addition of traditional breast implants.According to Q-Med, Macrolane(TM) is intended to last for 12-18 months in the body, dependingon the amount of volume used, although it recommends that each individual treatment programmeincludes a yearly top-up, as required, to maintain the optimal results, and that potentially over timethis top-up may reduce in quantity. It will be some time however before long term data on theaverage duration is properly known.With costs for treatment starting in the region of £2,800, with top-up treatments of£1,400, this could prove to be more costly than traditional breast augmentation in the longterm. However, the more temporary and less invasive nature of the procedure may well appeal toa wider audience than surgical options.Mechanical StimulationThe use of sustained mechanical force to promote tissue growth in the breasts, and hence cause
the breasts to enlarge, has been touted as a new method to achieve a modest ½ to 1 cupsize improvement in breast size for a number of years now.The Breast Enhancement and Shaping System, marketed under the brand name Brava®, ismuch like wearing a very large bra which is fitted with two silicone domes and a motor and wornby the patient for a minimum of ten weeks, for ten hours a day, (usually at night). The principle ofthe procedure is that the breasts are gently stretched by the motor in the bra which causes them toexpand during the night.While some doctors have reported promising results with this technique, others claim widespreadfailure to achieve satisfactory results. Consequently, patients have often been disappointed withthis treatment.However, one study carried out in Europe and published in November 2007, reported that themajority of women who completed a trial using the Brava System increased their breast size by anaverage of 155cc, or well over one full breast cup size, (range: 95cc to 300cc).Of the 40 women (aged 17 - 53 years old) who completed the study, the average participant usedthe system for 11 hours per day for an average of 18½ weeks (range: 14 to 52 weeks).Overall, 75% were said to be either "satisfied" or "very satisfied" with their results. However,12.5% were reported to be disappointed because of little growth, which the investigators put downto lesser intensity of wear of the device and low body mass individuals. Over 85% stated that theywould "recommend it to a friend", although 12.5% who had acknowledged enlargement of theirbreasts considered the treatment too bothersome. All of the surveyed participants indicated that"the treatment was painless."All 40 women were evaluated at an interval averaging 10 months after discontinuation of treatment(range: 7 to 20 months). It was shown that not only did they maintain their breast volume growth,but sustained it long after the stabilisation phase.The investigators concluded that to avoid disappointment and early discontinuation with thedevice, women should be well informed about the time and lifestyle commitment required.The manufacturers of the Brava System hailed this as a significant clinical result since previouspublished medical studies had demonstrated an average breast size increase of 100cc, or one-cup size, when wearing the Brava System for 10 weeks. Although one could argue that thechances of it producing a more pronounced result after more prolonged wear were highly likely inthe first instance.The cost of Brava systems start from approximately $1,300 (£650).SummaryWith more and more women simply not prepared to sit back and do nothing about breasts thatbother them and cause them to be self-conscious, and with an increase in the social acceptanceof breast augmentation, fuelled somewhat by media coverage and celebrity stories, it is no wonderthat this is now the number one global cosmetic surgery procedure.