End of Silicone Implant Era



Silicone breast implants were first developed and used in cosmetic breast surgery in the early 1960s. Very little has changed in the basic technology of these devices over the last fifty years. Despite the silicon controversy of the '90s, silicone implants, filled with saline or silicone gel, have been very popular with plastic surgeons, while patients have been less enthusiastic.

The FDA moratorium on silicone implants was begun in 1992 and started a period of intense research and evaluation of their possible effects following rupture. In the absence of any medical evidence for silicone causing systemic disease, the FDA approved their re-introduction into the market in 2006. However, they cautioned patients with the following statement: More important than this potential drawback is the fact that silicone implant lifespan exceeds its aesthetic performance in most patients. It is commonly known, by professionals in the breast implant world, that the aesthetic outcome of silicone breast implants diminishes after four years. Two factors account for the majority of problems: first capsular contracture, secondly breast ptosis. Because the body can not grow into a silicone implant it isolates it with a collagen capsule. In some situations it remains soft for many years, but all too often it becomes tight or thick and can make the implant and breast rock hard. In a worse case scenario, the capsule tightens, causing the implant to be pushed up to the neck, while the actual breast tissue overlying the implant is pulled down by gravity and sags. This leaves a very elongated and odd shaped breast that is completely un-natural. Even worse is when this tightness effects only one side, leading to considerable asymmetry.

Other times, if the capsule is too soft, the weight of the implant causes the breast to stretch out and sag due to its large size and weight. This is called, “bottoming out”. In a best case scenario, the implant behaves well with a good aesthetic outcome for ten to fifteen years before rupturing and needing to be replaced.

This begs the question, if large implants cause stretching of the breast and bottoming out, why don’t surgeons use smaller diameter implants more often? The answer: because many patients seeking cosmetic breast surgery have already had children and experience loose, stretched out breasts. Though the surface skin can be tightened and the nipple made smaller and raised with traditional breast lifts, or mastopexy, until now there has been no effective way to tighten the inside of the breast and decrease a base diameter that is too wide. Therefore the surgeon must pick an implant which “fills” the stretched out breast.

Over the last two and one half years we have developed a safe and effective means to reliably control the base diameter of the breast and have called this an “Internal Mastopexy”. It relies on a purse string suture placed through the connective tissue fascia and fat that surrounds the breast gland, like an inner tube, called the circum-mammary ligament. This suture is permanent and effectively gathers together the perimeter of the breast, narrowing its base diameter and forcing the breast volume up and out, to give a breast with more upper pole fullness and projection. It has the effect on the breast that a push up bra gives. When combined with fat grafting, from the abdomen or thighs, many patients no longer require a silicone breast implant.

In the more than 200 breasts that we have treated with this new technique, we have seen a very high level of patient satisfaction with very few complications. Patients have been thrilled that they can attain full, perky, youthful breasts without large breast implants that require costly maintenance and replacement. The fact that they also are receiving liposuction is an added bonus.