The history and development of breast implants.

This review discusses the historical development of smooth and textured silicone gel filled implants, and examines the reasoning behind product development and aspects of surgical technique from a surgeon's perspective.

2020 special issue: Twenty years of breast reconstruction: Past, present, and future.

Breast reconstruction has evolved in the last 25 years to provide women with better autologous and implant-based options. The general trends of breast reconstruction have shifted to skin and nipple-areolar complex preservation, resulting in improved aesthetics and patient satisfaction. Autologous reconstruction has made a dramatic movement toward microsurgical reconstruction by free tissue transfer and has addressed lymphedema and breast sensation. Using the patient's own tissues, several aesthetic refinements have led to optimizing the cosmetic appearance of the reconstructed breast. Implant-based reconstruction has improved with the invention of form-stable silicone implants, acellular dermal matrix, and fat grafting. These positive trends will continue into the future. We hope that all women with a diagnosis of breast cancer will have the option of a consultation with a reconstructive plastic surgeon, ideally prior to undergoing resective surgery, to ensure they are aware of all reconstructive options to maximize their reconstructive result.

Evolution in Tissue Expander Design for Breast Reconstruction: Technological Innovation to Optimize Patient Outcomes.

Tissue expander design in breast reconstruction has evolved substantially over the last 60 years. An insightful appreciation of breast aesthetics, coupled with competition among industry partners, has resulted in innovative and disruptive technology to benefit patients desiring immediate reconstruction following mastectomy. In this article, we discuss the evolution of breast expander technology and the implications in improving patient outcomes in breast reconstruction.

[History of breast cancer reconstruction treatment]. / Historique du traitement du cancer du sein.

The authors summarize in those six pages of drawings the history of breast cancer reconstruction treatment. The focus is on the variety of techniques available for breast reconstruction and on the debates around different indications.

Breast Reconstruction: A Century of Controversies and Progress.

Breast cancer treatment has dramatically changed over the past century. Since Halsted's first description of radical mastectomy in 1882, breast reconstruction has evolved slowly from being considered as a useless or even dangerous procedure by surgeons to the possibility nowadays of reconstructing almost any kind of defect. In this review on the development of breast reconstruction, we outline the historical milestone innovations that led to the current management of the mastectomy defect in an attempt to understand the economic, social and psychological factors, which contributed to slow down its acceptance for several decades.

Surgical anatomy of reduction mammaplasty: a historical perspective and current concepts.

Reduction mammaplasty is the volumetric reduction in the bulk of the breast. Techniques have evolved from primarily reducing the breast bulk to reducing with emphasis on functional and aesthetic outcome. The deeper understanding of the surgical anatomy of the breast has guided this development. While Paulus Aegina (sixth century AD), Dieffenbach (1848) and Gaillard-Thomas (1882) set the pace in glandular reduction; Pousson (1897) and Dehner (1908) focused on breast ptosis. It took quite some time before the enigma of the vascularization to the nipple areolar complex could be solved. Progress over a decade saw Thorek's (1922) free nipple grafting replaced by the periareolar de-epithelialization introduced by Schwarzmann (1930); which subsequently gave way to the Gillies and McIndoe (1939) skin-gland undermining technique. The era of breast remodeling while preserving the nipple areolar complex was soon ushered forward. This was driven by Arie (1957), Strombeck (1960) and Pitanguy (1961). The preservation of the subdermal plexus became crucial whilst retaining sensory supply to the breast as the pectoral fascia was spared. Skoog's (1963) nipple transposition without skin-gland undermining formed the basis for modern day reduction mammaplasty. Aesthetics was in mind throughout this period as different skin incisions were developed and advanced following Dieffenbach's small submammary incision in 1848. Surgical landmarks that ensured reproducible aesthetic outcomes were described by Penn (1955) and Wise (1956). Liposuction-assisted reduction was introduced by Teimourian in 1985 and is best utilised in patients with predominantly fatty breast tissue.

[Pierre Mornard (1883-1929), unrecognized plastic surgeon]. / Pierre Mornard, (1883­1929), un plasticien méconnu.

Many operations of aesthetic surgery were described between 1920 and 1930. Several French surgeons are recognized as pioneers of the speciality. Pierre Mornard (1883-1929) published numerous articles of plastic and aesthetic surgery between 1925 and 1929 the date of his death. The articles were illustrated with drawings of surgery he had practiced. He described in 1929 the first abdominoplasty with umbilical transposition. Pierre Mornard can be considered a pioneer of aesthetic surgery.

Reconstrucción mamaria post-mastectomía: contribución de cirujanos plásticos argentinos / Post- mastectomy breast reconstruction: contribution of argentine plastic surgeons

Se describen los inicios -a finales del siglo XIX- de las técnicas de reconstrucción mamaria post-mastectomía. Se enumeran las técnicas más importantes que las continuaron y quiénes las crearon en el mundo. Se destacan los aportes de dos cirujanos plásticos argentinos, Julián Fernández (1965) y Enrique Gandolfo (1982), que utilizaron tejidos autólogos del abdomen, colgajos dermograso con abordaje vertical y musculo-cutáneo con abordaje horizontal, respectivamente.

