Next Wave of Breast Implants

From the WebMD Archives

May 10, 2001 (New York) -"We must, we must, we must increase our bust!"

For decades, women have been chanting this mantra, doing special exercises, having enhancement surgery and many other things to make their breasts larger.

And information presented recently at the annual meeting of the American Society for Aesthetic and Plastic Surgery (ASAPS) held here suggests that today's surgeons and their female patients have some new and improved tools -- including cohesive gel implants and vacuum-bras -- at their disposal.

For one, silicone breast implants are back. But they are not the same as the implants that the FDA banned in 1992 because of their propensity to leak and possibly cause disease. The newest generation of silicone breast implants are made from cohesive gel. Therefore, there is a substantially lower risk of rupture problems, says Mark L. Jewell, MD, a plastic surgeon in Eugene, Ore.

"It's a viscous gel that doesn't run or migrate or even have the propensity for migration," he tells WebMD. "You can cut it, come back a year later and there is still no gel migration."

Jewell and several other U.S. plastic surgeons are currently enrolling women in a 10-year study that is designed to look at 450 women who receive the cohesive gel implants.

And so far, so good, he tells WebMD.

In Europe and Australia, thousands of women have had these implants. In the U.S., there have been about 100 done by about 25 plastic surgeons, including Jewell.

"The consensus is that they are safe and women really like how they look," he says. "They retain their original shape and give a very nice appearance."

Importantly, "they don't look fake and most women want a natural look."

Saline implants feel more liquid to the touch, which is why some women do not like them, he explains. "The cohesive gel implants feel very natural to the touch," Jewell says.

Mired in controversy for years, the older-generation of silicone-filled breast implants were banned by the FDA following reports of high rates of rupture as well as diseases where the immune system goes awry such as rheumatoid arthritis, lupus, scleroderma, and the "dry-eye" condition known as Sjögren's syndrome.

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But, an independent panel convened by the prestigious Institute of Medicine concluded that silicone breast implants do not cause cancer or other illnesses such as those previously mentioned.

And a large review study in the New England Journal of Medicine found that women with silicone breast implants do not appear to have a higher risk of developing diseases of the immune system.

"Silicone-filled implants have been carefully studied and the concerns that were raised in regard to disease risk have been addressed," Jewell says.

Rupture rates, however, are still a concern, he says, which is one reason that the cohesive gel implants are better.

"I think the cohesive gel looks promising but they are new and need further study," says

New York plastic surgeon Darrick Antell, MD. Until that time, Antell will continue using saline implants for all of his breast augmentation surgeries. Both saline and silicone-filled implants have a silicone shell. But if the saline implants leak, deflate, or rupture, which they often do, they would release only salt water and not silicone into the body.

In 2000, there were 203,310 breast enlargement surgeries performed, making it the third most popular cosmetic surgery procedure, according to statistics from the ASAPS.

No surgery is without risks and for some women, an external vacuum bra called the BRAVA Breast Enhancement and Shaping System may suffice to help breasts increase in size, Jewell says. "This must be worn 16 hours a day for 10 weeks," Jewell says.

"It's like wearing a breast pump for that length of time," Jewell says. "The long term results are unknown."

This bra may be an answer for some women, but it is certainly not the answer, Antell says.

"Most women do not wear the bra for the time periods that they have to in order to see results and the average increase is very small - not even a cup size," he says. That's not the case with implants, where surgeons are able to increase a woman's bust line by one or more bra cup sizes.

"[The vacuum bra] is a step in the right direction, but it doesn't allow for controlling the shape of the breast, " Antell says. "People will not be satisfied and will want the real thing."

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Still, "breast-enhancing pills and creams are heavily advertised in magazines and newspapers and we know they don't work. This bra works but not enough," he adds.

Some women will forever be in search of a better breast -- maybe bigger, maybe rounder, maybe perkier. But the definition of the perfect breast differs from year to year and from country to country, Antell says.

"The perfect breast in France is the size of a champagne flute and the bigger the better is the American way," he says.

The good news, Jewell adds, is that today women have many options in their quest for the perfect breast. "It's just not one size fits all type of thing."

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