breast augmentation breast augmentation breast augmentation and augmentation mammoplasty is a cosmetic surgery technique using breast-implants and fat-graft mammoplasty techniques to increase the size, change the shape, and alter the texture of the breasts. augmentation mammoplasty is applied to correct congenital defects of the breasts and the chest wall. as an elective cosmetic surgery, primary augmentation changes the aesthetics – of size, shape, and texture – of healthy breasts. breast augmentationthe pre-operative aspects (left), and the post-operative aspects (right) of a bilateral, sub-muscular emplacement of 350 cc saline implants through an infra-mammary fold (imf) incisionspecialtyplastic surgeon the surgical implantation approach creates a spherical augmentation of the breast hemisphere, using a breast implant filled with either saline solution or silicone gel; the fat-graft transfer approach augments the size and corrects contour defects of the breast hemisphere with grafts of the adipocyte fat tissue, drawn from the person's body. in a breast reconstruction procedure, a tissue expander (a temporary breast implant device) is sometimes put in place and inflated with saline to prepare (shape and enlarge) the recipient site (implant pocket) to receive and accommodate the breast implant prosthesis. in most instances of fat-graft breast augmentation, the increase is of modest volume, usually only one bra cup size or less, which is thought to be the physiological limit allowed by the metabolism of the human body. surgical breast augmentation breast implants there are four types of implant: saline implants filled with sterile saline solution. silicone implants filled with viscous silicone gel. alternative-composition implants (no longer manufactured), filled with various fillers such as soy oil or polypropylene string. "structured" implants using nested elastomer silicone shells with saline between the shells. saline breast implant the saline breast implant, filled with saline solution, was first manufactured by the laboratoires arion company, in france, and introduced for use as a prosthetic medical device in 1964. modern-day versions of saline breast implants are manufactured with thicker, room-temperature vulcanized (rtv) shells made of a silicone elastomer. 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 prosthesis for "corrective breast surgery". nonetheless, in the 1990s, the saline breast implant was mandated to be the prosthesis usual for breast augmentation surgery, the result of the u.s. food and drug administration's (fda) temporary restriction against the importation of silicone-filled breast implants. the technical goal of saline-implant technique was a less-invasive surgical technique, by inserting an empty, rolled-up breast implant through a smaller surgical incision. in surgical practice, after having installed the empty breast implants in the implant pockets, the plastic surgeon would then fill each device with saline solution through a one-way valve and, because the required insertion incisions were short and small, the resultant incision scars would be smaller and shorter than the surgical scars typical of the pre-filled, silicone-gel implant surgical technique. when compared with the results achieved with a silicone-gel breast implant, the saline implant can yield "good-to-excellent" results of increased breast size, a smoother hemisphere-contour, and realistic consistency; yet it is likelier to cause cosmetic problems, such as the rippling and the wrinkling of the breast-envelope skin, and technical problems, such as the implant's presence being noticeable to the eye and to the touch. the occurrence of such cosmetic problems is likelier in the case of a person with very little breast tissue; in the case of a person who requires post-mastectomy breast reconstruction, the silicone-gel implant is the technically superior prosthetic device for breast reconstruction. in the case of the person with much breast tissue, for whom sub-muscular placement is the recommended surgical approach, saline breast implants can give an aesthetic result much like that produced by silicone breast implants: an appearance of proportionate breast size, smooth contour, and realistic consistency. silicone-gel breast implant the modern prosthetic breast was invented in 1961, by the american plastic surgeons thomas cronin and frank gerow, and manufactured by the dow corning corporation; in due course, the first augmentation mammoplasty was performed in 1962. there are five generations of medical device technology for the breast-implant models filled with silicone gel; each generation of breast prosthesis is defined by common model-manufacturing techniques. first generation the cronin–gerow implant, prosthesis model 1963, was a silicone rubber envelope-sack, shaped like a teardrop, which was filled with viscous silicone-gel. to reduce the rotation of the emplaced breast-implant upon the chest wall, the model 1963 prosthesis was affixed to the implant pocket with a fastener-patch, made of dacron material (polyethylene terephthalate), which was attached to the rear of the breast implant shell. second generation in the 1970s, manufacturers offered the second generation of breast implant prostheses the first developments were a thinner-gauge implant shell, and a filler gel of low-cohesion silicone, which made the devices more functional and realistic (size, appearance, and consistency). yet, in clinical practice, second-generation breast implants proved fragile, with greater rates of shell rupture and filler leakage ("silicone-gel bleed") through the "intact device's shell. the consequences, plus increased rates of capsular contracture, precipitated faulty product class action-lawsuits by the u.s. government against the dow corning corporation and other manufacturers of breast prostheses. the second technological development was a polyurethane foam coating for the shell of the implant; the coating reduced the degree of capsular contracture by causing an inflammatory reaction that impeded the formation of a capsule of fibrous collagen tissue around the coated device. nevertheless, despite the intentions behind the polyurethane foam coating, the medical use of polyurethane-coated breast implants was briefly discontinued due to the potential health risk posed by 2,4-toluenediamine (tda), a carcinogenic by-product of the chemical breakdown of the polyurethane foam coating of the breast implant. after reviewing the medical data, the fda concluded that tda-induced breast cancer was an infinitesimal health risk to anyone with breast implants, and did not justify legally requiring physicians to explain the matter to their patients. ultimately, polyurethane-coated breast implants remain in plastic surgery practice in europe and in south america; no manufacturer has sought fda approval for medical sales of such