Early (late nineteenth century) techniques post-mastectomy breast reconstructions are described. Techniques that continued and its creators in the world are listed. The contributions of two plastic surgeons from Argentina, Julian Fernandez (1965) and Enrique Gandolfo (1982), who used autologous tissue from the abdomen, dermofat flaps vertically approach and musculocutaneous flaps with horizontal approach, respectively stand.

21 year follow up of a DIEP (deep inferior epigastric perforator) flap: a tale of a "nulltiple".

Since the first description of "The free abdominoplasty flap for breast reconstruction" by Hans Holmstrom in 1979, [see Ref. 1] the use of lower abdominal tissue has revolutionised reconstruction of the breast. DIEP (deep inferior epigastric perforator) free flap offers an abundance of reconstructive material, aesthetically-pleasing results and limited donor site morbidity. We report our first case of breast reconstruction with what presently is known as DIEP flap, performed in 1991 at St. Andrew's Centre for Plastic Surgery and Burns in Essex, The United Kingdom and the recent follow up results. We also discuss the historical events surrounding the evolution of this unpublished case and other documented cases.

Barbed sutures in breast reconstruction.

Postoperative closure techniques in breast reconstruction have remained largely unchanged over the past 75 years, despite recent use of adhesives and subcuticular staples and the advent of self-anchoring barbed sutures. In this article, the author discusses the applications for barbed sutures in breast reconstruction and describes specific techniques. Innovations in barbed suture material are also described, and the author's personal experiences are presented in comparison with traditional suturing techniques.

Siliconoma mamario / Breast Siliconomas

Nuestra Unidad recibe por su área programática de influencia, pacientes de bajos recursos socioeconómicos y culturales que fueron sometidos a prácticas ilegales de inclusión de materiales de uso no médico por vía infiltrativa en las mamas y que requirieron trtamiento quirúrgico como consecuencia de haber causado procesos inflamatorios inespecíficos con deformidad y dolor invalidante. En el período comprendido entre el 26/10/2009 al 26/10/2010 en la Unidad de Cirugía Plástica del HZGA Dr. Lucio A. Meléndez de Adrogué tres pacients intervenidos quirúrgicamente por presentar siliconomas mamarios. El procedimiento de elección fue adenomastectomia subcutánea bilateral con reconstrucción posterior con implantes, con buenos resultados estéticos. El desconocimiento y las consecuencias por la aplicación infiltrativa de siliconas industriales en las mamas obligan al equipo de cirugía plástica a desarrollar nuevas tácticas para solucionr las consecuencias devastadoras que las mismas producen en los pacientes

Our Unit received for its program area of influence, patients with low socioeconomic and cultural resources that were subjected to illegal practices including non-medical use materials via infiltration in the breast and needed surgery as a consequence of nonspecific inflammatory processes caused by deformity and crippling pain. In the period from 26/10/2009 to 26/10/2010 in the Unit of Plastic Surgery Dr. Lucio A. HZGA Melendez Adrogué three patients undergoing surgery for breast siliconomas present. The election procedure was adenomastecty reconstruction after bilateral subcutaneous implants, with good aesthetic results. The ignorance and the consequences for the application infiltrative industrial silicone breast forces the plastic surgery team to develop new tactics to adress the devstating consequences that they produce in patients

Siliconoma mamario / Breast Siliconomas

Nuestra Unidad recibe por su área programática de influencia, pacientes de bajos recursos socioeconómicos y culturales que fueron sometidos a prácticas ilegales de inclusión de materiales de uso no médico por vía infiltrativa en las mamas y que requirieron trtamiento quirúrgico como consecuencia de haber causado procesos inflamatorios inespecíficos con deformidad y dolor invalidante. En el período comprendido entre el 26/10/2009 al 26/10/2010 en la Unidad de Cirugía Plástica del HZGA Dr. Lucio A. Meléndez de Adrogué tres pacients intervenidos quirúrgicamente por presentar siliconomas mamarios. El procedimiento de elección fue adenomastectomia subcutánea bilateral con reconstrucción posterior con implantes, con buenos resultados estéticos. El desconocimiento y las consecuencias por la aplicación infiltrativa de siliconas industriales en las mamas obligan al equipo de cirugía plástica a desarrollar nuevas tácticas para solucionr las consecuencias devastadoras que las mismas producen en los pacientes(AU)

Our Unit received for its program area of influence, patients with low socioeconomic and cultural resources that were subjected to illegal practices including non-medical use materials via infiltration in the breast and needed surgery as a consequence of nonspecific inflammatory processes caused by deformity and crippling pain. In the period from 26/10/2009 to 26/10/2010 in the Unit of Plastic Surgery Dr. Lucio A. HZGA Melendez Adrogué three patients undergoing surgery for breast siliconomas present. The election procedure was adenomastecty reconstruction after bilateral subcutaneous implants, with good aesthetic results. The ignorance and the consequences for the application infiltrative industrial silicone breast forces the plastic surgery team to develop new tactics to adress the devstating consequences that they produce in patients(AU)

The evolution of breast reconstruction: a historical perspective.

