Breast: Options for Breast Enlargement in the 21st Century

NEW YORK, NY (November 2, 2000) — The popularity of breast augmentation is on the rise, with a 51% increase in the number of breast enlargements performed from 1998-1999 [statistics from the American Society for Aesthetic Plastic Surgery (ASAPS)]. Women considering this cosmetic procedure may wonder what developments are on the horizon.

Approximately 10% of the implants used in the US are filled with silicone gel, although this type of implant is only allowed within the Food and Drug Administration (FDA) approved study for breast reconstruction, implant replacement, and treatment of severe breast ptosis (sagging). However, there is speculation that the FDA may grant pre-market approval for several types of silicone gel-filled breast implants within the next several years. "Silicone gel has regained popularity, primarily because it produces the most natural-feeling breast," according to Scott L. Spear, MD, of Washington, DC, who authored an article in ASAPS' Aesthetic Surgery Journal, peer reviewed publication. "With scientific studies supporting its safety, a number of manufacturers may decide to take the steps defined by the FDA as necessary for the return of silicone gel-filled implants to non-restricted use."

Cohesive silicone gel is the next filler innovation expected to be available in the US. Much thicker than other forms of silicone gel, this implant filler holds its shape and will not flow out even if the implant shell is sliced open. Almost 40,000 cohesive gel devices have been implanted internationally.

Another type of implant that is expected soon to enter the US regulatory process is a polyvinylpyrrolidone (PVP) device, which was originally introduced in the late 1980s, then reformulated for the 90s. Like silicone, PVP has a long history of medical applications. Its new hydrogel formulation for breast implants has been tested and used in Europe. It is speculated that FDA approval of both the cohesive gel and PVP implants could occur within several years.

Saline-filled breast implants, approved by the FDA in May, have been the mainstay of breast augmentation procedures since the FDA's ban on silicone gel-filled implants for breast enlargement, and also are undergoing change. Currently, one company offers saline-filled implants that are pre-filled, rather than being filled with sterile saltwater solution at the time of surgery. The company claims this eliminates valve leakage and increases sterility. One disadvantage is that a longer incision is required to insert the implant.

These and other innovations are likely to provide increased options for breast augmentation patients in the 21st century. In the meantime, women seeking breast enlargement have a number of choices from among current implant styles, including round versus anatomically-shaped implants and smooth versus textured shells.


The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world's leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; Active Members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and nonsurgical aesthetic procedures. International Active Members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.


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