A Brief History
Below is a brief history of Breast Implants and Breast Augmentation in general. All FDA approved Breast Implants that are currently available in the US are featured, as well as many of the Breast Implants that preceded them. It is not meant as an exhaustive listing of all Breast Implants, as several popular past choices are not mentioned for clarity.
2012 marked the entry of a new US based and FDA approved Breast Implant manufacturer. Long time US Breast Implant manufacturers, Natrelle® (Allergan) and Mentor® (J&J) where joined by newcomer Sientra® (OPUS®). Sientra® brought the first FDA approved high-strength silicone gel filled, “gummy bear” teardrop shaped breast implants to the US market. Sientra® uses this soft, form-stable silicone gel in all their implants, sometimes referred to as “gummy bear” breast implants. Natrelle® (Allergan) and Mentor® (J&J) have since received approval for their own versions of shaped silicone gel implants: Natrelle® style 410 and Mentor® CPG line, respectively.
Before Breast Implants
- 1889 – Surgeon Robert Gersuny tried using paraffin and vaseline injections for breast augmentation. While the breast size increased, the results were disastrous. Paraffin augmented breasts became hard, and the breasts experienced a severe, chronic and disfiguring inflammatory response.
- 1895 – Vincenz Czerny transplanted fat from the lower back to the breasts. A benign fatty tumor (a lipoma) was removed from the lower back and placed in the breast to reconstruct a defect originally caused by removing a breast tumor. Thus, fat grafting precedes Breast Implants for Breast Augmentation by at least 67 years.
- 1900’s – Many other substrates were tried including: ivory, glass balls, ground rubber, ox cartilage, Terylene wool, gutta-percha, Dicora, polyethylene chips, Ivalon (polyvinyl alcohol-formaldehyde polymer sponge), a polyethylene sac with Ivalon, polyether foam sponge (Etheron), polyethylene tape (Polystan) strips wound into a ball, polyester (polyurethane foam sponge) Silastic rubber, and teflon-silicone prostheses.
- 1945 – Morton Berson performed a rotational flap to increase the volume of the breast.
- 1950 – Jacques Maliniac performed a rotational flap to increase the volume of the breast.
- 1950-1960’s – Free silicone was injected into the breast with good results initially, and later disastrous results due to the formation of silicone granulomas and breast hardening, sometimes severe enough to require a mastectomy for treatment.
The First Breast Implants
- 1961 – American plastic surgeons Thomas Cronin and Frank Gerow, and the Dow Corning Corporation, developed the first silicone breast prosthesis, filled with silicone gel.
- 1962 – The first augmentation mammoplasty was performed in 1962 using the Cronin-Gerow Implant (breast prosthesis).
- 1964 – The French company Laboratories Arion developed and manufactured saline filled breast implants.
- 1976 – US Congress passes the 1976 Medical Device Amendments to the Federal Food, Drug, and Cosmetic Act. Breast Implants are classified as moderate risk (Class II) devices and required to comply with general controls and performance standards. The FDA reviews new breast implants through the 510(k) premarket notification process.
- 1980′s – Concerns are raised about associations between breast implants, particularly the Silicone Gel Filled Breast Implants, and serious health issues such as breast cancer and systemic connective tissue disorders like lupus, scleroderma and rheumatoid arthritis. The FDA reclassifies breast implants into Class III, higher-risk products needing premarket approval (PMA), and called for manufacturers to provide data demonstrating the devices are safe and effective.
- 1992 – The FDA decides that breast implant manufacturers have not adequately addressed public concerns about certain complications associated with the use of breast implants. Rather than selecting the devices with a poor record, the FDA removes all silicone gel filled breast implants from the market; however the ruling applies only for elective cosmetic breast augmentation. The FDA continues to allow manufacturers to provide silicone gel filled implants for breast reconstruction after mastectomy, correction of congenital deformities, replacement of existing implants and for breast augmentation performed in conjunction with a breast lift.
The Breast Implant Adjunct Studies were created, so that data could be collected about device performance and safety in large groups of women. In order to make breast implants available again for elective cosmetic breast augmentation, the FDA requires manufacturers to submit premarket approval applications containing data on safety and effectiveness – like a new product. Europe follows the lead, but removes restrictions after a few months, after reviewing the available literature and finding no links to serious systemic health issues.
- 1993 – The next generation of Breast Implants (Allergan Style 410 and Mentor Contour Profile Gel), textured, anatomic, highly cohesive (nearly form stable), silicone gel filled breast implants are complete, tested, and ready for submission for FDA studies in the United States and Europe … and Europe takes the lead with early approval.
- 1999 – The Institute of Medicine (IOM) releases a comprehensive report of the published literature and ongoing studies on breast implants, entitled Safety of Silicone Breast Implants. The study concludes that there is no evidence that silicone breast implants cause systemic health effects, such as cancer or autoimmune disease. Local complications (infection, bleeding, pain, deflation, capsular contracture, additional surgery) remain the primary safety issues with silicone breast implants.
