Increasing mammoplasty, the history of the development of methods of increasing the mammary glands

The development of methods to increase the mammary glands includes five main directions:

• injection into the tissue by injection of various semi-liquid synthetic materials and own fat tissue;
• implant alloplasty of adipose tissue taken from corpses;
• Implantation of artificial mammary glands (endoprostheses) made of synthetic materials;
• Reconstructive mammoplasty due to transplantation of patient tissue sites;
• the method of A.Vishnevsky.

Injection methods. The introduction of liquid paraffin was proposed by R. Gersuny in 1887. The results of using this method turned out to be terrible. Patients remained 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 to increase mammary glands in 1959. Early results were often good, but later in most patients, inflammatory changes developed in the places of gel administration and painful seals appeared. Subsequent study of this method has shown that its frequent complications are the migration of the gel and the formation of painful seals. Our and research has established that in all cases, without exception, the gel, introduced into the mammary gland, regardless of its variety (PAGINTERFAL, Pharmacryl), is widely distributed in breast tissue and in the large pectoral muscle. At the same time, the boundaries of its distribution are not exactly determined. The gel introduced into the tissue is found in the form of: 1) dense cicatricial-gel conglomerates having relatively clear boundaries; 2) loose, encapsulated, relatively large masses, and 3) diffuse impregnation of tissues.

In most cases, all these forms are combined with one another in one combination or another. 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 surrounding tissue gel occurs at a later time. However, more significant is the fact that the presence of gel in the tissues of the breast complicates the diagnosis of her diseases, including the most dangerous - cancer, and the results of treatment are significantly worse. In this regard, the introduction of synthetic gels in the mammary gland is currently prohibited in all countries of Western Europe and the United States. In Russia, the increase in mammary glands with the help of gel, unfortunately, is still being used, as a rule, by non-specialists who do not know modern methods of plasticizing the mammary glands.

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

Implantation of biological allomaterials. A new era in the development of methods to increase mammary glands began in 1940 with the use of skin fat transplants, taken from corpses.

They were placed under the muscle, thereby creating an 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 around the fatty prostheses of powerful scars and the development of infection. The high incidence of complications prevented this method from spreading. Nevertheless, in Russia it was used until the early 90s.

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

In 1960, the first silicone prostheses appeared, which revolutionized breast surgery. They were filled with an isotonic solution of sodium chloride or silicone gel. The frequency of development of the compressive prosthesis of a powerful cicatricial capsule fell from 100% (when using prosthetic devices from a sponge) to 40% and lower (with the use of silicone prostheses) [16, 24].

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

This operation has become one of the most frequent in aesthetic surgery. So, until 1992, more than 150,000 such interventions were performed annually in the United States alone.

"Crisis of implants" in the USA. During the period 1990-1991, A campaign against the use of silicone implants developed in the USA. It was based on the initiation of a lawsuit against the manufacturer of the endoprosthesis manufacturer by the patient who underwent the operation, on the grounds that it damaged her health.

The case won in court with obtaining a "victim" solid cash compensation was widely publicized in the press and caused an avalanche of similar cases. At the heart of this artificially created phenomenon were several factors specific to the United States. These include:

• presence of a huge army of lawyers, interested in the initiation of any lawsuits;
• the readiness of American courts to consider any cases and make a decision primarily in favor of the consumer of goods and services;
• The interest of the media in inflating sensations and their huge impact on consumers.

In the further development of the "implant crisis" many institutions and politicians were involved (up to the US Congress). The result of this campaign was a temporary restriction announced by the State Department for 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 allowed without restrictions. Subsequent scientific studies have confirmed the complete unreasonableness of those accusations that have been made about the use of silicone implants. This was facilitated by the extensive experience of European surgeons, 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 US, albeit with limitations.

At present, there is every reason to believe that the "silicone implant crisis", created artificially in the US, is close to its completion.

The method of AL Vishnevsky. In 1981, AA Vishnevsky proposed a two-stage method of increasing the mammary glands. The first stage in the tissue implanted a temporary endoprosthesis made of organic glass to create a connective tissue capsule. The second stage in 14-16 days the prosthesis was removed and replaced with vegetable oil (olive, apricot, peach). This method was developed in our country. It did not spread 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 nekrovo-supplied autotkaney. In 1931 W. Reinhard performed a free transplantation of half a healthy breast to increase the underdeveloped second gland.

In 1934, F.Burian performed transplantation of adipose tissue from the submammary region to increase the mammary gland. Later, he began to use the areas of adipose tissue taken from the gluteal region. This approach has become widespread. However, the resorption of a significant part of the nekrovo-supplied fat transplants became the basis for the search for new solutions.

Transplantation of blood-supplying tissue complexes, both islet and free, most often involves the use of a flap including the rectus abdominis muscle, thoracodorsal flap and skin-fat flaps on the branches of the upper gluteal artery. Their advantages include the preservation of the viability of transplanted tissues and the possibility of their engraftment in unfavorable conditions of the cicatricial-altered bed, and also with the consequences of its irradiation.

One of the drawbacks of these operations is the formation of new, often extensive scars in the donor zone. Therefore, at present, such methods are used only with the consequences of mammary gland removal, when simpler ways of creating volume (implantation of prostheses) can not be used.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]