Implant and Implant Assisted Breast Reconstructions

The number of women in the USA with breast implants is now estimated at over 6 million based on national surveys. This is numerically in excess of 5% of the female adult population. The majority of these women had cosmetic augmentations but 20-30% had implant based post-mastectomy breast reconstructions or correction of congenital abnormalities. In 2010, 296203 breast augmentations were performed in the USA and silicone implants were used in 60% of cases (American Society of Plastic Surgeons [ASPS], 2010). 93083 breast reconstructions were performed for congenital or postmastectomy defects. Of these 67% were performed using tissue expander and implant techniques. The significant majority of implants used in breast reconstruction were silicone (73%). Reconstructions using autologous tissue formed a small percentage of overall reconstructions (transverse rectus abdominus myocutaneous flaps (TRAM) 7%, latissimus dorsi (LD) flaps 7% and deep inferior epigastric perforator flaps (DIEP) 5%). Table 1. Breakdown of breast reconstruction procedures performed in 2010 according to procedure type and age range (ASPS, Report of the 2010 Plastic Surgery Statistics) The history of implant based breast reconstruction spans five decades when the first silicone breast implants became available. The last 20 years have seen rapid advances in expander and implant technology such that the era in which implant reconstructions aimed at simply producing the appearance of a breast mound in clothing has transitioned into the current era in which in appropriately selected patients an implant based reconstruction has the potential to resemble a natural breast in contour, projection and a well-defined inframammary crease.