- 2006 – The FDA approves Allergan’s Natrelle Silicone Gel Filled Breast Implants and Mentor’s MemoryGel Silicone Gel Filled Breast Implants. The FDA based each approval on the manufacturers’ Core Studies. These clinical PMA studies followed hundreds of women with Silicone Gel Filled Breast Implants for 4 years (Allergan) or 3 years (Mentor). The FDA determines that silicone filled breast implants are safe and effective. They further conclude that the benefits and risks of breast implants are sufficiently well understood for women to make informed decisions about their use.
As conditions of approval, the FDA requires both Allergan and Mentor to conduct six post-approval studies to investigate the long-term performance and safety of their silicone gel filled breast implants. From the FDA’s site these studies are:
- Core Post-Approval Studies (Core Studies) – To assess long-term clinical performance of breast implants in women that enrolled in studies to support premarket approval applications. These studies were designed to follow women for 10 years after initial implantation.
- Large Post-Approval Studies (Large Studies) – To assess long-term outcomes and identify rare adverse events by enrolling more than 40,000 silicone gel-filled breast implant patients and following them for 10-years.
- Device Failure Studies (Failure Studies) – To further characterize the modes and causes of failure of explanted devices over a 10-year period.
- Focus Group Studies – To improve the format and content of the patient labeling.
- Annual Physician Informed Decision Survey (Informed Decision Study) – To monitor the process of how patient labeling is distributed to women considering silicone gel-filled breast implants.
- Adjunct Studies – To provide performance and safety information about silicone gel-filled breast implants provided to U.S. women from 1992-2006, prior to approval, when implants could only be used for reconstruction and replacement of existing implants.
The move to form-stable fillers makes possible the manufacture of soft, solid, shaped implants, that can better maintain lower pole fullness for breast reconstruction and the treatment of congenital breast defects like Tubular Breasts and Poland Syndrome.
Currently Available Breast Implants
Breast Implants come in hundreds of shapes, sizes and contours, making customization of results more practical. If you are looking for the fine details of today’s Breast Implants, be certain to visit our Currently Available Breast Implants Page. There you find listings of the types, sizes, dimensions, contours, profiles and fillers available from the three current US Breast Implant makers. Full catalogs from Natrelle® (Allergan), Mentor® (J&J) and Sientra® (OPUS®) are available to view.
Natrelle® (Allergan) Breast Implants
Natrelle® (Allergan) – Allergan offers a full line of both Saline filled Breast Implants and Cohesive Silicone Gel filled Breast Implants. Both saline and silicone gel filled round implants are available and come in a variety of profiles and dimensions. Allergan is the manufacturer, and their Breast Implants are marketed under the brand name Natrelle®. Their texturing process, called BioCell® was associated with a rare lymphoma (BIA-ALCL) and was withdrawn from the world markets on July 24, 2019.
® (J&J) Breast Implants
Mentor® (J&J) – Mentor® also offers a complete line of Breast Implants including both Saline filled Breast Implants and Silicone filled. Mentor’s® Silicone Breast Implants are marketed under the brand name MemoryGel®, and their textured Breast Implants are marketed as Siltex®.
Sientra® OPUS® Breast Implants
Sientra® (OPUS®) – Sientra® is the newest company to offer FDA approved Breast Implants. They do not have a Saline filled Breast Implant line. Sientra® offers smooth round, textured round and textured shaped Silicone Filled Breast Implants. Their textured Breast Implants are marketed as TRUE Texture™ The aggressiveness of Sientra’s TRUE Texture™ texturing is slightly more aggresive than Mentor’s® stamped on Siltex® texturing.
They are the first US company to use a high strength silicone gel filler in their Breast Implants. This type of implant has been available outside the US for several years, and is sometimes referred to as the Gummy Bear Breast Implant. The high strength gel provides stability of form and allows Sientra® to manufacture the first FDA approved teardrop shaped silicone gel Breast Implants in the US.
The same high strength gel used in the textured teardrop shaped Breast Implants is also used in their Round Breast Implants. Recently released 5-year data shows that the leakage rate for these Silicone Breast Implants is about half that seen in the PMA data of previous manufacturers. The reported 5-year gel migration rate is a very reassuring 0%.
For more information about your options in Breast Implants, be certain to visit our Breast Implants Page. For more information about the currently available breast implants visit our Currently Available Breast Implants Page.
What’s Next in Breast Implants
Now that the Gummy Bear, High-Strength, Form-Stable Silicone Breast Implants are available, what’s next? San Francisco Bay Area Breast Augmentation patients and Plastic Surgeons alike, want to know. The latest generation of breast implants provide for a reduction in one of the most frequent reasons for Breast Implant Revision Surgery – deflation. Since the centers are a soft solid, the new high-strength silicone gel resists migration. Even when the shell develops a rent, the filling is less likely to migrate outside the capsule.
Capsular Contracture rates declined with the advent of cohesive silicone gel and low-bleed shells. Perhaps, the next generation of breast implants will have a coating which further reduces the risk of capsular contracture.
Larger implant sizes. While this is a problem for a minority of Breast Augmentation patients, larger breast implant volumes are needed for some Breast Reconstruction patients. Currently, matching procedures like a breast lift or a breast reduction, are performed on the opposite breast during breast reconstruction. If larger breast implant volumes where available, fewer matching breast reductions would be needed.