Evolution of Technology

Surgical Breast Implants

Surgical implantation of material into the breast began in the early 20th century. After trial and error with numerous substances, the first silicone breast implant was developed in the 1960’s. This implant was notable for its novel design involving a tough but elastic silicone shell with a softer silicone gel filling. In the following years, this basic design was improved upon which aimed to create breast implants that were more natural appearing and more resistant to rupture or leakage.

Saline (salt water) breast implants were also developed concurrently. They use the same silicone shell as in silicone implants but differ in their use of saline to fill the inner contents. Saline implants were commonly used in the 1990’s during a period of time where there was a temporary moratorium on silicone-filled implants.

Currently, silicone gel implants are significantly more popular than saline due to a more natural feel and appearance. Implants are available in various sizes, shapes, fill types, and textures. Choosing the right implant is a complex topic and should be done in close communication with a plastic surgeon. Modern day breast implants have been rigorously studied in hundreds of thousands of women and have an exceptional track record of safety. As with any medical device, breast implants do carry certain risks that should be discussed with a plastic surgeon.

Evolution of Procedure

Mastectomy & Breast Reconstruction with Implant

Treatment of breast cancer primarily depends on the type, size, and location of the cancer. Treatment options are varied but share in common the surgical removal of the cancerous cells. They vary in the degree of surrounding breast tissue that should be removed as well. Lumpectomy, or removal of part of the breast tissue, may be used for less-invasive, smaller breast cancers. Mastectomy, or surgery to remove all of the breast tissue, may be the best choice to ensure full removal of the cancer and avoid recurrence. Various types of mastectomies also exist, the most common being skin sparing mastectomy (where the nipple and areola are removed but the skin overlying the breast tissue is preserved) and nipple-sparing mastectomy (similar to a skin sparing mastectomy but the nipple and areola are preserved).

Reconstruction of the breast after mastectomy is a commonly performed procedure. All women should be given the option for breast reconstruction and federal law mandates it be covered by insurance carriers. Breast reconstruction can be performed immediately at the time of mastectomy or later, in a delayed fashion. Reconstruction of the breast can be done through the use of your own tissue or with implants. This article will focus only on breast reconstruction using implants.

Breast reconstruction surgery with an implant fills the defect left by the missing breast. The implant may be placed immediately after the mastectomy, known as a direct to implant reconstruction, or in a staged fashion involving use of a tissue expander first. If used, tissue expanders serve to stretch out the breast skin. Tissue expanders are not designed to be permanent and will be switched out for a breast implant at a later stage.

Evolution of Technology

Post Operative Healing / Breast Marker

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The cavity left over from the removed tissue often fills with fluid that eventually scars down over several years. This healing process may worsen the appearance of the breast and may also make post-operative radiation more difficult since the remaining tissue is distorted.

Recently, technologies have developed to place a 3- dimensional marker into the cavity. This marker may prevent some fluid accumulation and may prevent extensive tissue remodeling or scarring.

Evolution of Technology

Breast Cancer Localizers

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Better screening and improved breast cancer awareness has led to some cancers being identified before they are able to be felt through the skin. In such cases, it is necessary to “mark” the cancer prior to surgically removing it. In the early 2000’s, this was accomplished by inserting a wire into the cancerous area under radiologic guidance. This was sometimes logistically challenging, as the patient would have to get to the hospital several hours before surgery to undergo the localization procedure.

The wire could also get pulled out during the wait for surgery. Seed localization was introduced partly in response to these challenges. A tiny, radioactive “seed” is introduced into the cancerous area within several days of surgery. With this method, the logistic challenges are eliminated since patients do not need an extra procedure on the day of surgery.

Additionally, the seed does not have substantial risk of being dislodged. During the surgery, a small, handheld Geiger counter is used to detect the small level of radiation being emitted from the seed. However, because of the low dose radiation of the seed, it must be placed a few days prior to surgery. A further advance in cancer localization came in the form of magnetic seeds. These devices relied on magnetic energy rather than a low level of radioactivity.

Magnetic seeds may be able to remain in the body longer compared with the radioactive seed. The magnetic seed is localized using a hand held magnetic sensor.