Plastic surgeons have been performing operations to improve the aesthetic aspect of the breast for centuries. Throughout ancient times, great controversy produced many theories of how breast cancer occurred and the best treatment. Because of beliefs that closure of mastectomy sites could conceal tumor recurrence, breast reconstruction did not gain wide acceptance until the mid-1900s. Today, plastic surgeons have a variety of techniques to reconstruct the breast. The first autologous muscle flap for breast reconstruction was the latissimus dorsi myocutaneous flap, described in 1896 by Iginio Tansini. The introduction of Carl Hartrampf's transverse rectus abdominis myocutaneous flap and Robert J. Allen's deep inferior epigastric perforator flap have also provided excellent reconstructive options. With regard to augmentation, Vincenz Czerny attempted to enhance a woman's breast in 1895 with implantation of a lumbar lipoma. Soon after, surgeons used paraffin injections and polyvinylic alcohol sponge implantation, which yielded disastrous results. In 1961, Thomas Cronin and Frank Gerow promoted the first silicone implant, paving the way for today's silicone and saline prototypes. Although reduction mammaplasty techniques had originated centuries earlier than mastopexy methods, the advancements of both have largely paralleled one another. In 1949, the Wise pattern was introduced to preoperatively plan safer and predictable outcomes in breast reductions. Efforts to minimize scars were achieved with Claude Lassus' introduction and Madeleine Lejour's subsequent modification of the vertical scar mammaplasty. In hopes of fostering an understanding of current post-mastectomy procedures and instilling passion for innovating future techniques, we provide a near-complete, surgically focused historical account of the primary contributors to breast reconstruction.

Breast cancer surgery: an historical narrative. Part III. From the sunset of the 19th to the dawn of the 21st century.

The 20th century is marked by significant advances regarding the management of breast cancer. A clear trend towards less aggressive surgical operation was constantly noted. Modified radical mastectomy gradually replaced radical mastectomy during the second half of the 20th century, while during the last two decades breast-conservation therapy became the treatment of choice for the treatment of breast cancer. This type of therapy includes segmental mastectomy (either quadrantectomy or lumpectomy) with axillary lymph node dissection, followed by postoperative irradiation. Other significant advances during the 20th century include the introduction of systemic therapy (chemotherapy, hormonal therapy) and radiation therapy. Better patient follow-up, statistical analysis, development of staging systems and the introduction of frozen section, the development and wide use of mammography (including screening mammography), breast reconstruction following mastectomy and the development of newer diagnostic methods [including breast magnetic resonance imaging and the advanced breast biopsy instrumentation (ABBI)] are other advances that contributed to a better management of breast cancer patients. Sentinel lymph node biopsy has been introduced during the 1990 s in an attempt to reduce morbidity due to axillary lymph node dissection. Despite these advances, breast cancer remains a significant problem and represents a field of active and intense research.

The aesthetic correction of the ptotic breast by the procedure of nipple-areola transposition - a contemporary translation and commentary.

'No vertical scar' techniques of breast shaping have received increasing attention during the last decade and are sometimes viewed as 'new' methods. In this article, we provide a comprehensive introduction to the roots of this procedure. Raymond Passot has to be credited with the original design of 'no vertical scar' methods. We provide a contemporary translation of his original article written in French in 1925. The historical context of this new procedure was researched using original sources that were in French and German languages. The evolution of the procedure and its reception by Passot's contemporaries up to 1932 are examined, which give insight into the concepts of blood supply to the breast, shaping techniques and the aetiopathology of breast deformities in the pre-World War II era, which were successfully developed by the Austrian-German school of thought, resulting in the birth of modern breast shaping surgery based on Passot's 'no vertical scar' procedure. The lasting truths discovered in that era were frequently reinvented in the subsequent decades in English without crediting the original authors.

[Pioneers and martyrs: Delpech, Guinard, Pozzi]. / Pionniers et martyrs : Delpech, Guinard, Pozzi.

Jacques Mathieu Delpech, Aimé Guinard Samuel Pozzi, three famous surgeons of the 19th and early 20th century were murdered by patients. All three contributed to the history of plastic surgery. Delpech (1777-1832) carried out the first plastic surgery in France using a forehead flap to replace a loss of substance on the face, Guinard (1856-1911) did the first reduction mammaplasty. Pozzi (1846-1918) was probably the first to perform an operation of face lift on one of his patients but did not publish it. These three surgeons were killed by unbalanced patients they had operated of benign lesions.

Pollicization, cleft lip, breast reconstruction... working in seventh heaven and the fifth circle of hell.

SUMMARY: The author establishes criteria for landmark contributions to plastic surgery during his career, describes five such contributions, and lends a personal perspective on each. The conclusions reached are that plastic surgery remains strong and vibrant because of the ability of our specialty to engage in continuous improvement and innovation.