Enlarging mammoplasty, history of development of breast augmentation methods

The development of methods for breast augmentation includes five main directions:

• introduction of various semi-liquid synthetic materials and one's own adipose tissue into tissues by injection;
• implantation alloplasty of adipose tissue taken from cadavers;
• implantation of artificial mammary glands (endoprostheses) made from synthetic materials;
• reconstructive mammoplasty by transplanting sections of the patient's tissue;
• AA Vishnevsky method.

Injection methods. The introduction of liquid paraffin was proposed by R. Gersuny in 1887. The results of using this method were terrible. Patients were left with dense heavy masses of foreign matter in the chest, which became hard and painful. The most severe complications were embolism of the vessels of the brain and lungs, blindness.

Introduction of synthetic gels. Silicone gel was first introduced for breast augmentation in 1959. Early results were often good, but later most patients developed inflammatory changes and painful lumps at the injection sites. Subsequent studies of this method showed that its frequent complications are gel migration and formation of painful lumps. Our research has established that in all cases without exception, the gel injected into the mammary gland, regardless of its type (PAGInterfal, Pharmacryl), widely spreads in the tissue of the mammary gland and in the pectoralis major muscle. However, the boundaries of its spread are not precisely defined. The gel injected into the tissue is detected as: 1) dense scar-gel conglomerates with relatively clear boundaries; 2) loose, encapsulated, relatively large masses; and 3) diffuse tissue impregnation.

In most observations, all these forms are combined with each other in one or another combination. The introduction of the gel can lead to a pronounced purulent or purulent-necrotic process in the early postoperative period. In some cases, suppuration of the tissues surrounding the gel occurs at a later date. However, a more significant circumstance is that the presence of gel in the tissues of the mammary gland complicates the diagnosis of its diseases, including the most dangerous - cancer, and the results of treatment become significantly worse. In this regard, the introduction of synthetic gels into the mammary gland is currently prohibited in all Western European countries and in the USA. In Russia, breast augmentation with gel, unfortunately, is still used, as a rule, by non-specialists who do not have modern methods of mammary gland plastic surgery.

Introduction of adipose tissue. A special place is occupied by injection of adipose tissue taken from the patient's body into the mammary gland. While creating an excellent early result, the injected fat can subsequently be absorbed, so this method has not found wide application.

Implantation of biological allomaterials. A new era in the development of methods for breast augmentation began in 1940 with the use of skin fat grafts taken from cadavers.

They were placed under the muscle, thereby creating additional volume. At the same time, the transplanted tissues remained foreign to the body and caused a chronic inflammatory reaction of the surrounding tissues. Its results were the formation of powerful scars around the fat prostheses and the development of infection. The high frequency of complications did not allow this method to spread. Nevertheless, it was used in Russia until the early 90s.

Implantation of foreign materials. In 1936, E. Schwarzmann performed the first implantation of glass beads to enlarge the mammary glands. However, this method was used for a relatively short time due to the development of polymer chemistry and the appearance of highly inert synthetic materials. The first synthetic mammary gland endoprostheses began to be used in 1950. They were made of ivalon sponge, and later - of etheron. The simplicity of the operation and good early results quickly made this intervention very popular. However, it soon became clear that the late results were disappointing: the development of scar tissue and its ingrowth into the prosthesis led to compaction and deformation of the mammary gland.

In 1960, the first silicone prostheses appeared, which revolutionized breast surgery. They were filled with isotonic sodium chloride solution or silicone gel. The incidence of a powerful scar capsule compressing the prosthesis fell from 100% (when using sponge prostheses) to 40% and below (when using silicone prostheses) [16, 24].

Further development of this method was directed towards improving the design of prostheses, their surface and implantation techniques. Silicone endoprostheses remain the most studied and popular in the world.

This operation has become one of the most common in aesthetic surgery. Thus, until 1992, more than 150 thousand such interventions were performed annually in the USA alone.

"Implant Crisis" in the USA. During 1990-1991, a campaign against the use of silicone implants developed in the USA. It was based on a lawsuit brought against the manufacturer of the endoprostheses by a patient who had undergone the operation, on the grounds that it had caused damage to her health.

The case won in court, with the "victim" receiving a substantial monetary compensation, received wide publicity in the press and caused an avalanche-like growth of similar cases. This artificially created phenomenon was based on several factors specific to the USA. These include:

• the presence of a huge army of lawyers interested in initiating any lawsuits;
• the willingness of American courts to consider any case and make decisions primarily in favor of the consumer of goods and services;
• the media's interest in sensationalizing stories and their enormous influence on consumers.

Many authorities and politicians (including the US Congress) were involved in the further development of the "implant crisis". The result of this campaign was a temporary restriction announced by the State Department on the use of endoprostheses with silicone filler. The use of the latter was limited only to those clinical observations that were under the control of a special commission, while the implantation of silicone prostheses filled with isotonic sodium chloride solution was permitted without restrictions. Subsequent scientific studies confirmed the complete groundlessness of the accusations made regarding the use of silicone implants. This was also facilitated by the rich experience of surgeons in Europe, where the use of silicone endoprostheses continued on a large scale. As a result, in recent years the use of silicone endoprostheses with silicone fillers has again been permitted in the USA, albeit with restrictions.

There is now every reason to believe that the artificially created "silicone implant crisis" in the United States is nearing its end.

A. A. Vishnevsky's method. In 1981, A. A. Vishnevsky proposed a two-stage method for breast augmentation. The first stage involved implanting a temporary endoprosthesis made of organic glass into the tissue to create a connective tissue capsule. The second stage involved removing the prosthesis after 14-16 days and replacing it with vegetable oil (olive, apricot, peach). This method was developed in our country. It has not gained popularity abroad due to its obvious shortcomings (relatively rapid development of a dense fibrous capsule, its frequent ruptures, etc.).

Transplantation of tissue complexes from other anatomical zones. Use of necrotic autotissues. In 1931 W. Reinhard performed a free transplantation of half of a healthy mammary gland to enlarge the underdeveloped second gland.

In 1934, F. Burian performed a transplant of submammary fat tissue to enlarge the mammary gland. Later, he began to use sections of fat tissue taken from the gluteal region. This approach became widespread. However, the absorption of a significant part of the necrotic fat transplants became the basis for searching for new solutions.

Transplantation of blood-supplied tissue complexes, both insular and free, most often involves the use of a flap including the rectus abdominis muscle, a thoracodorsal flap, and skin-fat flaps on the branches of the superior gluteal artery. Their advantages include maintaining the viability of the transplanted tissues and the possibility of their engraftment in unfavorable conditions of a cicatricially altered bed, as well as in the aftermath of its irradiation.

One of the disadvantages of these operations is the formation of new, often extensive scars in the donor area. Therefore, at present, such methods are used only in the aftermath of mammary gland removal, when simpler methods of creating volume (implantation of prostheses) cannot be used.

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