A Short History of Breast Augmentation and Modern Implants

• Breasts that remained small or developed unevenly after puberty.
• Loss of volume and shape after pregnancy, breastfeeding or weight loss.
• Visible asymmetry between the two breasts.
• Reconstruction after breast cancer surgery, which drove much of the early medical research.

For a long time these wishes were far ahead of what medicine could safely offer. Much of the history of the operation is the search for a material that the body tolerates well and that keeps its shape over many years.

• Transfer of the patient's own fat tissue: one of the earliest recorded attempts used fat from another part of the body. The idea was sound, but without modern techniques much of the fat did not survive.
• Injections of foreign substances: at the turn of the twentieth century various substances, such as paraffin, were injected directly into the breast. They caused hard lumps, inflammation and serious complications.
• Solid materials: in the first half of the twentieth century surgeons tried materials such as glass balls, sponges and various plastics. The body reacted to them with hardening, infection and deformity.
• Injections of liquid silicone: in the middle of the century free liquid silicone was injected into the breast in some countries, leading to lumps, migration of the material and lasting damage.

These failures taught an important lesson: whatever is placed in the breast must be enclosed, stable and well tolerated by the tissues.

Shortly afterwards implants filled with saline, a sterile salt solution, were introduced. They are filled with liquid during the operation and, if the shell breaks, the body simply absorbs the saline. However, they tend to feel firmer and are more likely to form visible ripples.

• Stronger shells: multi-layer shells reduced gel leakage and the rate of rupture.
• Cohesive gel: modern gel holds together like a soft solid, so if the shell breaks the gel usually stays in place.
• New shapes: in addition to round implants, anatomical teardrop implants were developed to imitate the natural slope of the breast.
• Different surfaces: smooth and textured shells were introduced, each with its own advantages and considerations.

Safety has also been the subject of intense public debate. In the early 1990s regulators in the United States restricted the use of silicone gel implants while their safety was studied, and they were fully allowed again in the mid-2000s after large studies. In recent years a rare type of lymphoma associated mainly with certain textured implants was identified, and some textured models were withdrawn. These events led to stricter regulation, better patient information and long-term registries.

• Material: silicone gel implants look and feel the most natural; saline implants are used less often.
• Shape: round implants add fullness to the upper part of the breast, while anatomical teardrop implants give a more gradual slope.
• Surface: smooth or textured; the choice depends on the implant type and the surgeon's approach.
• Size and profile: selected according to the width of the chest, the tissue available and the desired result.

Even modern implants are not lifetime devices. They may need to be replaced or removed at some point, and regular follow-up remains important. Possible complications include capsular contracture, rupture and changes in shape over time.

The operation is performed in an inpatient setting, and compression garments are worn for 1–1.5 months. Dressings, check-ups and follow-up by your plastic surgeon continue for a full year after surgery. The first consultation is free and can be held online: send photos and describe the result you want. The doctor names the cost after the assessment, and it is then fixed in the contract. A personal coordinator stays with you from the first message to the end of recovery. More details are on the breast augmentation page.