breast implants in the u.s. the third technological development was the double-lumen breast implant, a double-cavity prosthesis composed of a silicone breast implant contained within a saline breast 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 whose volume is post-operatively adjustable. unfortunately, the more complex design of the double-lumen breast implant had a device-failure rate greater than that of single-lumen breast implants. this style of implant, in modern times, is primarily used for breast reconstruction. third and fourth generations in the 1980s, the third- and fourth-generation implants were stepwise advances in manufacturing technology, such as elastomer-coated shells that decreased gel bleed (filler leakage), and a thicker, increased-cohesion filler gel. the manufacturers of implantable breast prostheses then designed and made anatomic models (like the natural breast) and "shaped" models, which realistically corresponded with the breast and body types of actual women. the tapered models of breast implant have a uniformly textured surface, to reduce rotation of the prosthesis within the implant pocket; round models of breast implant are available in both smooth-surface and textured-surface models, as rotation is not an issue. fifth generation since the mid-1990s, the fifth generation of silicone gel breast implant is made of a semi-solid gel, which mostly eliminates the occurrences of filler leakage ("silicone-gel bleed") and of the migration of the silicone filler from the implant-pocket to other areas of the person's 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 relatively lower rates of capsular contracture and of device-shell rupture, and relatively greater rates of "medical safety" and "technical efficacy" than those of early-generation breast implants. alternative-composition implants saline and silicone gel are the most common types of breast implant used in the world today. alternative-composition implants have largely been discontinued. these implants featured fillers such as soy oil and polypropylene string. other discontinued materials include ox cartilage, terylene "wool", ground rubber, silastic rubber, and teflon-silicone prostheses. "structured" implants structured implants were approved by the fda and health canada in 2014 as a fourth category of breast implant. these implants incorporate both saline and silicone gel implant technology. the filler is saline solution, in case of rupture, and has a natural feel, like silicone gel implants. this implant type uses an internal structure consisting of three nested silicone rubber "shells" that support the upper half of the breast, with the two spaces between the three shells filled with saline. the implant is inserted, empty, then filled once in place, which requires a smaller incision than a pre-filled implant. implants and breastfeeding the breasts are apocrine glands which produce milk for the feeding of infant children, breast augmentation: cross-section scheme of the mammary gland. chest wallpectoralis muscleslobulesnippleareolamilk ductfatty tissueskin envelope a functional breast: a mammary gland feeding an infant child. breast implant toxicity digestive tract contamination and systemic toxicity due to the leakage of breast implant filler to the breast milk are the principal infant-health concerns with breast implants. breast implant fillers are biologically inert: silicone filler is indigestible and saline filler is mostly salt and water. each of these substances should be chemically inert and present in the environment. moreover, "proponent" physicians have stated that there "should be no absolute contraindication to breast-feeding by women with silicone breast implants." in the early 1990s, at the beginning of the silicone gel breast implant illness panic, small-scale, non-randomized studies indicated possible breast-feeding complications from silicone implants; no one study was able to demonstrate disease causality due to implants. impediments to breastfeeding a person with breast implants is usually able to breastfeed an infant; yet implants can cause functional breastfeeding difficulties, especially with mammoplasty procedures that involve cutting around the areola, and implant placement directly beneath the breast, which tend to cause greater breast-feeding difficulties. patients are advised to select a procedure which causes the least damage to the lactiferous ducts and the nerves of the nipple-areola complex (nac). functional breastfeeding difficulties arise if the surgeon cuts the milk ducts or the major nerves innervating the breast, or if the milk glands are otherwise damaged. some surgical approaches, including imf (inframammary fold), taba (trans-axillary breast augmentation), and tuba (trans-umbilical breast augmentation), avoid the tissue of the nipple-areola complex; if the person is concerned about possible breast-feeding difficulties, the periareolar incisions can sometimes be made so as to reduce damage to the milk ducts and to the nerves of the nac. the milk glands are affected most by subglandular implants (under the gland), and by large-sized breast implants, which pinch the lactiferous ducts and impede milk flow. small-sized breast implants, and submuscular implantation, cause fewer breast function problems; however, some women have managed to successfully breastfeed after undergoing periareolar incisions and subglandular emplacement. the patient further information: body dysmorphic disorder, body image, and beauty psychology 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, had low self-esteem, presented frequent occurrences of psychological depression, had attempted suicide, and had body dysmorphia – a type of mental illness wherein she perceives non-existent physical defects. post-operative patient surveys about the mental health and the quality of life of the women, reported improved physical health, physical appearance, social life, self-confidence, self-esteem, and satisfactory sexual functioning. furthermore, most of the women reported long-term satisfaction with their breast implants; some despite having had medical complications that required surgical revision, either corrective or aesthetic. likewise, in denmark, 8.0 percent of breast augmentation patients had a pre-operative history of psychiatric hospitalization. women bodybuilders breast augmentation is an occasional recourse for women bodybuilders to retain the female figure lost when achieving a lean and muscular physique. (professional bodybuilder nikki fuller) the cosmeticsurgery.com article they need bosoms, too – women weight lifters (2013) reported that women weight-lifters have resorted to breast augmentation surgery to maintain a feminine physique, and so compensate for the loss of breast mass consequent to the increased lean-body mass and decreased body-fat consequent to lifting weights. mental health